01/22/2024
As the grandchild of a rural farmer, Iโve been gifted with the opportunity to deeply witness community-centered culture, and hear the stories of birth in that culture from those who witnessed it long before I was born. My great aunt told me about my grandfatherโs birth and how women of the community โ friends and family, all gathered togetherโฆ some to take care of the young children at another home, and others to support my great grandmother in labor until there was a need to call the doctor to the house. This wasnโt something that was heavily romanticized. In fact, at that time, it was practical support while poor rural farmers did the best they could with their lack of resources. It was necessity. Farmers were much more in tune with the cycles and laws of nature, and I love hearing this story over and over because it is the the last glimpse of rural American life I personally have before modern industrializationโs dramatic attempts to ruin family, farming, and childbirth reached my home in South Georgia. As an adult, my papaโs generation was deceived into moving over to hospital birth as the โnew, advanced, fancyโ experience that it wasnโt for the births of my mother and her siblings. He later marched on Washington with thousands of other farmers in the 70s to protest the damage the laws that promoted industrialized farming had done to his community and his multi-generational craft.
As doulas, it is extremely important for us to learn as much as possible about what brought us here today and why our profession exists โ especially because our existence is so controversial. Michel Odentโs book, The Farmer and the Obstetrician, offers a particularly fascinating observation of the industrialization of childbirth and farming side-by-side. All of Robbie Davis Floydโs work as a childbirth-focused medical anthropologist is highly recommended, especially the books Birth as an American Rite of Passage and Mainstreaming Midwives: The Politics of Change. The most easily digestible book Iโve found is Reclaiming Childbirth as a Rite of Passage by Rachel Reed, and if you donโt read anything else, please read this.
The rise of modern medicine and hospital birth shifted the focus of birth from emotional support to medical intervention and brought on a crisis that eventually led to the modern emergence of doulas. Many doula organizations teach that we should always submissively defer to the provider, while offering nothing but emotional support and basic physical support like hip squeezes and gentle massage. My doula training organization taught me nothing about hospital navigation or patient advocacy, and very little about holistic support. As a new doula, I remember expressing that I wanted to go deep in the preparation process with my clients and being told by the greater birth community that this was not only strange, but people didnโt want that type of support. My thought was that no one else was doing it โ there was a need, and it looks like many doulas like me moved forward with the same chargeโฆ We have since seen a dramatic shift in doula support from base level emotional, physical and educational support to deep emotional and physical preparation for a reason.
Due to the 40%+ maternity care provider shortage all providers are spread thin in the US. We all know the obstetric system of support rarely incorporates the relationship-focused midwifery model for many reasons, including the massive client loads that this fraudulent system has forced them into taking on in order to pay all the fees required for them to work within it (student loans, malpractice insurance, hospital fees, etcโฆ). In an attempt to be recognized and acknowledged professionally, midwifery has had an interesting evolution over the decades. It has slowly become more and more clinical as many midwives choose to become nothing more than transactional enforcers of state regulations rather than protectors of holistic birth preparation and autonomous, informed, deeply supported birth (read Robbieโs books to explore this evolution in depth). Entry level midwifery has been a battleground for far longer than Iโve been alive, and the fight over whether one needs deep indoctrination in the Western medical sciences in order to effectively support what is mostly a natural physiologic process is something I see midwives bickering over among themselves to this day. Midwives and doctors alike are overwhelmed with client loads and fear of non-compliance with the unrealistic standards that have been created by law men and hospital systems.
In recent years weโve seen a mass awakening surrounding the horrific birth practices in our country, and we are in the midst of an exodus from the system weโve chosen to birth in for all these decades. This has extended the nationwide crisis to out of hospital midwives, many of whom have been reactive to this intense influx of need within our communities. Many have begun taking on entirely too many clients for their small practices, limiting their support to a clinical focus, and inadvertently negating the community-focused relational support that is so integral to the midwifery model of care. This has rippled out and shifted the role of the doula in the entire prenatal and perinatal experience, expanding the role to fit the greater unmet needs of education and physical and emotional preparation for families moving through this massive paradigm shift. Small midwifery practices that have taken on too large of a client load are overwhelmed, burned out, and unable to meet their clientsโ non-emergent needs in pregnancy or in labor (and especially in postpartum). This has required doulas who are truly attempting to support their communities to educate themselves more deeply in order to fill the gap in these unmet needs.
Outside of these important factors, the most important thing we can consider when looking at the evolution of the need for doula work is the culture. Americanโs have been plagued with unhealthy ideologies in the past century. Our school systems were created alongside industrialization to create compliant workers. Weโve been systematically abused by the medical establishment over the past century. Having been indoctrinated from a very young age to be โgood and compliant,โ many have remained quiet in their trauma, or subscribed to the belief systems that birth strips us of our dignity. Birth has become a taboo topic, hidden behind the door of the hospital room. The concept of the Nuclear Family and modern technology have led us to become isolated and self protective, not wanting to be seen in our own areas of vulnerability. The events of 2020 led to further isolation and deterioration of our collective mental health.
Some say that the modern doula is an abomination. Itโs true that the modern doula profession stems from an unhealthy system and culture, and yes, any good doula should agree that our profession shouldnโt have to exist, but it does, and here we areโฆ I see so much romanticizing about โthe days of oldโ when women supported women and there was no need for doulas because everyone was deeply integrated into their communities. But our culture has shifted too much for the โoldโ model to work as it did. We are in a time where community is only seen as a luxury and a privilege for many people. Those who have not been raised within a connected community may have a difficult time finding a new one. We also live in households that require two or more incomes to survive in the current economy, or sacrifice that is more often than not only accessible to the privileged. Many are too exhausted to seek out community at the end of the day, and unless one is involved in a religious institution, community has more-often-than-not been diminished to the people we see throughout our day.
Even when we build strong communities and fortified relationships, those who are freshly aware of how best to support other women through this transition may not be able or willing to leave their young children. Those who are birthing in the hospital setting need much more than โjust a friend.โ They need someone who is skilled and educated in the subjects of body mechanics, trauma-informed support, and hospital navigation. Many who are birthing in the home setting donโt have access to a holistic practicing midwifery team and need very similar support.
I get pretty disgusted when I see people minimizing the role of doula to โa hired friend.โ Yes, the old โhold your hand and defer to the providerโ model of support definitely isโฆ but to say that all you need is a friend or neighbor in your birth space (when youโre working with clinical-only providers) is not only naive and overly-simplified, it is insulting to the profession. Many doulas put thousands of hours into holistic education so that we can understand the nuances of body mechanics, somatics, and the nervous systemโs functionality in the birth space. These subjects are rarely ever integrated into your providerโs practice, and they definitely arenโt taught these things unless they seek them out of interest. We arenโt stepping into a savior role โ any good doula is emphasizing the importance of community to our own nervous systems and our childrenโs neurodevelopment. We are encouraging our clients to grow their systems of support prenatally so they have a community to reach for in postpartum. Our profession is so much more more than a โpaid for friend,โ and when others choose to minimize our profession in this way, they are sorely missing the point and frankly, they have no idea what theyโre talking about. We are a RESOURCE, and if we do our work well, a web of never ending resources, because we never stop learning and connecting.
Itโs not like doulas arenโt trying to build communities. Nearly every active birth doula I know has tried to create parenting and mother-centered gatherings, both free and paid (because some of us have to pay bills), and since Iโve been a doula Iโve noticed fewer and fewer people showing up. People nowadays are more often looking for hybrid childbirth classes so they donโt have to drive across town, but are inadvertently missing out on the opportunity for community that comes from in-person gathering. This is part of the reason why I chose to study community-centered holistic midwifery. Iโve found a beautiful model to learn from with a functional community that expands from within the midwifery practice. Friendships ripple out from birth circles into an extended community of support that expands far beyond the birth and postpartum spaces. People show up willingly. We need midwives holding vulnerable space and creating communities on every corner. I want to learn the intricacies of the holistic craft of midwifery โ not just the clinical, body mechanics, somatic, or advocacy โ I want to learn the art of building community and extend this knowledge of birth and mothering to every woman who wants itโฆ and I truly believe that the doulas who are diving deep and learning things that have never been accessible to us in the past will one day become the holistic midwives that create the most incredible communities through their deep work.
I see a lot of judgment alongside very little action to bring actual change to our birth communities โ and I want to say this LOUDLY. If you truly feel so strongly about this profession not needing to exist, I invite you to dive into the trenches of this work with the rest of us who are actively working to bring positive change โ not just in the general community, but within the BIRTH community as well. And know that Iโm more than happy to chat and brainstorm with youโฆ Otherwise youโre wasting your energy behind the keyboard.
We no longer live in the time where community came together out of necessity to support birth. For many of us, especially the underprivileged, birth has moved out of the community and into the hospital. In order to bring back any semblance of what was, we need to work together proactively to bring a greater positive change, while also understanding that the professions surrounding birth are actively and dramatically shifting. Weโll never go back to the โolden daysโ and I guarantee you that if you could speak with someone from those times, it sure wasnโt as romantic as you have come to believe it isโฆ
I write this not only to set the record straight about the depths of my profession, but to bring encouragement. If we all actively work to build community (personally and professionally) and fortified relationships โ if every midwife works continuously to deepen their practice in a community-centered way โ imagine what our world could beโฆ This is so important to the health of our bodies, the development of our babies, and our culture, and it takes intentional work on the individualโs part to make it happen. We can shift what is and grow into what is possible. Unfortunately we canโt throw away the present to go back to the days of old, but we can intentionally shape our futures for our children and theirs, and there are so many beautiful possibilities.
Disclaimer: I want to be very clear that I am referencing a national crisis and the books that have studied and address it โ NOT this community specifically. We are blessed to be an oasis in a birth desert of the Southeast, and we are continuously learning and growing together to raise the standard. Birth is evolving and our birth community is evolving with it. ๐คโจ
๐ธ: A powerful woman in labor being supported by her husband, her extended family, and her skilled doula. Photo by Leslie Lowe at Green and Grey Photo
