Doula Right Thing: Subversion Through Subservience, A Conversation With a Young Feminist Birth Assistant, Leda Ward

Photo: Natural Pregnancy Mentor

By EMMA DORSEY

April 5, 2011

It is likely that you were once a baby.  You may someday be a mother. Yet, how often do you think about birth? If you’re like me, you gathered from health class that birth is a bloodier, more painful version of a GYN exam + baby.  But a movement is rising that rejects this view of birth as pathology and insists on the importance of another kind of birth for public health and women’s empowerment.  This movement has roots in the natural childbirth movement of the 70’s, but with a new emphasis on a care giver called a doula.

“Doula” translates roughly to “female slave,” (many birth assistants focused on racial justice resist the word for this reason) and her role is to honor, inform, and empower mothers.  Ironically, this subservience works to subvert the paradigm that insists doctors, not mothers, should direct birth.

Many studies and even more anecdotes show that hospital protocol for birth can be physically and psychologically harmful to women: induction is becoming routine; contractions are “augmented,” often painfully, to speed up birth; and roughly one third of births end in major abdominal surgery.  With childbirth seen as medicine, it has become the domain of doctors– occurring on their schedules and according to their insurance policies and expertise– the treatment of sickness.

Next to debates about work/life balance, childcare, and the right to choose, many feminists forget about birth or place it squarely in the realm of medicine, rather than justice.  But doula work is gaining traction as a kind of “care as activism” feminist movement, popularized by women like Miriam Perez, blogger at radicaldoula.com, who recently gave an address at Yale.

Recently, I had the opportunity to sit down with a young, radical doula named Leda Ward for an invigorating conversation about politics, power, and lady-parts.  She laid it out for me: “If a woman chooses to give birth in a hospital, she is not only emotionally vulnerable because of all the hormones that are going through her body, but she is indoctrinated into a system where she is not wearing her own clothes, she’s hooked up to these machines, someone is inserting their fingers into her vagina every hour and a half, her body is totally a tool for that institution.  And if you have on top of that your care provider disrespecting you and not honoring the power that you’re capable of, it’s a shit show.”

Clean and smiley, sipping carrot juice in a cafe full of hungover hipsters, Leda doesn’t look much like a bra burner.  She shies away from terms like “activist,” and “radical,” joking, “a feminist can use a power drill and I can’t.”  But underneath her humility, Leda is a pretty righteous babe and birth activist. Your first clue is the confidence that stems from the practicality of her work– doulas have been proven to shorten births and increase satisfaction with birth experiences.  Leda is one of the 7,000 doulas certified by the biggest doula organization in the US– Doula Organization of North America (DONA).  While there is some kickback against what can be seen as an attempt to standardize and professionalize a practice that is, by definition, unique to each individual.  Leda explains, “I’m just the type of person that likes to have everything official.” This penchant for uprightness seemed to be a theme as we spoke.

In a generation of social justice activists that flock to microfinancing faster than hippie communes, efficacy is privileged above (and sometimes posed as oppositional to) flair.  The political expression of our generation seeks to change the world without rocking the boat.  Call it crazy, call it lazy, the fact is that feminists today are far more likely to work within the system.  While Jennifer Block, author of Pushed: The Painful Truth About Childbirth and Modern Maternity Care, notes that doulas have a “demedicalizing, decomodifying effect on birth,” she also points out a common critique, that a doula is “an enabler,” and that “by buffering the level of intervention, they are perpetuating the very system that they are in the business of changing.”

I asked Leda if she believed that there was a space in the hospital for empowering women.  “It’s hard.  It’s really hard because the system is not equipped for that.  The culture is assuming that any moment the birth could derail and become a disaster.  Anything outside of [protocol] is up for lawsuit.  Even if you have an exceptional provider, even if you have a midwife in the hospital, they are still constrained by the administration, by the attending physician, and by the nursing team.”

Leda’s job is to be supportive, even of births that are not aligned with her knowledge of the dangers of excessive interventions.  She reflects that “difficult births” are not necessarily those that end in intervention or even those that are unusually exhausting for the mother.  She explains, “A woman can go through a really rough time with her body where things are not working the way she wants them to work, but that can still be a really sweet birth. It’s how she’s being treated that makes a birth difficult for me to witness.  I’ve been to births where the doctor just really abused the woman. I come away from that feeling like I’ve witnessed injustice.”

Hospital births can follow a relatively predictable script.  Leda explains, “When a new nurse or a resident doctor comes on duty and it’s time to check you, they come into the room and they don’t even look at you and they say [monotone] ‘Hello, my name is Nurse So-and-So and I’m here to take care of you what’s goin’ on….’ and they go to the computer without even looking at you.  I know that they’re saying this to some 30 women a day who come into the hospital but I have to wonder why they can’t look her in the eye and shake her hand.  I’ve had so many situations where we’re doing the nesting thing, the lights are dim, there’s lavender and all that stuff and they just barge in like the town crier.”

While some women turn to birthing centers, and others choose home birth, most births take place in hospitals.  Financial constraints mean hospital birth is the only option for some women, as they are the only births covered by many insurance plans (including most Medicaid plans).  Leda works for a program called “By My Side Doula Support,” where Healthy Start Brooklyn funds doula support for laboring women that qualify by income level and zip code.  She finds that socio-economic status can greatly influence the care a woman receives in the hospital: “The women who have private insurance and are paying the hospital a nice sum of money are treated better.  Usually with the women that I work with through Healthy Start Brooklyn, the lack of eye contact never ends.  What boggles my mind is when you have a resident who hardly acknowledges a woman and then does a vaginal check.  How could you not look a woman in the eye and then put your hand in her vagina and make a judgment?  I mean, it’s not just that you’re invading her body.  It’s that you’re doing that and then making a judgment about whether or not her body is doing something right, or whether or not she’s progressing.  It’s an invasion of her most sacred body part, her womanhood.”  In fact, many people are calling this phenomenon “birth rape.”  Women, especially those who are survivors of sexual assault, should never have to fear such trauma.  Birth should be a time where women are discovering the immense power of their bodies, not having their power taken away.

Still, Leda’s favorite birth occurred in a hospital.  She was working with a mom who came to her through Healthy Start.  Leda gushes that her OB/GYN had “beautiful bedside manner,” which was especially important considering that she was pregnant with twins.  Most health care providers don’t consider vaginal birth an option for multiples, and they are often born by scheduled c-section.  Leda had some serious concerns about being able to achieve the natural birth that the mother had wanted. “It’s unheard of to have a vaginal twin delivery,” she explains. “It’s unheard of.  By her whole profile, you’d think ‘They’re just going to cut her open at the first chance of anything because they can and they don’t think that she’ll say anything otherwise.’  But this woman was hip.”  Not only did she achieve a healthy vaginal twin birth, her second baby was footling breech– another no-man’s land for most physicians.  Leda says, “I was high for days from that birth.”

I asked how her work with birth has intersected with queer issues.  “I did some postpartum work for a queer couple.  It was really great and no different from straight couples.”  She chuckled, “In fact, it was absolutely the same!  The biological mother was worried about breastfeeding, was exhausted beyond belief.  Her partner was trying to figure out how to change a diaper and was like ‘is this normal?  Is the baby jaundiced?’” Yet, a doula can be even more important for queer couples navigating institutional prejudice during birth.

Increasingly, doulas are focusing on non-traditional pregnancy work, including adoption and abortion.  Leda works with one so-called “full spectrum” doula project called, quite simply, The Doula Project.  She sees the overlap between birth and abortion doula work as self-apparent: “They are both about supporting a woman during an emotional time in her life when she has the right to unbiased emotional support.  Both are woman-centered.  At a birth, I am not worried about what the fetal heart rate is doing.  I’m worried about how she’s managing the pain, how confident she feels, how scared she feels… I’m worried about her. ”  In the care of pregnant women and the nation’s abortion debate, Leda laments that “the focus is on the fetus and not on the mothers.”  And what is a doula’s job but to work against this tide?

The caricature of a feminist usually involves rabble rousing, not massage.  The doula model is, in some ways, an expression of politics as nurture.  I asked Leda if she believed that care could be radical in a feminist context.  She replied with characteristic humility, “I need to think about this more,” noting that her thoughts had evolved: “When I first started out, I thought of the work as really radical, but what I have experienced is that it is not. When I think of radicalism, I think of the ability to make extreme change.  But doulas are really powerless.  I used to tell women that I could advocate for them in the delivery room but I can’t.  Even if I tried, who am I?  I’m a doula.  First of all, no one cares.  I’m not related to the mother and I have no say.  Second of all, I’m going to get someone pissed off at me and then at the mom for bringing me with her.  Instead, what I say is, ‘I can help you advocate for yourself.  I can tell you some things that you can say.’  I don’t really think that my work is radical because I can’t advocate.  I don’t really think of the abortion work as radical either. Maybe it’s radical in the sense that I’m bridging the gap between the anti-choice and the pro-choice.”

But perhaps subservience can be as radical as advocacy.  A doula’s job is to listen to a woman, acknowledge her needs and desires, and believe in her ability to accomplish one of the most difficult tasks a human can face.  Could this work be as important as demonstrations and legislation?  Who are we asking?

Leda does the right thing.  She graduated Summa Cum Laude from Barnard.  She wears a neat haircut, has a bright and healthy look, smiles, and aspires to work (at least for awhile) as a stay-at-home mother.  She seems kind and above all things trustworthy.  But her amenability is a tool with which she does radical work to empower pregnant women.

Emma Dorsey, Barnard ‘10, is a repro­duc­tive jus­tice activist.  She is a con­tribut­ing writer for Broad Recognition.

This article will be reprinted as part of the upcoming show, “i am not a good enough feminist” at Concrete Utopia, a Brooklyn project space.