Published on January 12th, 2017 | by Jacqui Morton0
Radical Care for Pregnant People: Jacqui Morton Interviews THE DOULAS
Doula. Don’t you love this word? Its very presence has purpose. Doula is derived from ancient Greek. The core of its definition—a person who supports a mother in pregnancy, labor, and beyond—is a timeless role in our world. When people hear that I doula as a part-time job, they sometimes say, “Like a midwife?” No. We are not medical professionals. We are companions, cheerleaders, deep breathers, and story keepers.
Purple and yellow are my favorite colors, but its vibrant cover is not the only reason I was excited to hold Mary Mahoney and Lauren Mitchell’s beautiful book, The Doulas: Radical Care for Pregnant People, out now via Feminist Press. I was excited for the arrival of the first-to-my-knowledge book about the work of full-spectrum doulas, those of us committed to providing support for every pregnancy outcome, including abortion, miscarriage, stillbirth, and adoption.
I was grateful to find myself in the pages of The Doulas and to connect with Lauren and Mary via email. Their words, and the stories in the book, held me through the months I spent with them, and will stay with me. What follows is condensed version of our chat, which, perhaps fittingly, has been gestating a bit between our inboxes… – Jacqui Morton
MUTHA: I was excited to read about full-spectrum doula care. I am frustrated by the huge disconnect between birth and abortion care in our communities, because I feel a pregnant person should receive the same level of care whether they decide to have a baby or not. Do you think that if we can get past the politics of abortion, we could see more compassionate care?
LAUREN: We’ll start by saying that our place in doula work has been heavily informed by our activist politics. The entire spectrum of reproductive choices—whether it’s birth, abortion, adoption, miscarriage, or stillbirth—is fraught with politics, whether we like it or not. There are a lot of policies that are under way that emphasize fetal personhood, and these laws are used to create structures that will allow court-ordered c-sections, and can be used to criminalize pregnant people who have had miscarriages, among many other things. The politics of birth and abortion are linked: reproductive justice came into existence because it acknowledges the need for an intersectional approach to advocacy and care; one that takes into consideration how someone’s race, class, and gender/gender presentation might affect her access to care, and the decisions she will be able to make.
We both came from backgrounds that were organizing and policy based. We had a lot of ideas about how reproductive justice would fit in cleanly with the doula model of care, which centers on forms of quiet, compassionate activism that builds up from individual connections between clients and caregivers, rather than shaking things up and demanding change from the top down. When working one-on-one with a client, we rarely get into political discussions, and the ways in which we advocate are soft, quiet, patient.
But that doesn’t mean we’ve transcended politics. To the contrary, while our activism has taken on a different form, doula work can be thought of in terms of a politics of compassion, where the intersectional framework given to us by the founders of the Reproductive Justice movement is what leads our approach. Compassionate care needs to come from a space that meets people where they’re at, with humility and the willingness to offer a stranger abundant love.
MUTHA: I love this thing you refer to as “story-based care.” It makes sense that pregnant people should be able to turn to someone who understands all the stories that their body holds, in the moments when that matters most. Is this why the book is The Doulas, not The Doula Project? Was this a no brainer—to focus more on people vs the organization you built?
MARY: We chose the title The Doulas because we wanted to emphasize the many different ways there are of being a doula—birth, abortion, post-partum, etc.—and that one is not more important or purer than the other—we don’t need to separate them. We also want to constantly put that word out into the world so more people know what doulas are—where better than on the cover of a really loud, bright book? Maybe people will look at it and see that weird word and read the back (or buy it?!) and have a little bit of knowledge to take home. I just did a career day at the middle I work at in Brownsville and talked about doulas, and these kids were utterly captivated—now my nickname at the school is “doula” and I hear them talking about it and they come up and ask me questions. The more we put that word out there, the more interest we generate and the more access we can create for pregnant people to have doulas.
We wanted to focus on people, in addition to organization because it’s an entire movement we are trying to speak to, not just the Doula Project. With our “How To” sections, we interviewed people all over the country because we recognize that doula work can look really different depending on your geographic location. And it’s vital, challenging work no matter where or how you practice.
MUTHA: I love how vignettes are interspersed with the guidance. How did you determine which stories to share? How are people responding to their stories? Also I am impressed by the details recalled in these stories. It’s almost as if they were carefully preserved for this purpose. The book really beautifully captures many intimate moments between doulas and the people they are with.
MARY: The stories themselves happened somewhat organically. With a few exceptions, we didn’t know which way the oral histories would go or what the doulas would want to share. We chose an oral history format because we wanted things to be as open and respectful as possible for the people we were interviewing. The details came through sensory activities we asked them to do during the interview. And many of the doulas told the most transformative stories of their careers or lives so the details were deeply ingrained in their memories—we just helped bring them out into the light.
We were intentional about the doulas we selected to be part of the book. We wanted a diversity of experiences and personal backgrounds and seasoned doulas who had seen a lot. Kat’s was the first oral history I did, and it really helped shape the book for me and guide direction. And I would just sob transcribing and thinking about her and how incredible she is. And then you have Kira, who, literally everything she said was a beautiful soundbite and I had to force myself to stop doing large chunk quotes in her chapter. Or Symone, who did one of the hardest things, which was talk about working with a difficult client.
They shared their souls and then it became our responsibility to tell their story in the most meaningful, respectful way. And while we were writing this book, these doulas were always in our heads. Always. I said to them, “you think no one thinks about you more than your mom, but you’re wrong, we do.” Probably to a creepy level! We wanted to invite them into the editing process, and Ann Fessler, who helped advise us on how to collect oral histories, recommended reading aloud to the interviewee. And so the most terrifying and beautiful part of the book-writing process became meeting with each doula and reading their chapter out loud to them. I cry just thinking about it! In a way, you can’t get more intimate with a person—that exchange requires so much love and trust. I mean, they allowed us to write their stories. I still can’t believe it. Lauren and I constantly say to each other, how are we going to get through this book tour without buckets of our own tears?
MUTHA: In the book you also talk about your work with stillbirth inductions & adoption plans. The two differ but seem spiritually similar, and it seems we don’t talk about either enough. I know it’s hard to guide someone without being present, but… Can you talk about what families might want to ask for if they are facing either of these outcomes? What if they don’t have access to a doula?
LAUREN: This answer shifts a lot depending on whether we’re talking about stillbirth or supporting people who have made adoption plans, but if families are moving through either of these processes without a doula, the best suggestion we can offer is to find someone in the institution where you’re going—whether it’s a hospital, birth center, adoption agency, law firm, wherever—who will take the time to spell out as much information as you need. We know that this is easier said than done, but we often suggest that people take as much time as they can with their decisions—though often there isn’t a lot of time to waste—if it means that they can move forward confidently.
For the book, we did an oral history one of our former clients, Kiya, who discussed the hazards of trying to make an adoption plan on her own; the couple was friends with her high-school guidance counselor. In her seventh month of pregnancy, they old her that they had already gotten another baby lined up. They agreed to adopt her child as long as she would agree to a completely closed adoption and they could raise both babies “as twins.” She realized that to them, it didn’t matter who she was—they just wanted a baby. And, navigating the situation on her own meant that she was pretty powerless: she had no money, no lawyer to advocate for her and to tell her about her rights. The adoptive parents had a disproportionate amount of control.
Many of our clients who chose adoption were very alone in the process, save for their social workers and their doulas, and having the support of a fantastic adoption agency helped them understand their rights. Having some kind of external support from an organization or lawyer is crucial for birth parents; laws vary state-by-state, and it’s really important to have someone available who can talk through all of the nuances, in addition to providing therapeutic support if the birth parent wants it. We would encourage any potential birth parent in search of an adoption agency to look for somewhere that emphasizes open adoption—meaning that the birth parents have access to their child, and vice versa. What those relationships look like, specifically, will vary, but a good adoption agency will help mediate those terms.
Stillbirth inductions are more straightforward in the sense that most hospital (or birth center) staff will have some knowledge about what to do—the process is a lot more medically standard. When we’ve attended stillbirths, we find that although we offer a lot of physical support, a lot of our job is being a continuous, loving, normalizing presence.
MUTHA: What would you say to someone supporting a mother through stillbirth?
LAUREN: Stillbirths are brutal; often-induced labors, with contractions that are long, hard and painful, and the process can take way longer than a typical birth.
Remain focused on the needs of the mother, who is not only going through a deep emotional grief, but also an intense physical process. Offering her steady, strong, unflinching support is crucial—let her cry on your shoulder if she needs to, give her space to be angry, don’t be alarmed if she is completely numb. Whatever she is feeling, make room for it. When she walks away from the experience, her body will still be reeling from the birth process, and so offering physical presence and comfort, like meals, massages, and running errands, will be helpful. Offer your presence without demand; write letters without the expectation that she will answer them. If she wants to talk about it, remind her that she is no less a mother for having experienced a loss; remind her that there is nothing wrong with her; remind her that being a parent can come in many different forms.
MUTHA: How do you tend to your own souls through such experiences?
LAUREN: The connections we’ve made with our clients is rare and beautiful—many doulas will agree with this. Often doulas will have a high ceiling of tolerance for enduring grief, and a higher-than-average capacity for care. But, it’s hard; we’re human. We could say all of the basic things—that after stillbirths or adoption births we tried to be kind to ourselves, and develop a “self care” practice, but the reality is it’s more complicated than that. It can be a slow-burning fire that turns into a form of “provider trauma” if you’re not careful.
In part—and this is represented in the book, too—part of tending to our own souls is letting ourselves burn out a little and taking a step back. A lot of doulas take time away, even when they consider it a calling. A lot of people think of burning out as an ending point, but as we tried to show in the book, it can actually be a cyclical process. You’re stopping to replenish, so you can come back stronger, and more loving to yourself as well as your clients.
Part of it also means seeking or creating a community of doulas or caregivers who are willing to go into these difficult emotional spaces with you. We’ve been super-grateful for the doulas in The Doula Project who we are so, so lucky to have as friends. It’s a small army of some of the most compassionate and loving people we know. There’s a lot of mutual support within the organization.
Realistically, this work can be hard—and not always appropriate—to talk about with friends, family, or partners. In addition to being mindful of our client’s confidentiality… well. People often just don’t want to hear about stillbirths and adoptions over the dinner table. Not everyone has signed up for this work. Many doulas have an important community surrounding them and supporting them in the work they do, whether by being able to bear witness to our stories, and at times, our trauma, or being available to care for us in more intuitive, or basic ways: calling to check in is a huge kindness.
MUTHA: So, when I am working as a doula in addition to my other responsibilities, it’s a lot to juggle. I am sure you get this. Do you have tips for newer doulas that are kind of juggling multiple “jobs”? I know this sort of gets into burnout and self-care, but really how do you stay rooted in your own real life?
MARY: We talk about this A LOT in the book because most full-spectrum doulas face this challenge. I think for both me and Lauren, we were just so driven and inspired to make this happen. You have to want to do it so badly, you have to really really love it. And that will take you far because then it’s authentic and it becomes part of your real life, you don’t have to separate. Is that sustainable? For me, yes and no. I burned through that way with the The Doula Project for four or five years, and then I discovered some other things I was interested in, like mental health and social work, and wanted to go deeper with that, so I transitioned out of such a huge role with the DP. But 10 years later at the age of 35, I think I am probably working as hard and juggling as many things as I was when we started the DP, my inspiration has just shifted a bit. I’m all about following what inspires me, first and foremost. If that’s not there, I won’t make it far.
Speaking to self-care, for me it’s never been a list of activities I do or this really conscious “tonight is self-care night.” It’s a continuous process of self-awareness and reality-checking. Annie talks about it beautifully in a chapter in our book. My best advice is know your limits, know when it’s time to give a little more or a little less, and, most importantly, surround yourself with people who get that and support that way of doing the work. I was so lucky because when we started the DP, I had a boss, Aimee Thorne-Thomsen, who was 100% supportive and would just be like “do what you need to do.” She knew the work at my day job would get done and, I think in her mind, what Lauren and I were doing was bigger than making sure I sat at my desk 8 hours a day. I recognize I was in a very very unique position, and I owe a lot of my early efforts with the Doula Project to having that supportive person who started every conversation with “how are YOU doing?”
Lauren found herself in a good spot too because the clinic where we were doulas hired her full time, so she could juggle more Doula Project work directly on site and didn’t have to separate it out quite so much. Were we tired all the time? God, yes. But we were in our 20s and only had to worry about ourselves, we didn’t have kids or other major family situations pulling at us, we both had lower-middle class backgrounds and education privilege. You always have to take those factors into account before you can go too deeply into any advice on self-care. We’re capable of different things at different points in our lives. I’m about to have a baby and I’ve started saying “no” more than I ever have before…and it’s both uncomfortable and liberating. At the end of the day, no matter how low Lauren and I would get—and it did happen—we were pretty fearless and incredibly patient. We were able to see the long-term vision of the work and knew people would eventually come around to it.
MUTHA: The world doesn’t look as we planned for it, when we first scheduled this interview before the election. I am nervous, as a doula, as a parent, and as a woman. And I did make an appointment for an IUD. I’ve been thinking about it for a couple of years anyway, and because I live in Massachusetts I know I’ll be able to access care, but still, I did sort of think “maybe I better get this reproductive health stuff done now!” What are your post-election thoughts?
MARY: We are feeling very stricken like many others in the country right now. We have a unique opportunity with the release of the book and our book tour, to go into communities, both pro-choice and anti-choice, that are struggling and to listen and discuss plans of action to help support those who will be most affected by the new administration. Outside of that, all the doulas in the Project remain dedicated to being a listening ear and a loving presence to all the pregnant people they encounter.
MUTHA: What is the most important thing that you’ve learned from your work and founding the Doula Project?
MARY: The first and most obvious that the emotional labor of doula work will change you in ways you won’t be able to anticipate. In her interview for the book, the doulas talk about their work—our work—as a kind of ethical calling. It’s not work for money, but it’s looking to our ability to hold physical and complex emotional spaces. Kat Broadway says that after working with the Doula Project, being a doula is core part of her identity. She will always be a doula. Even when we step back from the work itself, we’re still always doulas. It becomes an embedded part of who you are, no matter where you go.
We’ve learned that being a good activist doesn’t necessarily make you a good doula. Doula work can be a form of activism—at least, we certainly think it is in the Doula Project’s model—but it is a very different set of skills. Political advocacy and organizing thinks about the macro-level pieces that will hopefully obtain collective liberation and justice. There isn’t a lot of room for the messiness of individual narratives when shit needs to get done, when mobilization needs to happen. Direct care is the opposite. You get down low in the nuances of someone’s story, and you stay there. Often, no one has any idea about the work you do, and that’s okay because that’s not why you’re there. You come home tired and exhilarated in equal proportion. Political rhetoric can seem painful and alienating compared to the vulnerabilities of the people you take care of, and you yourself.
Doula care has also offered us the rare opportunity to let go of skepticism toward other people. Our job is to offer compassionate care to everyone who reaches out to us. That doesn’t mean we’ll necessarily always like our clients—people are people, some aren’t nice—but we at least get to begin from a loving space that gives the benefit of the doubt. That’s what makes it all worth it.
There are a lot of other more logistical lessons, too, including “learning where to stand during an abortion procedure” and “how to make small talk” and “how to rub someone’s lower back during contractions.” Also, “how to get dozens of volunteers through cumbersome clinic volunteer processes” and “how to swallow your ego in front of clinic bureaucrats so your program doesn’t get shut down.”
MUTHA: Wow. Thank you. I think it’s really important to make space for the difficult stuff in our lives, and yet it’s so hard. On that topic of self-care, here’s my last important question: What’s your favorite ice cream flavor? (Mine is Oreo though I feel I should have a more exciting favorite.)
Lauren: Good question. I’m a fan of flavors that involve cookie dough, and peanut butter.
Mary: I can’t lie—my favorite is Oreo, too! This may give away my Indiana upbringing, but is there anything better than an Oreo Blizzard from Dairy Queen?
Let’s pause here where we can all soak in this lesson from The Doulas, shall we? Be a listening ear and a loving presence to all people we encounter. Maybe this book is really for everyone.
Thank you, Lauren and Mary!