There’s no one way to describe what it’s like to be present when a baby is born. For me, it’s electric. It’s the most bold, most primal work of human existence, happening both all at once and in slow motion: shivery, sweaty, bloody, beautiful. It’s the biggest joy and the greatest privilege I’ve experienced in my life so far, the fact that women choose me to be their witness and support on the day they give birth. When I watch a mother see her baby for the first time, the edges all around me blur and spin, then sharpen, each and every time.
I’m a birth doula, so I get to experience this overwhelming honor and privilege fairly frequently. A doula is a non-medical childbirth support person. A labor coach, of sorts, a person (usually female) who provides continuous emotional and physical support to the laboring woman and her family. That support might include massage, suggestions of position changes, distraction, knowledge of hospital or care provider policies, or simply a helpful presence. Doulas have been in existence since the beginning of time, basically (Imagine a woman giving birth before modern obstetrics and the various women who might have helped her—sisters, neighbors, friends) but as a profession, doula-ism (that’s what I call it, at least) has existed for roughly 25 years. The movement was largely spurred by the work of Penny Simkin and DONA International, which is the largest certifying organizations for doulas in the world, founded in 1992.
I became a doula because I wanted to support women on one on the most monumental days of their lives. Having a baby is, after all, a really fucking big deal, whether you’ve done it several times before or whether it’s your first birth, whether it’s an accidental pregnancy or a baby you’ve tried for years to conceive. Giving birth is emotionally, mentally, and physically taxing, both before and after you set eyes on the little person who’s been dwelling in your uterus for months. It’s surreal while also being profoundly real, and it’s incredibly crazy and it’s just plain incredible.
I wanted to be a part of it, not just for myself, but because, as a pro-choice woman, I feel passionately that women should be supported in all of their health care decisions. Women are entitled to bodily autonomy, to bodily integrity, from birth control to giving birth and beyond. My doula work is informed by, is imbued with this; my fierce belief that women must have choice in all aspects of the reproductive process. I was a pro-choice feminist before I was ever a doula and I will be a pro-choice feminist if I ever stop my work as a doula.
Outside of the birth world, that there’s an idea that doulas are for wealthy hippies. (I had one! She rocked! She said I was a beautiful Xena: Warrior Princess-type person and dug elbows into my back! – Ed. [I kind of think they are for hippies! – Other Ed.]) There’s an idea that you can only have a doula if you want an unmedicated birth. There’s an idea that you can only have a doula if you’re planning to give birth at home or in a birthing center. I think there’s also an idea that doulas are crunchy, anti-science, earth mother-types who pretty much exclusively serve rich white women, women who think that doctors are the devil. I once had a man say to me, “You’re a doula? Isn’t that a really bougie thing to be?”
Some of these stereotypes are rooted in truth, I suppose. I’m crunchy…ish. I own a copy of Wise Woman Herbal For The Childbearing Year, I use a DivaCup, I drive a Prius. But the reality is that doulas are as diverse in personality, values, and ideals as the people in any profession, although I think it’s safe to say that a woman (or man!) who chooses doula work has a healthy interest in pregnancy, birth, and motherhood. I don’t find it difficult, though, to reconcile my own lifelong fascination with motherhood with my position as a pro-choice, feminist woman. My commitment to making sure women feel empowered and supported on the day they give birth arises naturally out of my feminist conviction that women should be empowered and supported in their health care choices–always. If you don’t want to have a baby, you shouldn’t have to. If you do want to have one, you should be able to do so in a way that feels right to you.
I entered my doula training a year ago, seriously fired up about the sorry state of childbirth in America: our rapidly-rising Caesarean section rate (currently at around 30%, a full 15% higher than what the World Health Organization recommends), the “cascade of interventions,” out of control hospital costs, unnecessary episiotomies, and more. I was pissed off.
A year later, I’m not any less pissed off about our flawed maternity system. But what I’ve learned is that I cannot and will not let my personal feelings about what a birth “should” or “should not” be affect the birth experiences of my clients or the caliber of my commitment to doula work. As a doula, my role is to support the hopes, desires, and choices of the laboring woman and her family: Her body, her birth, her baby, her choice. Period.
There are doulas in my community who refuse to work with women who think they might want epidurals, as well as doulas who won’t attend hospital births (or inductions, or births in particular hospitals, with particular doctors or midwives, and so on). Those doulas are entitled to run their practices in whatever way feels right to them. Doula work, is after all, profoundly personal. I try as hard as I can to make sure my own practice is centered around continuous emotional and physical support to any woman that wants that support, no matter what her particular choices might be and no matter what happens in the course of her care.
When a client hires me as her doula, we have an in-depth meeting where we discuss her preferences for her birth: Does she want an epidural? How about analgesic pain medication, continuous fetal monitoring, a IV heplock? Is she hoping to have an unmedicated, low-intervention birth? Would she like massage, guided visualizations, coached breathing, low lights in the room? Would she like to be free to push in whatever position feels right to her? Does she desire her partner to catch the baby? Does she want her baby kept in the room with her once the baby is born? These preferences are personal and they are complex—as complex as the decision to carry a baby to term, or not. It’s not my place to question any woman’s choices or assertions throughout their pregnancy or labor. It’s my place to support them and their partner, if they have one: to ask questions, to facilitate communication, to smile, to reassure, to remain calm.
Unlike the doctors, nurses, and even the woman’s partner, my presence at a birth is exclusively centered on the woman, my client. My focus is not on the being that’s about to be born; it’s on the living, breathing, laboring woman in front of me. During a labor (especially those that happen in a hospital setting), the beeping monitors and busy-ness of a labor and delivery floor can sometimes make it seem like the baby’s physical safety is greater, more vital, than that of the woman laboring to bring the baby into the world. While I obviously value the lives of the babies my clients are working to have, my commitment is to their mothers.
Of course, there are an infinite number of factors that can affect the choices and decisions that these mothers make: everything from insurance companies to medical conditions to hospital policies to the baby’s position during labor to the care provider who happens to be working the day someone gives birth. Birth is a process and that means everything—and I mean everything— is constantly subject to change: the “plan,” the preferences, the emotions, the mood in the room, the baby’s heart rate, the mother’s blood pressure, and on and on and on.
There are no guarantees in birth. The only thing anyone can be sure of is that a baby is going to get out of a body, hopefully in a way that is safe for both mother and child. Ideally, the mother has positive feelings about her experience. Ideally, so does her partner. That very uncertainty, is, in my opinion, why it can be helpful to have a trained support person like a doula present during labor (if you want one, of course). I don’t like to generalize any further, because if there’s one thing that birth work has taught me, it’s that there is always an exception to the rule. Nothing is ever unequivocal. Not during the pregnancy, not during the hard work of the birth, and certainly not once the baby is finally out, finally an independent being. It’s a good thing, this fluidity, this uncertainty; it means that there is space, that we can make space, for different women in different circumstances with different choices.
And for me, that’s the crux of my conviction: choice. Choice is the the reason I started this work and it’s the reason I continue. It’s the reason I stand for hours, putting pressure on a laboring mother’s back, the reason my life is planned months in advance in anticipation of a birth that could happen at any time, and why a birth ball blocks the back windshield of my car three weeks of each month. For me, having choice in childbirth easily connects to the larger reproductive rights agenda. A woman should be able to choose if and when she becomes a mother, just as she should be able to choose how and where that happens, as well as with whom. (Necessary disclaimer: Barring those infinite variables, both medical and non-medical, that directly impact the health and/or survival of the mother and baby).
When a woman I’ve doula-ed gets the birth she wanted and planned, I’m happy, proud and satisfied. But I leave each birth hoping, more than anything, that I’ve helped the mother feel secure and supported in the choices she made throughout her birth, no matter what her outcome might have been.
As a pro-choice feminist, I plan to eventually expand my practice and focus some of my energy on the doula work that’s happening outside of the labor room. There is a small, growing, doula movement to support every woman on the reproductive spectrum: Full-spectrum doulas provide support for every pregnancy outcome, including abortion, stillbirth, miscarriage, adoption, surrogacy, and, yes, birth. There’s still more work to be done, of course; The birth world has a long way to go in terms of supporting low-income families, LGBT families, and other people who don’t have access to the spectrum of “choice” that the (often) privileged, cisgendered women who have the means to hire a doula are afforded.
Still, I’m proud to be part of a community devoted to making birth better for women, and I’m eager to see how the role of a doula might change and evolve in different settings, not only here in the United States, but around the world. In my own small corner, I continue my work with birthing women, listening, valuing, encouraging, affirming. Her body, her birth, her baby, her choice.
For more information on pro-choice and full spectrum doulas, visit RadicalDoula.com or the Full Spectrum Doula Network.
