Being a Radical Doula
How pro-choice advocacy and birth activism go hand in hand.
By Miriam Pérez, Swarthmore College
Monday April 16, 2007
How can the same person be a pro-choice activist and a birthing-rights advocate devoted to supporting women through childbirth? When I became interested in the rights of pregnant and birthing women in college, I never imagined there was a contradiction between my pro-choice politics and my newfound passion for midwifery. But a few months ago, Lynn Paltrow, executive director of the National Advocates for Pregnant Women, clued me into a longstanding divide between the pro-choice and birthing communities. She and her organization put together a groundbreaking conference that attempted to bridge the gap between these two groups, who rarely talk about each other’s issues.
Abortion had never been addressed at the midwifery conferences I had attended, and the issue gets little mention on the websites of the most prominent midwifery and doula organizations. (A doula is a person trained to provide support to women in labor.) Initially these silences led me to believe that birth activists held my pro-choice beliefs, but I recognize now that they are actually a sign of discord. Rather than address what can be a controversial topic (particularly for a movement that includes religious midwives and doulas), most birthing rights advocates choose to avoid the topic of abortion entirely. With a confirmed focus on the pregnant woman and her journey toward birth, such a high value can be placed on motherhood that it becomes difficult to condone practices like abortion. Similarly, within the pro-choice movement, such a large emphasis is placed on the rights of women not to parent that one can forget about the rights of women who choose to parent.
When I was thrust into the world of what I call “birth activism,” I approached the issues with my usual attitude: People who didn’t get it just didn’t have the facts yet. They hadn’t seen what I’d seen or read what I had read about how terrible the current state of childbirth is in the United States, particularly in the hospital setting. The documentary “Born in the USA” plainly demonstrates how much better midwives and out-of-hospital settings are for low-risk births, and how the bureaucratic obstetrics ward contributes to a landslide of unnecessary medical interventions that aren’t good for mothers or children. Childbirth in its current form—attended by an obstetrician in the hospital—has only existed since the 1920s. Before that time, midwifery care in the home was the standard practice. According to author Karla Hay, before 1900 only 5 percent of American births occurred in hospitals. By 2000, the Centers for Disease Control reported that 99 percent of births did.
What’s wrong with all this? There are many negative effects of the medicalization of birth, but let’s keep it simple. Childbirth is more medicalized now than ever, with more interventions, more drugs, and more surgeries. Our Caesarean section rate is up to around 30 percent, despite World Health Organization recommendations of 15 percent. Are women and babies healthier? Safer? Happier? The answer is no. The United States continues to rank near the bottom of developed countries in relation to infant mortality, coming in second to last in 2006. Experts disagree on why. Some cite sub par health care for low-income pregnant women, while others point to increasingly complicated neonatal surgical interventions for otherwise unviable pregnancies. The simple fact is that Americans have one of the most costly health care systems in the world, but in many respects our health outcomes are nothing to brag about among our developed-world peers.
Beyond all of this, what the birthing rights movement addresses is the narrowing scope of women’s choices about how they give birth. Hospitals and doctors have increasingly specific requirements and regulations about childbirth, many times based on standardized ideas of how a “normal” birth progresses. When women fail to meet these standards, interventions are employed, many of which are costly and cause a landslide of further intervention. Let’s not forget the emotional and psychological component. Many women give birth in environments where they feel unsupported, a fact exacerbated by hospital staffers who are overworked and face increasing productivity demands. They instead rely on family to give emotional support, but not all women have the familial support they need or want.
Birth activism provided me with a new outlet for my feminist politics and a way to support women during an important time in their lives. After a harrowing experience in a public maternity ward in Ecuador, where I briefly lived, I became a doula, accompanying women during labor. Unfortunately, working as a doula—while an incredible opportunity—was not the empowering experience that I had hoped it would be. I found that I had little ability to influence births and I could be in the birthing room only as long as I kept my mouth shut and stayed out of the way. I accompanied four women during their labors and deliveries in this hospital, but by then I was at my breaking point.
Activists working in the abortion-rights field have similar experiences. It is almost impossible for a woman to have an abortion in a totally safe and supportive environment, free from social and familial stigma. No matter how much we pro-choice advocates fight, there will always be a loud and ever-present group on the other side (often just outside the clinic doors) telling women they should feel guilty about their choices and that they are based on selfishness and sin. Women are rarely allowed the freedom to make these choices in the idealistic environment that we abortion-rights advocates dream about, free from the influence of divisive politics. This is where the connection between abortion-rights advocates and birth activists seems exceedingly clear to me: Both are attempts to fight back against rhetoric that prioritizes the unborn fetus instead of the adult woman.
When a woman is giving birth in an American hospital, the doctors, nurses, and extended medical team are almost wholly focused on the status of the fetus inside of her—constantly employing technologies to monitor it and drugs to regulate it, allowing fetal well-being to be their dominant concern. When we think of a woman with an unintended pregnancy (and this could be the same woman, in a different phase of her life), a similar logic applies. Anti-choice activists don’t trust women to make responsible decisions about their lives and ability to parent; they instead focus on the potential life inside a woman, and place all emphasis on the future of the fetus rather than on the future of the woman. Anti-choice activism and overly-medicalized birthing practices are both based on a lack of trust in women. Consider the many restrictions imposed on birthing women: rules regulating out-of-hospital midwives, mandatory waiting periods for abortions, forced C-sections, and biased pre-abortion counseling are all examples of how people do not trust women (or their support networks) to make responsible decisions about family well-being.
What is unique about the role of the doula is that she gets to be one of the only people in the birthing process exclusively focused on the woman. She focuses entirely on how the woman is feeling, providing accompaniment and support through a process that can be scary and lonely, particularly in a hospital. Studies show the positive effect that this kind of unconditional support and attention can have on both the mother and her child. That’s the logic that really connects the birthing and the pro-choice movements—if we support women and their decisions, everyone will fare better, including children.
Miriam Pérez is the Advocacy Associate at the National Latina Institute for Reproductive Health in New York City and blogs at Radical Doula. She graduated from Swarthmore College last year.
--------
Comments
Leave a comment about this article below. For more discussion, visit our community page and sign up for your own Campus Progress blog!
|
!
You are a badass, Miriam! This is my first exposure to the idea of radical birthing. Sounds amazing! Keep up the good work. Fight the good fight!
— Caroline - Apr 23, 01:54 AM - #I \\\My daughter Kathleen studied two years in Seattle midwife school, delivered 50 babies in San Luc ia, ecame a licensed midwife in Spokane for many years then added a BS and an MS in Nursing. she was always a healer and still is. Speaks fluent Spanishm too, doulas, Midwives working together need a good backup Doctor who stays in the backgvround unless REALLY needed.
— jean doran - Apr 24, 01:35 PM - #Denial is the answer to the first question posed by the author of this article. Suppotring a women giving birth to a living breathing child is COMPLETELY DIFFERENT than assisting a woman to spread her legs so that her child can be sucked into a vacuum cleaner, dismembered with medical instruments, or be partially delivered and have its skull caved in and brains sucked out.
I know from personal experience that midwives and doulas are very helpful in the birthing process. The doulas that I know help a woman understand what is going on inside of her and help a great deal with emotional support. However, I cannot imagine a doula calmly and honestly being so indifferent to say something to the effect that the living fetus inside a woman is a “choice” not a person, and that it can just go away and it will be just fine.
Doulas play no role in death advocay. Sorry.
— S. Palmer - May 5, 02:39 PM - #A “birth activist” is logically an activist for birth. An abortion activist is logically an activist for death. These are two sides of an “issue” and cannot be mixed up.
I know several doulas and I know for a fact that even discussion of “choice” to kill would disgust them. You see, doulas deliver, not dismember!
Thanks for missing the entire point, S. Plamer.
— Sayna - May 6, 01:51 PM - #nice to know S.Palmer got exactly one sentence into the article before s/he commented… This is an amazing article! it definitely makes me more hopeful for the future to see the rise of birth attendants who acknowledge ALL phases in women’s fertility, not just pregnancy and birth. great job, Miriam!
— R. Edwards - May 6, 03:15 PM - #S. Plamer: the real answer to the question is “How could it not?” Both work to give individual women the procedure they want, in the manner they desire, with all the support they can possibly give. Thus, they have the same goal: helping women achieve what is important to them.
— Kyra - May 6, 04:35 PM - #It is hopeful to see that at least S. Palmer has their head on straight.
— Anti-Nazi - May 8, 09:48 AM - #What the heck? Abortion is not a phase of women’s fertility the last time I checked! And a birth attendent attends a birth, moron. You Nazis are trying to redifine things in a typical Commie/facsist/leftist fashion with total disregard to reality. I agree with Palmer that killing a baby and delivering one are not the same thing. No gray area here. There is a choice allright…the choice to turn a woman’s womb into Auschwitz!
A procedure to kill and a procedure to bring life are two entirely different procedures, please do see the difference and do not expect a doula or midwife to not know the difference! You were brought into life because you are reading this, if you would have been “delivered” the other way, well, I rest my case. It’s too bad that some have to feel sorry for a mother rather than an unborn child without considering that she too was an unborn child who had life immediately after conception. That’s the real issue here, when does life begin? When is it okay to hurt and kill life? This question is one that an individual can make in this society because of laws that permit this type of killing. There is only one state that does not allow this that I know of and that is South Dakota. Back to the doulas and midwives and what they are capable of and routinely do with their mamas. Doulas and midwives are loving, giving and special people who attend the mama before, during and after the birth of the child. In addition to preparing the woman for a beautiful birthing experience, after the baby is born she will also help with nursing, make meals for the new mama, talk and provide comfort as needed and much, much more. Sure, one could say that a doula or midwife could do this for a woman who has killed her child, but the situation is entirely different. Who is there to nurse? Who is there to cuddle? Who is there to love? I wouldn’t expect that it would be easy for a doula or midwife to provide counseling services to a woman who had an abortion since there are other occupations who address this. Perhaps it would be best to let these women enjoy life and what they do best, bring new life into the world!
— Mother - May 8, 10:35 PM - #Absolutely a fabulous article. I am a pro-choice, pro-woman, pro-wanted children activist. I completely agree about the over-medicalization of birth, but I hadn’t connected the dots on why it upset me so much. Because the woman, her medical needs, and the manner in which she wishes her body to be cared for are disregarded in both situations. Thanks for this article. Yet another reason that a Privacy in Health Care Act is needed in every state.
— KP - May 9, 12:01 AM - #Thank you so much for that inspiring article. I personally am struggling for a way to get my voice heard and change the horrific course obstetrics is taking. I am a doula and if I see one more woman terrified into an unnecissary c-section by out and out lies, I may go postal. How do we change this? What is the answer?
— Chari - May 10, 11:35 PM - #A wonderful article. I’m a man. I’m pro-choice. I’m pro-women’s rights. And I’m AGAINST the double standards of selfish so-called religious groups in America that don’t take into consideration the reality of unwanted children their life-long consequences. KEEP AMERICA FREE.
— Carlos A. - May 14, 12:59 PM - #I read your article enthusiastically, as I agree with your opinion. It hadn’t yet occurred to me that this was a controversial idea! I have been a pro-choice activist since I first became aware of, and researched the issue. I have supported birth and motherhood my whole life, honoring mothers, mothering, and the sacred role of women as life-bringers. I too, see no contradiction in this. As a doula, I know I will have clients with whom I will disagree on a significant range of issues. But, as a doula, it is not my job to change the politics of my clients. It is my job to support women in their journey, give them permission to follow their own path on that journey, and to help with family bonding and helping children come into the world in a loving, supported way. I was shocked by S. Palmer’s graphic, denigrating language in his/her response, and stunned to hear such completely closed off opinions from people who claim to support nurturing and loving behaviour. I think no one but a pregnant woman (and whatever counsel she cleaves to) can know the right course for her particular situation. And while we’re discussing the whole pro-choice/pro-life false dichotomy, I object to people having co-opted a political term that should mean so much more than anti-choice: I am pro-life! While I support the legally required option to enable women to choose (including aid for those in poverty) abortion if that is what is right for them in their particular circumstances, I am pro-life: I support humans (women, men, children); endangered species; the environment; the spread of knowledge; cultures; ideas; and diversity. I think all humans have certain inalienable rights, and that includes women/ mothers-to-be/ and mothers. Thank you, Ms. Miriam Perez, for writing a well-informed, relatively neutral, evidence-based article which draws attention to important issues for everyone in the 21st century.
— JG - May 22, 02:18 AM - #Mother”-
I feel like you might be missing the point. Your post reminded me of a bumper sticker I saw a while ago that said “Your Mother Was Pro-Life”. I was really tempted to leave a note on the car that said “No, my Mom is pro-choice – and she CHOSE to have me!” I’m pro-choice, and I can’t wait to have kids. And when I do, I’ll approach my pregnancy and impending motherhood the same way I’ve approached birth control – by actively taking part in all the decisions that have to be made, discussing them with my partner, and being involved in the whole process. I’ve chosen what methods of birth control make the most sense for me, and I’ll be choosing which type of birthing will be right for me as well.
Also, I don’t think there’s anything in the article that compares an abortion to a birthing in any way OTHER THAN the way some people disregard the woman in the situation. It seems as though you read the article the way you wanted to so that you could inject your whole ‘abortion is murder’ rhetoric into a response. And misreading the author’s intent only serves to make your opinion seem even less credible. I really doubt the author is suggesting that doulas everywhere should start post-abortion counseling on a part-time basis. And this is not about when life begins. This is about policies that make it okay to treat women as non-entities as soon as the sperm hits the egg – after that, we’re just incubators. And we are so much more than that.
As for S. Palmer, I think Kyra said it best, so I’m not even going to go there. And I suspect that Anti-Nazi is too far gone to make it worth the effort to explain my views as a female (which I highly doubt A-N is) who has given these issues a lot of thought (which I doubt A-N has). Really, why should you put any thought into an issue when you can use a bunch of tired cliches and graphic imagery and buzz words to pretend you have an opinion worth listening to?
— Violet - Jun 13, 02:11 AM - #What’s missing in this debate is the fact that midwives (pre-1900) were the providers of all aspects of healthcare in a woman’s life and that INCLUDED abortion. Before antibiotics, and anesthesia midwives had to be knowledgeable in all types of herbal remedies. Some of the same herbs that assist in labor and birth also cause abortion, or the completion of a miscarriage, if given earlier in the pregnancy. In the time before hormonal birth control, the only effective form of birth control was abortion. Abortion wasn’t something invented in 1973 along with Roe v Wade. There is documentation of widespread use of abortion in ancient Rome. Midwives were the healthcare providers for women and so they saw all the positive and negative results of pregnancy. For example, as many as 10% of women died in childbirth pre-1900, and poor families could starve if there were too many mouths to feed. Given this knowledge, I doubt there was as much “debate” about the morality of abortion, especially when it was seen as one part of the continuum of human life.
— Corey - Aug 31, 09:22 AM - #Good article. I’m pro-choice, and I want to be a nurse-midwife one day. Apparently, there are more pro-choice midwives than people think there are. Message to people like S.Palmer
— Sarah - Dec 10, 10:51 PM - #Midwife means “With WOMAN”, not child. Attending births is only part of the job. That means they are with women for all of their medical care, not just birth. Midwives provide complete gyneclogical care, and abortion is part of that. I find no conflict between my pro-choice and pro-midwife views.
When I am a midwife, I will be a pro-choice midwife, because my first obligation is to make things better for women!