Culture & Conversation Maternity and Birthing

‘The Doulas’: A Guide to the Radical Practice of Quality Counseling and Care for Pregnant People

Eleanor J. Bader

Being attentive to the individual patient should not be considered radical, but the fact that it is tells us how far the medical model has strayed from the promotion of human well-being. But thanks to a small group of feminist doulas, the pendulum may finally be swinging toward treatments that accommodate personal preferences, needs, and differences.

During the last decade, a small group of people—largely but not exclusively women—has emerged to offer no-cost emotional support to pregnant strangers, most of them poor. As doulas, they provide what they call “full-spectrum pregnancy care,” a service that includes the provision of nonjudgmental assistance to patients during an abortion as well as during a live birth, regardless of whether the baby goes home with its birth parent or is placed for adoption. What’s more, they provide a helping hand during miscarriages. It’s intense and complex work, and practitioners experience both exultant highs and devastating lows as they give immediate, but tangible, counsel to the patient.

“The new doulas echo the full-service midwives of previous centuries,” reproductive justice activist-scholar Loretta Ross writes in the foreword to Mary Mahoney and Lauren Mitchell’s new book, The Doulas: Radical Care for Pregnant People. “When physician-based medical care was unavailable to many people, they relied on midwives who handled births and deaths. The midwives were trusted, respected, and valued for the critical role they played in people’s lives from beginning to end. Through similar compassion and dedication, contemporary doulas are creating a new tradition and demonstrating profound expressions of feminism in action.”

Indeed, it was the idea of offering free, hands-on, nonmedical support to pregnant, low-income people that first motivated Mary Mahoney, Lauren Mitchell, and Miriam Zoila Pérez—three activists then living in New York City—to come together in 2007. Their initial brainstorming centered on how best to help abortion patients. As they saw it, their Abortion Doula Project would become the country’s first program of its kind: a way to bridge the divide between counseling and advocacy, and to provide witness and comfort to those choosing to end an unwanted pregnancy.

Over time, however, they realized that this focus was flawed: that if they really wanted to practice reproductive justice, they should not separate abortion from other reproductive services. In short order, they became the Doula Project, a name shift that reflected their expanded mission. “The reproductive justice movement promotes the idea that, in a lifetime, a woman might experience the full spectrum of reproductive health decisions, that these decisions are linked to other intersecting factors in their life, and that any decision she might make should be respected and protected,” they write in a chapter titled “A Great Idea.” And, as writer and professor Marlene Gerber Fried has said, the spectrum idea “forces the erasure of the bright line that divides the women who have abortions and the women who have babies.”

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Great idea aside, it took time to build the project. There was, after all, an organizational structure to develop; volunteer recruitment and training classes for prospective doulas; and the necessity of finding providers willing to allow doulas into operating and labor and delivery rooms. The group eventually partnered with a Brooklyn Planned Parenthood and an unidentified medical center they call City Hospital. Since the project’s initial foray in 2008, it reports that it’s served “tens of thousands of clients and trained close to a thousand abortion doulas around the country,” in places including Asheville, Atlanta, Boston, Los Angeles, Minneapolis, and the San Francisco Bay Area. In most cities, the doulas work in clinics, alongside doctors, nurses, and technicians.

It’s an incredible achievement, and the stories told in The Doulas celebrate many successes. At the same time, the book also points out the many unanticipated challenges they’ve had to grapple with as they confront real-life dilemmas—for example, birth complications that make it difficult to honor the patient’s fervent desire for a vaginal delivery without medical intervention; being asked to leave the delivery area due to restrictions on the number of people allowed in the room; or being treated with disrespect or hostility by a physician who sees the doula as unnecessary. The accounts are honest, raw, and charged.

They’re also unusual, since they appear alongside narratives that detail specific care interventions and the effect they had on both doula and patient. In fact, The Doulas is part memoir, part how-to manual, and part political treatise. It can be read from cover to cover or used as a guide by activists intent on starting a project of their own. Chapters are purposeful and explicit: “How to Use Your Birth Doula Training … and How Not to Use It” or “How to Pack a [Full-spectrum] Doula Bag and Unpack Assumptions,” among them. Other sections describe doula burnout and ways to avoid getting overwhelmed by the multiple needs of clients. It’s a well-crafted, comprehensive, and compelling mix.

My only quibble is in the authors’ promotion of the idea that it is young people like themselves who are best suited for doula work. Perhaps it’s simply that the group of doulas whose work they chronicle are all 20- or 30-something “young people,” they write, “longing for human connection.” There seems to be no reason why others, including elders, should not be encouraged to participate if they have the stamina, time, and desire to do so.

Still, regardless of who is providing the care, the authors emphasize that the emotional support that doulas offer—from hand holding to wiping sweat from a laboring brow, from suggesting deep breathing exercises to initiating a conversation about parenting or relationships—is invaluable. That the Doula Project offers help where it is most needed—in medical facilities that serve largely low-income populations—makes its work especially important.

In addition, as a way to move feminism from theory to practice, the Doula Project makes human empowerment a lived value and models high-quality and respectful health care. Dr. Willie Parker, a widely lauded abortion provider from Alabama, celebrates this in the book’s afterword: “Women now have possibilities during labor that all but disappeared with the medicalization of childbirth,” he writes. “Amidst our current social preoccupation with optimizing outcome for the labor process—defined by some as minimizing litigious concerns—the default to crude measures of infant mortality and or maternal morbidity has distracted us from the central players in pregnancy: women.”

In fact, the holistic approach promoted by the Doula Project restores the focus on the whole person and encourages medical providers to be humane and compassionate. Of course, being attentive to the individual patient should not be considered radical, but the fact that it is tells us how far the medical model has sometimes strayed from the promotion of human well-being. It’s maddening, and we obviously have a long way to go before all medical care is patient-centered. But thanks to a small group of feminist doulas, the pendulum may finally be swinging toward treatments that accommodate personal preferences, needs, and differences.

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