About PALS Doulas

Young black nigerian family with a newborn baby

About PALS Doulas

PALS Doulas is a 501(c)6 volunteer-led organization focused on growing and supporting the professional doula via a competency based certification process. This is a DYNAMIC, ACTIVE, ENERGETIC group of individuals dedicated to changing the cultural norms for certification, the doula profession, and moving PALS forward as an inclusive, anti-racist organization.

PALS is actively working to shift the emphasis of certification as a measure of experience to a community norm that embraces the heart of the work done by doulas, creates community, and builds a representative voice as a professional organization.


Guiding Documents


  • PALS Doulas envisions a future in which:
  • The myriad ways of coming to doula work are honored; and 
  • Doulas are fairly and sustainably compensated for their work, including through Medicaid and insurance; and
  • Doulas are valued as an essential part of the care team; and
  • Doulas have access to clients in all birth spaces; and
  • All birth care providers engage in respectful and productive conversations regarding client needs; and
  • All families experience non-judgmental, unbiased, safe, and culturally congruent birth care.


PALS Doulas works toward realizing our vision by providing the following services:

  • Culturally inclusive certification processes, with a lens on removing barriers to entry; and
  • Advocacy for doulas in all birth settings, especially hospitals; and
  • Grievance process to support doulas who experience challenges with birth professionals; and
  • Grievance process to support doulas who experience challenges with birth professionals; and
  • Facilitating and promoting educational opportunities for doulas; and
  • Building community for doulas to support one another and to actively support each other in practice settings; and
  • The organization is actively engaged in social justice and anti-racism work.


PALS Doulas values:

  • Accessibility
  • Advocacy 
  • Anti-racism
  • Community 
  • Cultural Humility 
  • Equity 
  • Transparency
  • Ongoing Learning 
  • Inclusivity for people of all genders, sexualities, family structures, abilities, sizes, religions, ages, incomes, races
  • Professional relationship building 
  • Stewardship
  • Sustainability

Standards of Practice

I. Scope

  • A. Services Rendered. The Doula accompanies their client continuously while in labor, gives emotional and physical support, suggests comfort measures, and offers encouragement and suggestions for both the client and any other support people. Whenever possible, the doula delivers prenatal and postpartum emotional support, including explanation and discussion of practices and procedures throughout the course of service.
  • B. Limits to Practice: The Doula does not perform invasive clinical tasks such as cervical exams, injections, or intravenous (IV) care. Doulas who have received training may assist clients with performing non-invasive clinical care tasks, such as: blood pressure measurements, temperature checks, assessments of postpartum bleeding, and newborn weight checks. These tasks are conditionally appropriate when recommended by clients’ medical care providers. The Doula does not initiate non-invasive clinical care tasks nor interpret the results. 
  • C. Advocacy: The Doula supports each client’s values and goals during prenatal conversations, intrapartum and postpartum discussions, and birth planning. The Doula supports clients’ advocacy of those values and goals at all times. The Doula supports communication and shared decision-making between clients and their care providers by encouraging clients to ask questions, share values and goals, and incorporate changes in plans. Doulas who have received training, have demonstrated skill and experience, and/or have longer-term culturally congruent relationships of trust such as Community Based Doulas or Outreach Doulas, may speak on behalf of their clients. This is always conditional on the permission of the client with the goal of client empowerment, self-advocacy, autonomy, and agency to cultivate an equitable, safe environment. Doulas do not participate in activities that decrease clients’ autonomy, agency, or ability to self-advocate, including speaking on behalf of the client without their permission or making decisions for the client.

II. Continuity of Care 

  • A. Back-up. The Doula will provide a back-up doula to ensure continuous services to the client if the Doula is unavailable. This includes following up with the client and backup doula to make sure the client’s needs are addressed. 
  • B. Referrals. For client needs beyond the scope of the Doula’s training or knowledge, referrals are offered to appropriate resources to the best of their ability. 
  • C. Transfer of Care. If the Doula finds it necessary to discontinue service with an established client before labor, it is the Doula’s responsibility to notify the client in writing and if appropriate, arrange for a replacement if the client so desires. 

III. Certification and Recertification

  • A. Certification. Doulas certified by PALS will have the experience as set forth in the PALS Requirements for Certification. A vote of the Board of Directors finalizes certification. 
  • B. Recertification. Doulas certified by PALS are required to recertification annually. Completion of a PALS Competency Assessment, submission of 6 continuing education credits (1 of which must be focused on social justice/equity/anti-racism work), review and renewal signature of the Standards of Practice, Code of Ethics, Values, Mission, and Vision statements, recertification interview, and birth data from the previous 12 months must be submitted.

IV. Record Keeping 

  • A. Documentation. The Certified Doula maintains clear and accurate records of each client relationship and the birth. While not currently bound by the Health Insurance Portability and Accountability Act (HIPAA), PALS Doulas recommends adhering to the privacy practices set out in HIPAA
  • B. Data Collection. The Doula will collect data on each birth attended and submit that data to PALS. The data is used for doula advocacy, statistics, and marketing. 

Code of Ethics

I.Rules of Conduct

  • Propriety
    The Certified Doula will maintain high standards of personal conduct in their labor support capacity and/or identity.
  • Competence and Professional Development
    The Certified Doula will strive to become and remain proficient in the professional practice and performance of labor support functions through continuing education, affiliation with related organizations, and associations with other doulas.
  • Integrity
    The Certified Doula will act in accordance with the highest standards of professional integrity. 

II. Ethical Responsibility to Clients

  • Primacy of Client’s Interests
    The Certified Doula’s primary responsibility is to their clients.
  • Rights and Prerogatives of Clients
    The Certified Doula will make every effort to foster maximum self-determination on the part of their clients.
  • Confidentiality and Privacy
      The Certified Doula will respect the privacy of clients and hold in confidence all information obtained in the course of professional services.
  • Obligation to Serve
      The Certified Doula will assist each client seeking labor support either by providing services or making appropriate referrals.
  • Reliability
    When the Certified Doula agrees to work with a particular client, the obligation is to do so reliably, without fail, for the term of the agreement. The agreement (verbal or written) will clearly state any limitations on the doula’s availability and include clear backup plans for such situations when the doula is unavailable. (See Continuity of Care as outlined in Standards of Practice.)
  • Fees
    When setting fees, the Certified Doula will ensure they are fair, reasonable, considerate, and commensurate with service performed and with due regard for the client’s ability to pay. The Certified Doula must clearly state their fees to the client and describe the services provided, terms of payment, and refund policies.  

III. Ethical Responsibility to Doula Colleagues

  • Respect, Fairness, and Courtesy.
    The Certified Doula will treat colleagues with respect, courtesy, fairness, and good faith.
  • Dealing with Colleagues’ Clients.
    The Certified Doula has the responsibility to relate to the clients of colleagues with full professional consideration.

IV. Ethical Responsibilities to Health Care Providers of the Client

  • Respect, Fairness, and Courtesy.
    The Certified Doula will treat their client’s caregivers with respect, courtesy, fairness, and good faith.
  • Recognition of Clinical Responsibility.
    The Certified Doula recognizes that responsibility for clinical management belongs to the Health Care Provider (nurse, midwife, physician) and the client. The Certified Doula does not interfere with clinical management beyond making suggestions to, or asking questions of, the Health Care Provider and client, based on their knowledge of the client’s birth plan and preferences.

V. Ethical Responsibility to the Doula Profession

  • Maintaining the Integrity of the Profession.
      The Certified Doula will uphold and advance the values, ethics, knowledge, and mission of the profession.
  • Community Service.
      The Certified Doula is encouraged to assist the profession by making reduced cost or no cost labor support services available when possible. 

VI. Ethical Responsibility to Society

  • Promotion of Maternal, Paternal, and Child Welfare.
      The Certified Doula will promote the general health of laboring families and their babies, and whenever possible, that of their family and friends as well. 

Grievance Process

File a Grievance

As a means of accountability and providing an avenue for growth and education, the PALS Incident & Grievance process provides a vehicle through which a complaint may be brought; a fair and complete investigation undertaken, and appropriate action taken.

A grievance/complaint may be filed:

  • By an individual/family who contracted for services with a PALS Certified Doula
  • By a perinatal provider who directly interacted with a PALS Certified Doula during the course of a patient's pregnancy/labor

The Grievance Committee discusses the circumstances, evaluates the situation, makes recommendations, and initiates change, when appropriate. Involved parties (client, caregiver, or doula) will be notified by the Chair of the Grievance Committee upon receipt and determination of actionability. Upon the completion of this process, you may select whether you wish to be notified and informed of any actions resulting.
To promote fairness, the grievance will be shared with the person, you will have the option to select whether it is the full content, or a summary of your grievance. PALS Doulas Grievance Policy

Other scenarios

  • This process is also available to PALS Certified Doulas when they have interactions with hospitals/providers that they would like to request mediation or support from the organization. While other providers are not subject to the PALS Standards of Practice/Code of Ethics, we value, support, and stand with our doulas in addressing systems of harm perpetuated towards the PALS Certified Doula and the families they support. 
PALS Logo yellow (1)



  • The North West Association of Labor Support Providers is founded by Penny Simkin and Annie Kennedy following the first Seattle Midwifery School sponsored Labor Support Course as a means to create community and encourage dialogue. 
  • N.W.A.L.S.P. began providing referrals for doulas within the first year and publishing quarterly newsletters via Pennypress Inc.
  • Renamed the Pacific Association of Labor Support


The Pacific Association of Labor Support (PALS Doulas) files for incorporation and develops bylaws, goals, and defines the 1st Doula Scope of Practice and Code of Ethics.



Warmest Welcome Conference in Seattle, WA co-sponsored by PALS, DONA, NAPCS (National Association of Postpartum Care Services) and the Women's Studies Department at the University of Washington.


  • Sister organization Northwest Association of Postpartum Support (NAPS Doulas) forms


  • PALS completes a 3 year restructuring as a 501(c)6 trade organization supporting doulas after the application to form as a 501(c)3 is rejected.
  • PALS sister organization, Pacific Foundation for Childbirth Support (PFCS), is formed and receives its 501(c)3 status. The mission of PFCS is to serve low-income birthing women through doula support. PFCS later renamed Open Arms Perinatal Services.
  • PALS launches its first website.


PALS moves into its first office at El Centro de la Raza out of Penny Simkin's offices.


  • PALS loses contracts with Medicaid funded agencies and together with PFCS (Open Arms Perinatal Services) is able to continue funding services through 2004.
  • PFCS becomes Open Arms Perinatal Services and begins co-administering the Mentored Pathway Apprenticeship with PALS.


PALS changes its name to PALS Doulas and officially changes their logo. The First Annual Northwest Doula Conference takes place in Seattle. It is presented by PALS Doulas and NAPS Doulas.


PALS begins to recertify doulas


PALS launches an updated website to include on-line referrals via certified doulas’ profiles.


  • The membership votes to transition the board from a working board to a governing board and the office manager is promoted to Program Director. The lasts less than a year and PALS is faced with the decision to either restructure or close it's doors. 


  • Release of a statewide survey exploring scope of practice for Washington based doulas from all communities. Results from this survey lead to an expansion of the PALS Standards of Practice (see Guiding Documents above) an inclusion of community-based doula practices.
  • Launch of dual certification program for those seeking certification with PALS who have already certified with another organization
  • Co-hosts the 12th Annual Northwest Doula Conference


  • Ongoing work with the DoulasForAll Washington Coalition to advocate reimbursement for doula services through the WA Health Care Authority and Department of Health.
    • Participates in a Lobby Day effort in support of this initiative
  • Expansion to accept all pathways of learning towards certification (classroom, virtual, ancestral/tribal, and community based programs)
  • PALS Doulas launches a competency based certification program, reducing barriers to access and building wider pathways to certification


  • Contracted PALS Certified Doulas are included in the Eastside Health Network in response to a Microsoft benefit reimbursing for certified doula services (birth and postpartum)