Book Review: Doulas and Intimate Labour: Boundaries, Bodies, and Birth

Doulas and Intimate Labour: Boundaries, Bodies, and Birth. Angela N. Casteneda and Julie Johnson Searcy, eds., Bradford: Ontario: Demeter Press, 2015, 252 pp.

Doula care is a sexy topic. Not a week goes by that some sort of media outlet, from National Public Radio to the New York Times, isn’t publishing something about doulas. Doulas have been around for centuries, but in the United States this descriptive word and accompanying profession was adopted in the 1980s.

While a growing body of scientific literature about doulas does exist, including within the social sciences, until now there hasn’t been enough written about the embodied work of being a doula and the tensions and boundaries in the multiplicity of relationships that doulas must navigate. This volume fills that hole, with chapters written mostly by doulas (but researchers and midwives too) who have walked the liminal space between expecting and beginning in a whole host of different contexts including birth, death, and more. Utilizing the medical literature as a springboard, the chapters explore the role of the doula more in depth to discover what it is like to be a doula and how doulas look at the world.

The chapters approach doulas from a reflexive view, with most of the authors trained as doulas, as well as through their experience-near ethnographic research. The overarching purpose of the book is to not only promote doula work in multiple different contexts and to prove its worth, but also to locate the doula’s place within the larger framework of reproduction and birth. Doulas are trained professionals who are neither medical professional nor patient within these settings. Doulas walk the line between the medical and the midwifery care models and bring their own unique viewpoints to every situation that they enter and help their clients navigate.

Angela N. Casteneda and Julie Johnson Searcy are both trained doulas whose research interests include reproduction, birth, and culture. They have assembled a nicely laid-out body of work including well-known scholars such as Robbie Davis-Floyd and Christine Morton and newcomers to the field. This volume greatly expands the scholarly dialogue about doulas, most notably from the doula perspective that most of the authors bring to their work and it works through the many different issues that doulas encounter while doing it.

The chapters span several different writing styles, from personal reflection to scientific research. They have two primary strengths: emic experience-near ethnography and placing the doula in ethnographic context. Through the three sections of the book detailing doulas and mothers, their communities, and institutions the authors trek through the territory of doula approaches and analysis of these approaches. These approaches are outlined neatly in Chapter 14 by Courtney Everson and Melissa Cheyney, who utilize the phrases of liminality and mandorla spaces, the meeting space of two juxtaposed ideas, to explain the positionality of a doula as bridging this overlapping space between the medical and midwifery model of care. This is an excellent metaphor for understanding the role of the doula within the hospital setting, especially as doulas hold the space for instigating social change at the individual, institutional, and societal levels.

The chapters invite the reader into the mind of the doula, asking questions such as: Where exactly are the boundaries of doula work in such an intimate setting as the birth of a new family? How do doulas navigate the relationships within the hospital setting with nurses, doctors, and midwives? What role do doulas play in the remaking of the rhetoric surrounding birth and the birthing body?

The strength of these chapters comes not from explanation but from reflection. Several of the authors take the time to reflect on their personal roles as doula, and the topic of wearing multiple hats comes to the fore several times. The doula’s role is not a simple one, as evidenced by the oft-debated scope of practice, and these reflective chapters help elucidate the unpacking and leaving behind of other roles in order to become a better doula for the client they are serving. This is not an easy task by any stretch of the imagination, but it places doula work in the center of the discussion of navigating roles, especially within a medical setting.

The only thing really missing is a frank discussion about the culture of doulas and the controversies that exist within it, which could be a fruitful avenue for further research. The concepts of doula services for every woman who wants one versus doulas as a luxury service only for those who can afford their prime fees is certainly a debate worthy of some ethical and scientific scholarship. Detailed in Chapter 1 by Megan Davidson, it is easy to see the effect that doulas have on birth outcomes for both mother and baby, but the debate rages on within the doula community about who actually deserves this kind of support. This issue needs to be explored.

This volume is a valuable contribution to our understanding of the role of the doula in the context of reproductive care and beyond. Starting with putting doulas in historical perspective, this book explores the influence of doulas on individual health and birth outcomes, reproductive knowledge production, and the applications of anthropological (and other disciplinary) theories to health-related practice. The chapters place doulas at the center of the discussion of the medical model of birth and all the encompassing issues that surround it. The book could easily be used in the medical anthropology classroom when discussing agency, reproduction, and community health care workers, and would be most appropriate for a more in-depth look at these topics.

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