Five years ago, I had no idea what a doula was. (Doula what? Doula who?) Then I saw the Ricki Lake documentary “The Business of Being Born” and was forever changed. I cried through most of it thinking about my cousin’s pregnancy and hospital childbirth via caesarian, and decided I wanted to learn more about doulas and even be one someday.
Miriam Zoila Perez, also known as Radical Doula, was one of the first people I talked to about being a doula, the training and it is really all about. As a co-founding member of the Abortion Doula Project and a radical queer woman of color, I trusted her guidance and was inspired by her commitment and encouragement. Because of her, I did an incredible doula training via the International Center for Traditional Childbearing (she also encouraged me to blog!). Much to my chagrin, I haven’t practiced as a doula YET but the things I learned and the people I met there have made a lasting impression on my respect for childbirth and the human body, and have driven my passion for reproductive justice.
Radical Doula is now a thriving blog and the go-to source for thorough and factual childbirth information with an intersectional lens. I’m so grateful, proud and excited that she has released “The Radical Doula Guide: A Political Primer for full spectrum pregnancy and childbirth support” which explains the basics of what doula are, their roles and responsibilities (including assisting with childbirth, abortion, adoption and miscarriage), and how doula work is both activist and political. Perez clearly explains how race/ethnicity, immigration status, socioeconomic status, gender, sexual orientation, ability, age and size relate to health care access; and how these things impact our pregnancy and childbirth experiences. These discussions about intersectionality are critical for continued reproductive justice building and for stronger linkages with mainstream reproductive rights and feminist communities.
I recommend this book not only for folks who are interested in being a doula or that need one for personal support but for anyone interested in understanding how childbirth is politicized in the United States. Order your copy now on Radical Doula.
Thanks for the link, it sounds like a very interesting book!
I considered getting a doula for my deliveries, but they still aren’t all that commonplace where I live. There are a whole lot of feminist-related issues bound up in the important mission of doulas, and I don’t think they get nearly the level or respect or recognition they deserve here in the U.S.
can you speak/explain a little bit more about the “abortion doula project?”
Correction: it’s “The Doula Project” and here is some info for you to check out: http://doulaproject.org/. They are doing excellent work.
Apologies for confusion!
If you wouldn’t mind helping me figure something out- in my experience the term ‘doula’ is very much connected to a stridently pro-breastfeeding/anti-epidural/’clean pregnancy’ type of advocacy, which I personaly find pretty problematic. I’m looking through your links, which seem really different- ‘non-judgmental care which assumes the patient knows best’ sounds really good- so I’m wondering if you have any idea what’s behind this disconnect. Is it possible I’ve simply interacted with people at the fringe (every movement has its outliers, of course)?
No, ambling, you haven’t. The doula movement IS rather connected with that junk. I sorted through a lot of doulas before finding the least crunchy choice available–and I have to tell you, next time I’d rather just ask a close female friend.
I think doulas CAN be enormously helpful for some women. Ours was moderately useful. A friend’s, however, pushed her so far towards natural childbirth that she never asked for meds when really, she wanted them/was traumatized by the pain (hello, unmedicated ventouse & precipitous first-time labor). Another friend didn’t ask for any pain meds while being stitched up, because the doula disapproved. A lot of women go internal and quiet when in pain, and a pushy doula can be a great thing–IF you trust her to advocate for you and not your agenda.
Blarg. HER agenda, not your agenda. Fail.
Anyway, I’m a little tweaked by this paragraph:
“Then I saw the Ricki Lake documentary “The Business of Being Born” and was forever changed. I cried through most of it thinking about my cousin’s pregnancy and hospital childbirth via caesarian, and decided I wanted to learn more about doulas and even be one someday.”
So, we arguably have too many sections in this country. But that movie declared all sorts of disgusting things about women and birth, among them insinuating that c-section mothers couldn’t bond with their babies, because chimps. Also, is your cousin really unhappy with her birth? If so, I get your reaction….if not, really, isn’t it none of your business?
Chava, I agree. I saw that documentary and had pretty much the opposite reaction as the one had by many of the people whose lives have been changed by it. I came to the film with a bias in favor of home births, but was so put off by the bad argumentation that I would hesitate to align myself with that movement.
You mentioned the horrid claim that giving birth by C-section means that the “love hormone” won’t be released, compromising the ability to bond with babies. It sounded like bad science to me, not to mention insulting to the millions of people who have had C-sections.
I also had a big problem with the constant claim that hospitals and ob/gyns are trying to instill fear into us, making us afraid of giving birth outside of a hospital. When I found that the documentary also did a pretty good job of instilling fear — fear of hospitals, doctors, Western medicine, science, etc. It seemed too reliant on the naturalistic fallacy and the idea that because childbirth is natural it must be inherently safe.
I’m rather bothered by the false dichotomy held by some, which holds that science is antithetical to feminism. (Not saying that the OP is forwarding these beliefs — I’m just talking about The Business of Being Born here.)
You cried about someone else’s C-section? Why? Was your cousin upset? Was it not medically indicated?
Personally, I don’t need any pity or grief groupering about my two sections. I consented to them voluntarily. They were necessary. I have two healthy kids. I’m healthy too. During my first birth, I also believed I was going to die, yes I imagined I was dying (back labor will do that, you see) until the epidural kicked in.
I’ll take modern medicine, thanks. And I find it awfully not-feminist to assume that medicalized birth represents women without education or victims rather than women exercising choice.
I’ll take the advice of my obstetrician with 35 years of practice over talk show burnout Ricki Lake in the field of childbirth, thanks.
The doulas who push “support is good; help is good; we can provide support and help; try your best to understand the risks and benefits of each procedure” are providing a valuable service that benefits their clients.
The doulas who push “reject modern medicine; don’t trust the evil doctors or the hospitals; women don’t need assistance to give birth; I know more than your doctor does and you should believe me over her” are providing a dangerous service that harms their clients.
This is not a simple discussion. The unfortunate reality is that most doulas are not educated in the sciences. As a result it can be very difficult for them to reliably distinguish between “good” and “bad” studies, procedures, risks, and benefits. It is almost impossible to have a cogent argument based on complex statistical risks when one party hasn’t been trained in statistics.
Doulas are entitled to their own set of opinions, but not their own set of scientific knowledge.
Thanks- I’m glad it’s not just me.
Jaz- I’d be really interested to hear your thoughts on the issues a couple posters have raised.
Yeah, this reasoning is incredibly idiotic. Maternal deaths in childbirth have historically been around 2 for every 100 births, and at times as high as 30 for every 100. In the US today, it’s about .024 death per hundred births. That’s a huge decrease and represents a lot of women who would otherwise be dead. And this isn’t even considering infant deaths in childbirth, which have fallen from a historical average of somewhere around 18/100 to less than .04/100. Thanks, modern medicine!
Trying to pressure women to avoid medical help during childbirth is misogynistic. Period.
My husband actually liked the idea of a post-partum doula who could come and help us out after the birth. I had an elective c-section, didn’t nurse (you know, “the worst possible outcome”). I chose it for mental health reasons, not that it needs explaining. The doula who came to help us did keep telling me what a shame it was that I had a c-section and couldn’t nurse. I finally did tell her that I didn’t feel bad at all, it was the far superior choice for me. She and I did not have a good relationship when she left.
I’m amazed that people who want to become doulas just don’t examine their own viewpoints and try to decide what kinds of births they’re comfortable at. If they would not want to be at a hospital birth / c-section / whatever kind of birth, that’s fine. A doula is sort of like a lawyer, to me. They have the ability to select their own clients based upon their values and such, but once you take on the client, you need to be unabashedly PRO client – whatever the client’s interests are.
And I tend to agree with Momma M – it’s a little presumptious to cry for another woman having a c-section, unless she personally told you that it was unwanted or unecessary.
DIfferent doulas have different philosophies. At their best, I think doulas can be really helpful–supporting a woman and her partner during birth, including helping a woman who wants to avoid medication do so, but also helping her understand what’s happening, suggesting ways to cope with pain and discomfort, and ensuring that she understands her various options, as well as supporting her partner through the process. But there are doulas who really have an agenda of their own and are willing to push it on their clients regardless of what the clients want.
I run in crunchy-leaning circles, and I often hear that that OB/GYNs push c-sections and inductions for their own convenience. That assumption of bad faith on the part of obstetricians makes me a little crazy. I think it’s true that they may suggest c-sections more readily than perhaps they ought, but I also think it’s because they’re trained to think in WORST CASE SCENARIO terms, not because of any nefarious reasons. If you want convenience and big bucks, you don’t go into obstetrics.
I had a medically necessary c-section (kid was breech*), and I don’t have any negative feelings about the experience. Everyone, from my nurse-midwife to the obstetrician who did the surgery to the maternity nurses, was incredibly kind and supportive throughout the whole delivery and recovery process. Obviously, all women don’t have that experience, but I feel like it’s important for people to hear about “good” c-sections as well as the horror stories.
*In most cases, babies flip so that their head is toward the birth canal. About 3-5% of the time, they don’t. My kid remained stubbornly right-side up.
most doctors, including feminist ones, agree that ricki lake’s documentary is bullshit.
My sister just had a home birth.
It when great, delivered a 10 pound baby!!! No complications.
I fail to see hoe this documentary was “bullshit”
lord look at those typos….
I once went to Las Vegas and walked away with a couple hundred more bucks then I went with, too.
That the documentary was bullshit isn’t disproved by your singular succesful home birth. It was full of psuedoscientific claims and made up statistics. It was bullshit.
I once went to Las Vegas and walked away with a couple hundred more bucks then I went with, too.
That the documentary was bullshit isn’t disproved by your singular succesful home birth. It was full of psuedoscientific claims and made up statistics. It was bullshit.
amblingalong: Thanks for the nudge :)
I agree with Katya that doulas cannot be lumped into one category. Nowhere in this post did I say that all women must have natural homebirths but I see that talking about doulas brings up a lot of personal feelings. My perspective, and the way that I was trained, is that doulas are there to support in advocating for what the woman wants. It’s not about what the doula wants. While doulas can give recommendations and information, a doula’s job is to advocate for the woman and support her. I don’t support anyone pushing their ideologies on anyone when it comes to their health and their bodies particularly something as personal as abortion, childbirth and adoption. Let me make that clear. I wouldn’t mess with a doula who isn’t listening to the woman and is more interested in furthering her own agenda.
I know that there are doulas who are pushy and dogmatic about natural childbirths and home births. Some nurses I know and trust have had difficult encounters with overbearing doulas. However during my training we had 2 instructors: one that works at home and the other who work in hospitals. This was important to have varied perspectives and to understand certain regulations that pregnant women have to deal with hospitals (i.e. not allowing women to get out of the bed to walk around during labor even though there was no “medical” reason that would prohibit that).
Re: The Business of Being Born: That movie sparked my interest in doulas and the medicalization of child birth. It has a slant BUT it inspired me to learn more and to ask questions. Caesarians are more common here than any place in the world…by a lot. Sometimes they are necessary and sometimes it’s a decision made by doctors with other interests. AGAIN, I am not saying all are bad but childbirth in the US (just like health in general) has become industrialized.
I thought about my cousin’s caesarian and was not upset so much by the procedure but by how she was treated in the hospital and her aftercare. She is fine with her experience but I know from talking with her that there were frustrations. Is it my business? Yes. That’s my family and I have a right to be upset when I feel like a member of my family (or any woman for that matter) is not treated appropriately in medical facility, especially after childbirth. That’s a part of reproductive justice for me. It’s not about me judging her for having a caesarian, it’s about ensuring that women receive quality care and that they are heard when it comes to their health, especially women of color who are at times treated differently.
Also the importance of the guide, as I mention, is that it discusses the political and social factors connected to childbirth and pregnancy in the United States. That’s why the guide is important!
This isn’t true. C-section rate in the US is 31.8% (in 2007), while China had a rate of 46% (in 2008). This took me 2 seconds to find on the Wikipedia page.
As for ‘other interests’, yes, there are some fucked up reasons pushing high c-section rates in the US particularly, but what it comes down to is this: C-sections exchange maternal morbidity (illness, side-effects) for infact mortality. C-sections stop babies being born brain damaged or dead, but can leave mothers with some nasty problems.
In some cases, it’s a no-brainer. If there’s a 50% chance the baby wil die without a c-section, then grab your scalpel and get cutting. Like SWNC I had a planned section for breech, to avoid a 5% chance of brain injury or death. At some point, though, it starts to get unsure. Is a c-section worth it to avoid a 1% chance of poor consequences for the baby? An 0.1% chance?
Doctors can very easily be sued (the way the system stands at the moment) for a fetal demise or birth injury, but are unlikely to be sued for the downstream effects of a caesarean section. So, for them, they might draw that line in a different place to where their patients would draw it. (They’re also pressured by hospital policy and insurance regulations, but that’s by-the-by). Also, no-one likes a stillbirth, and you get to see a fair few as an OB – every time you see an ominous fetal heart strip, you’re going to be very aware of how horrendous birth can be.
But the fact of the matter is, there’s no evil conspiracies or lying or malpractice or patriarchy necessary to drive a high c-section rate – we might, as a society, just have decided we really, really want to avoid stillbirth, and at a time when more than 3 kids in a family is a rarity, a low threshold for c-section is a good way to do that. Because, when you come down to it, reducing the c-section rate is going to cause a few stillbirths, and you need to be OK with that if you want to campaign for more vaginal births.
I used to defend doctors sued for medical malpractice, and if you don’t think that lots of doctors practice from a posture that is overly defensive because of fears over lawsuits then you’re kidding yourself. When that section goes wrong (because the potential for serious complications for the sectioned patient are quite significant, including hemmorhage and DIC, infection, pulmonary embolism, and stroke, to name just a few) and the reasons for that section were questionable in the first place then even I might be inclined to judge why it was even done at all.
From a feminist perspective, I think we need to be very careful about heading down that slippery slope where we use language and sentiments that are similar those used by the anti-choice crowd. The rights of a pregnant patient should never take a backseat to the fetus she is carrying, unless of course she has made that medically informed decision on her own. Furthermore, if any pregnant patient has decided she does not want to consent to a medical procedure that might (or might not) lessen a risk to her fetus then that is and should be her right and it should be respected.
I agree entirely, on both points.
In the UK (where I am) we have a less sue-happy culture, and also a fairly high c-section rate – although medical malpractice suits are certainly pushing it up, getting rid of insurance pressures isn’t, I don’t think, going to make a radical difference to the rates. The safer c-sections get (and their safety now compares favourably to vaginal birth these days, especially for elective CS), the more situations in which they’re going to be used. 30 years ago, CS for breech was rare, because CS was risky; now it’s safe, it’s what most women decide on.
The second point is totally what we need to have the conversation about. CS means a trade-off between mother’s and baby’s well-being. We need to acknowledge that, come to a consensus as to what the risks are in various situations and then understand that every woman is going to weight those risks differently, and make their own mind up. *This* is what we should be talking about – how to communicate this information to mothers before and during labour, and allow them to make their decisions – not burying our head in the sand saying that doulas or homebirth or midwives or water baths or epidurals or CS all round are the perfect solution with no downsides.
This also means making sure decisions are free from pressure in either direction – whether that’s bullying OBs going on about small risks to vulnerable women, or NCB advocates overvaluing the importance of vaginal delivery. Both cultures end up with women doing things they later regret.
We’re talking women who did not have epidurals? Because if you get an epidural, they are not letting you out of bed. Period. I live in a large city, but I’ve never heard of a hospital that wouldn’t let an unmedicated woman walk around during labor.
Many, many U.S. hospitals require CFM and IVs during all labors, which seriously hampers the ability of a patient to walk around during labor (even in the absence of an epidural.) Sometimes telemetry units are available, but it’s not a given. Prentice Hospital here in Chicago requires CFM and generally does not permit laboring patients on the L&D floor to leave their rooms and walk around, and requires all patients with an intact epi to stay in bed at all times. During 2 of my 3 of my labors I was actively discouraged from even getting out of bed at all and was only able to get a tele unit once.
I can’t even get into discussions with a certain brand of crunchy parent because of this kind of thing; there’s this weird irrational strain of doctors-want-to-fuck-me-over!! thinking that I can’t stand. It’s present in the whole anti-vax crowd for sure, and other places too.
I am finding it difficult to apply “choice”, “decision”, and “making their own mind up” to unplanned C-sections. Are there people who, in the middle of labor, when the OB says, “I recommend a C-section for [reason],” say, “Well, let’s discuss what the various risks are, and I’d like to think about how to weight them.”?
Not to mention that there are circumstances where a C-section is not really a choice. If nobody with medical certification is willing to attend a vaginal breech birth, the choices are a C-section or a vaginal birth without medical attention.