Constrained Care: Doula Practice and Hospital Birth

Doulas offer emotional, physical, and informational support to women during pregnancy, childbirth, and the early postpartum period. Their model of practice is based on providing continuity of care and helping clients feel well supported regardless of how their birth proceeds. In hospitals, these efforts are complicated by doulas’ lack of formal status in the health care system and by the medical model of birth, which views childbirth as a clinical event rather than one that requires support and encouragement. Presently, little is known about how these “complications” shape doulas’ work in hospitals. As more women train and practice as doulas, it is critical to understand the nature of their working conditions and their capacity to deliver their ideal model of care. I asked: How do doulas accomplish their work in hospitals? To explore this question, I conducted interviews with 26 doulas working in Toronto, Canada. I invited participants to describe the work involved in providing client support, their interactions with hospital staff, the overall demands of their role, and their level of satisfaction with doula practice. My analysis brought together data about the particularities of doulas’ work practices with feminist critiques of medicalized childbirth and the gendered organization of care work. I found that doulas’ position in hospitals created several challenges. Many participants reported an inability to perform their ideal model of care without tiptoeing around staff, a need to show deference to medical authority and appear as if they were not challenging the medical model of birth (even if that was their aim), and an implicit obligation to perform work outside of their scope of practice to assist busy nurses and ensure that their clients received adequate care. These demands were in addition to the considerable challenge of providing women with comfort and support during childbirth – a task that required a great deal of emotional labour – and the commitment involved in providing continuity of care. My findings suggest that the current model of doula practice is unsustainable and the challenges doulas face in hospitals highlight broader deficiencies in the organization and delivery of maternity care.Ph.D.2021-11-30 00:00:0