“There are lots of different ways to be doulas, I suppose,” she told the assembled group. “My husband is a great parallel parking doula,” she laughed gently. “But you will have to decide as a group whether or not you think it’s appropriate to call yourselves doulas. I’m not sure it is. Just think about all the things that doulas do.” She lowered her light voice slightly and tipped her chin down, very seriously. “You’re not really doulas.”
The confused trainees shifted uncomfortably in their seats as her words cut through the room. They looked to us, question marks in their eyes.
We swept in quickly, “Yes, we do all of the things that doulas do,” we assured them, glancing at each other with a cringe. “Yes we are—we are doulas!”
We were stunned. We were horrified. We were pissed. We invite her into our home, and she says this?
The trainer left shortly after. “What the fuck was that?” someone called out.
“We are doulas; this is what we are. It’s not a discussion,” we repeated clumsily. Everyone nodded in agreement, unsure what to say next.
As our anger faded, it occurred to us that this trainer didn’t automatically “get” what we were trying to do. Insult aside, her statement raised some important questions of mission and identity for us, ones we would be tasked with answering for years to come: What are we? Where do we belong? What do we want to become?
The Doula Project has always been an organization on the fringe. Since our inception we have struggled to figure out where exactly we “fit.” Are we a healthcare organization? Political advocates? Do we all identify as feminists? Where do we place ourselves in birthing justice? How do we participate in both macro-level activism and individual direct care at once? How can we be taken seriously when we operate under a radical leadership structure and are run by unpaid volunteers? What the hell are doulas anyway?
Let’s start with the easiest question. “Doula” finds its roots in the Greek word for “female slave,” an unfortunate denotation that has morphed over the years into the less embattled “woman who serves.” It’s a word that has slowly made its way into the zeitgeist. Over time its meaning has changed and expanded to include service to women, men, transgender and gender nonconforming people, those giving birth, those having abortions, and those dying.
In the mid-twentieth century, doulas were reinvented to attend to pregnant people in the months leading up to their birth, during the birth itself, and in the days and weeks that followed the birth. They were the nonmedical caregivers in the room, the ones who would give you a massage, introduce you to a new labor position, help you take that next deep breath, offer encouragement to avoid the epidural, and listen while you emotionally processed your experience after the delivery.
In the past decade, the rise of the “abortion doula” has brought a dynamic change to the job description. These doulas took the same model of continuous, nonjudgmental support that birth doulas had become known for and moved it into the abortion clinic. In doing so, an entire population of people who had previously gone without support became recipients of a dedicated, caring presence.
Following quickly on the heels of the abortion doula came the “full-spectrum doula,” a term we coined to describe a person who supports a pregnancy no matter the outcome—whether it is birth, abortion, miscarriage, or fetal anomaly. This brand of doula care typically consists of physical, emotional, educational, and spiritual support and almost always involves being present during an abortion or birth. Many full-spectrum doulas approach the work, not only from a stance of individual care and respect, but also from a deeper political conviction that anyone who becomes pregnant deserves bodily autonomy, meaningful support, and full access to quality health services. The Doula Project would come to identify as a full-spectrum organization and help define this term and its role within reproductive justice.
As legions of people around the country became interested in the work of the Doula Project, and in becoming doulas themselves, we began to ask why. What we found was a new movement in feminist activism. Young people were increasingly connecting to reproductive rights through direct service work, not just policy-advocacy methods. New pro-choice organizations and collectives were extending beyond traditional feminist advocacy groups like NARAL and NOW. Groups like Social Workers for Reproductive Justice, Nursing Students for Choice, and Medical Students for Choice, among others, were making strides to unite micro direct-care programs with macro policy initiatives.
Direct service workers have often been left on the outskirts of advocacy and social-change movements—not for lack of purpose or importance—but because they do not have a vehicle through which to channel their activism into a greater political movement. This new generation of abortion activists and service professionals was thirsty for the kind of work that could bridge the gap between local social service and broad-based social change. Full-spectrum doulas started to fill this gap; to many, the simple act of literally standing with someone during their abortion felt like a powerful political statement.
As we further investigated the sudden surge of full-spectrum doulas, we also found a group of young people longing for human connection. While much feminist and social-justice activism was taking place online, the doula movement allowed activists to connect face-to-face with people confronting the realities of what the “spectrum of choice” really means. The doula movement could be seen as a counterpoint to the online activist movement—a way to physically connect in a world that is increasingly reliant on virtual connection.
The human connection most doulas seek, however, comes with a price—being exposed to the underbelly of what pregnancy and reproductive healthcare truly look like in this country. Pregnancy, and the decision to become a parent or not, are realities that most families will confront. Yet for some people—particularly low-income people and people of color—these experiences are often silenced. Worse still, they suffer the loss of personal agency as decisions that should be private become politically and bureaucratically charged. In the current sociopolitical landscape—which features oppressive new state laws around abortion instituted by antichoice governors, high rates of cesarean sections and maternal mortality, and prohibitive healthcare costs—doulas are providing crucial support to pregnant clients and medical staff alike. Furthermore, we help give voice to the experiences of pregnant people that may otherwise go unheard.
Because of our unique hands-on relationship with healthcare institutions, full-spectrum doulas have an opportunity to challenge dominant medical and social paradigms. Ours is a quiet brand of activism: an advocacy of compassion, a watchful eye over the medical industrial complex. Most of the Doula Project doulas come to this role from the perspective of activists, both in the clients they seek to serve and in their capacity as unpaid volunteers. People frequently refer to us as “advocates.” While we would not argue that point, we hope this book will show you how advocacy as a doula looks different from advocacy in other realms.
Often it simply means this: we are “holders.” We hold space by creating safe, comfortable environments where our clients can be heard. We physically hold our clients through supportive and nurturing touch. We hold stories and experiences and reflect them back to our clients to help shape a memory that is meaningful. We hold abundant love for our clients and each other in times of crisis and in times of joy, even when we are little more than familiar strangers.
Telling Our Story
Our practice as doulas is a daily expression of the union between compassion and advocacy. Our story, shaped by our position as founders of the first full-spectrum doula organization and by years of experience in clinics, is both harrowing and beautiful. It is tinged with as many moments of social justice acumen as important lessons about life and love, all set within a medical framework that can feel both archaic and chaotic.
Above all, when we speak of our work, it is our stories of providing care that move