Credentialing care: COVID-19 and the bureaucratization of doulas

Abstract

Doulas in the United States offer embodied, informational, and continuous one-on-one care to birthing people. Doulas have historically sought certification to gain knowledge through training and to gain legitimacy for healthcare providers and clients. During the COVID-19 pandemic, hospitals required doulas to provide proof of certification. The COVID-19 pandemic, and the proliferation of state-sponsored doula programs, has sparked a shift in how doulas are viewed and regulated, enabling new forms of bureaucratic oversight and control. Based on participant observation, surveys, and semi-structured interviews, we examine the connection between certification and care including motivations doulas have for certification, the perceived value of certification, certification as a form of gatekeeping, and increased bureaucratization of doulas. Using a critical feminist approach, we argue that increased bureaucratization and surveillance of doulas has not improved standards of care or led to more equitable access. Indeed, doulas provide a window into the negative impact of bureaucratization on care. While some of these negative impacts are byproducts of policies intended to increase oversight and access to doula care, we argue that increased bureaucratization and surveillance of doulas is also intended to act as a gatekeeping mechanism demonstrating how policies contribute to uneven reproduction.