Title of Regulation: 12VAC5-403. Certification of Doulas (adding 12VAC5-403-10 through 12VAC5-403-70).

Statutory Authority: §§ 32.1-12 and 32.1-77.1 of the Code of Virginia.

Effective Date: January 6, 2022.

Agency Contact: Robin Buskey, Policy Analyst, Office of Family Health Services, Virginia Department of Health, 109 Governor Street, Richmond, VA 23219, telephone (804) 863-7253, or email robin.buskey@vdh.virginia.gov.

Summary:

Pursuant to Chapter 724 of the 2020 Acts of Assembly, the new regulation (i) establishes the minimum requirements to be considered a certified doula in Virginia based on the core competences for doula certification used by national organizations and community based organizations in Virginia and (ii) outlines the minimum standards required of the certifying body, which will be approved by the board and which will be responsible for confirming state-certified doulas, approving the training and education to meet doula certification requirements, and maintaining a registry of state-certified doulas available to the general public.

Summary of Public Comments and Agency's Response: A summary of comments made by the public and the agency's response may be obtained from the promulgating agency or viewed at the office of the Registrar of Regulations.

Chapter 403

Certification of Doulas

12VAC5-403-10. Definitions.

The following words and terms shall have the following meanings when used in this chapter unless the context clearly indicates otherwise:

"Antepartum" means the period of pregnancy prior to labor and delivery.

"Certifying body" means an organization approved by the State Board of Health that has as one of its purposes the certification of doulas.

"Community-based doula" means a doula who often has shared lived experiences and is trained to provide extended, culturally congruent support to families throughout pregnancy to include antepartum, intrapartum, during labor and birth, and up to one year postpartum. Community-based doulas provide an expanded set of services and play a crucial role in improving outcomes and experiences for communities most affected by discrimination and disparities in health outcomes.

"Doula" means a trained nonmedical professional who provides continuous physical, emotional, and informational support to a pregnant person during the antepartum or intrapartum period or during the period up to one year postpartum.

"Intrapartum" means the period of pregnancy after the onset of labor through delivery.

"Postpartum" means the period of pregnancy following birth.

"State-certified doula" means a trained, community-based nonmedical professional who provides continuous physical, emotional, and informational support to a pregnant person during the antepartum or intrapartum period or during the period up to one year postpartum who has been certified by a certifying body approved by the State Board of Health.

"Training entity" means an organization that has a training and education programs that are approved by a certifying body approved by the State Board of Health to meet the curriculum requirements for community-based doula certification.

12VAC5-403-20. State-certified doula.

Any person seeking to be a state-certified doula under this chapter shall be a community-based doula and shall (i) meet the qualifications and education requirements established in this chapter and (ii) hold a certification as a certified doula from a certifying body approved by the State Board of Health.

12VAC5-403-30. Qualifications.

A. Any person seeking to be a state-certified doula under this chapter shall complete at least 60 hours of doula training. Training shall be provided by one or more entities approved by a certifying body approved by the State Board of Health.

B. The training and education requirements outlined in 12VAC5-403-50 shall not apply to doulas who have already obtained an initial level of certification within three years prior to [ (insert the effective date of this regulation) January 6, 2022, ] and are applying to be a state-certified doula through the certifying body approved by the State Board of Health, provided that the applicant provides proof of completion of any unmet training and education requirements within one year of application.

12VAC5-403-40. Minimum standards for certifying bodies.

A. The State Board of Health shall approve a certifying body that has adopted standards from a nationally recognized organization that has a doula certification that reflects national best practices pertaining to community-based doula training and certification to establish certified doula training and education programs and to approve or accept continuing education courses for renewing doula certification in Virginia.

B. The certifying body shall:

1. Maintain a registry of state-certified doulas that is accessible to the public and displays the certification status of doulas.

2. Submit to the State Board of Health an annual report by the end of every fiscal year that identifies the number of new and cumulative state-certified doulas and the number of new and cumulative training programs approved for the purpose of providing doula certification.

C. The certifying body shall require its certificate holders to:

1. Adhere to a code of ethics set forth by the certifying body.

2. Complete at least 60 hours of training and education provided by one or more training entities approved by the certifying body.

12VAC5-403-50. Curriculum requirements.

A. Unless the exception in 12VAC5-403-30 B is met, any person seeking to be a state-certified doula under this chapter shall complete doula training and education programs that have been approved by the certifying body. The curriculum requirements for the certified doula training and education programs are outlined in the Virginia Curriculum Requirements for the State-Certified Doula and shall be approved by the certifying body.

B. The curriculum requirements for the certified doula training and education programs shall include a minimum of 60 hours in the following topics:

1. Maternal and infant health concepts and approaches ( [ 2 two ] hours).

a. Provision of perinatal support services from [ 1st first ] trimester to [ twelve 12 ] months postpartum.

b. Provision of emotional and social support, including navigating pregnancy loss.

2. Lactation anticipatory guidance and support (10 hours).

3. Service coordination and system navigation (20 hours).

a. Provision of in-home prenatal and postpartum care support.

b. Assessing psychosocial and health needs, including perinatal mood and anxiety disorders (PMADs) screening.

c. Goal setting and prioritization of psychosocial and health needs.

d. Antepartum (high-risk) maternal care support.

e. Labor support.

f. Education and referrals for developmental screenings.

g. Resource navigation for wraparound services (i.e., intimate partner violence, domestic violence, oral health, family planning).

4. Health promotion and prevention ( [ 8 eight ] hours).

a. Provision of perinatal health education.

b. Provision of newborn parenting education

c. Provision of wellness and self-care coaching.

5. Advocacy, outreach, and engagement ( [ 5 five ] hours).

a. Serving as an advocate for respectful maternal care.

b. Intentional reflection of the community served.

c. Care coordination and social service navigation.

d. Provision of reproductive rights education, informed choice and decision making, and birth planning.

e. Child abuse and neglect mandatory reporting.

6. Communication ( [ 2 two ] hours).

a. Respectful, client-centered maternal care.

b. Active listening.

c. Navigating patient families, medical support staff, and other support systems.

d. Responding to challenges.

7. Cultural humility and responsiveness ( [ 8 eight ] hours).

a. Intersectionality and cultural humility, including language access.

b. Health literacy.

c. Trauma-informed care.

8. Ethical responsibilities and professionalism ( [ 5 five ] hours).

a. Code of ethics, standards of practice, and [ HIPAA the Health Insurance Portability and Accountability Act of 1996 (P.L. 104–191) ].

b. Required charting and documentation.

c. Serving as an accountability partner.

12VAC5-403-60. Continuing education.

Any person seeking to be a state-certified doula under this chapter shall be required to complete a minimum of 15 hours of continuing education every two years from the date of certification from a training entity approved by the certifying body pursuant to 12VAC5-403-40. These hours shall be in courses outlined in the Virginia Curriculum Requirements for the State-Certified Doula.

12VAC5-403-70. Certification not required.

This regulation does not require a doula to be certified by a certifying body approved by the State Board of Health in order to practice as a doula in Virginia.