Creating a Five-Year Career Development Plan as a Doula or Perinatal Professional

By Birth & Baby University · Last updated: October 2026 · 4 min read

A five-year plan sounds like a corporate exercise, but for a doula or other perinatal professional it can be a practical way to sequence training, credentials, income and rest. The difficulty is that the ground shifts: state payment programs have expanded quickly, certification rules differ by organization and state, and demand varies by community. This article uses planning guidance and the few relevant studies to propose a flexible five-year template with built-in review points, rather than a forecast.

Key takeaways

• The SBA’s plan guidance asks for a prospective financial outlook for the next five years, with the first year more specific, using quarterly or even monthly projections.
• The landscape moves fast: the National Health Law Program counted 15 states plus Washington, DC with Medicaid doula coverage in January 2025, and NASHP counted 26 states plus Washington, DC as of March 2026 (counts made at different dates).
• Coverage does not guarantee work: in Virginia, fewer than half of 130 state-certified Medicaid doula providers billed Medicaid.
• If-then planning had a large effect on goal attainment in a meta-analysis of 28 experimental studies in people with mental health problems, but no study tested it with doulas.

What the research and guidance say

How planning guidance frames five years

The SBA’s business plan guidance says a plan guides you through each stage of a business, that there is no right or wrong way to write one, and that its financial projections section should give a prospective outlook for the next five years, with the first year even more specific, using quarterly or monthly projections. That is general small business advice; a solo doula can scale it down to a page.

A moving environment

The National Health Law Program’s January 2025 update counted 15 states plus Washington, DC with Medicaid coverage of doula care, up from five in early 2022, and reported rates rising in several states. NASHP’s state tracker reports 26 states and Washington, DC reimburse doula services as of March 2026. The counts come from different organizations and dates, but both show change within a few years. A 2026 study of Virginia found that 130 state-certified Medicaid doula providers were registered but fewer than half billed Medicaid and utilization among beneficiaries was below 1 percent from 2022 to 2024. Opportunities can arrive faster than the systems that make them workable.

Credentials and pathways take years

Some pathways have built-in timelines. DONA’s trainer page lists six consecutive years of membership, certification for at least two full terms, 120 teaching hours and re-approval every three years. Lactation, childbirth education and bereavement credentials each carry their own hours and supervision. A realistic plan allots time for each step and allows for slow years.

What helps plans become action

A 2016 meta-analysis of if-then planning (implementation intentions) found a large effect on goal attainment (d+ = 0.99, 28 studies, 1,636 participants) among people with mental health problems or high scores on clinical measures. It is evidence about a technique in clinical and analogue samples, not about career plans. A 2025 co-design study with 14 participants in Western Australia identified extended orientation, consistent mentorship, emotional support, professional development opportunities and structured feedback as essential supports for novice midwives. It is a small participatory study of employed midwives.

What this means for doulas

• Plan in pencil. Rules and payers change, so schedule review dates.
• Be specific in year one. The SBA’s advice to detail the first year applies: concrete clients, hours, income and costs.
• Sequence, do not stack. New credentials, new services and growth in client numbers at once is a recipe for overload.
• Build in support and rest. Mentorship, feedback and recovery time are part of retention, not extras.

Putting the evidence into practice

• Write a one-page vision for year five: who you serve, what you do, how many hours per week you want to work and what income you need.
• Work backwards: year three, year two, and a detailed year one with quarterly milestones, such as a credential, a number of clients, a mentor relationship and a financial target.
• Add if-then plans for obstacles: “If I have fewer than the clients I planned by month six, I will meet my mentor and review pricing and referrals.”
• List external conditions that would change your plan, such as a state starting or changing Medicaid coverage, a certifier changing requirements or a hospital changing policy.
• Choose two review dates per year, and invite a mentor or peer to challenge your assumptions.
• At each review, update costs, hours worked and how you feel about the work, then revise.

The bottom line

A five-year plan for a doula is a tool for choosing among options in a field that is still changing. Be specific for the next year, flexible beyond it, honest about your capacity and review it regularly with someone who will ask hard questions.

Related reading: How to Build a Doula Business Plan That Supports Long-Term Growth; How Continuing Education Helps Doulas Maintain Evidence-Based Practice; From New Doula to Experienced Professional: Building Competence Through Deliberate Practice.

This article is for professional education. It is not medical, legal, financial or tax advice. Check the standards of your certifying organization and the rules where you work.

Sources and further reading

• U.S. Small Business Administration. Write your business plan (page read October 2026). Read the source
• Peters R, Robles-Fradet A. 2024 Update: Medicaid Coverage for Doula Care Requires Sustainable and Equitable Reimbursement to be Successful. National Health Law Program, January 2025. Read the source
• National Academy for State Health Policy. State Medicaid Approaches to Doula Service Benefits (data as of March 2026). Read the source
• Mensah DL, et al. Doula services for Medicaid beneficiaries in Virginia: access, utilization, and policy lessons. Health Affairs Scholar 2026. Read the source
• DONA International. DONA Doula Trainer (page read October 2026). Read the source
• Toli A, et al. Does forming implementation intentions help people with mental health problems to achieve goals? A meta-analysis of experimental studies with clinical and analogue samples. British Journal of Clinical Psychology 2016. Read the source
• Bloxsome D, et al. Co-designing a resilience-based mentoring program for novice midwives: A participatory action research approach. Nurse Education in Practice 2025. Read the source

A career plan is easier to keep with a mentor. Birth & Baby University’s For Doulas page outlines training, recertification and mentorship options for doulas at different stages. Treat every date and figure in your plan as a draft and check certifier, state and payer rules again before you commit money or time.

More for professionals: the Professionals Blog.