Paid labor: Labor support doulas and the institutional control of birth

This dissertation explores the emergence of labor support doulas as an occupational group and the implications of the rise of the doula for women, families, and the American birth system, more generally. A labor doula provides emotional, social, and physical support to women throughout labor and childbirth, but performs no clinical tasks. Many women come to doula work following their own dissatisfying births, with the hopes of preparing women for better experiences. With support as their primary goal, doulas often find themselves reconciling competing personal and professional ideologies. Doulas formulate and implement a range of practice strategies in the birthplace, intended to placate medical caregivers, hospital administrators, and their private clients. Two phases of in-depth interviews were conducted with 30 doulas in two geographic regions. Data were collected over two years and approximately half of the respondents participated in follow-up interviews, providing information on individuals\u27 longer-term commitments to providing doula care. I investigate how doulas come to this work and how they craft occupational strategies; the development of credentialism and certification programs for doulas; how doulas approach advocacy in their everyday work; the proliferation of hospital-based doula programs; and the extent to which doulas identify, both personally and professionally, with feminism and political action. I argue that doulas are humanist caregivers who represent the bridge between the obstetric and midwifery models of care. Doulas perceive themselves as messengers—rather than as agents—of social change. Hence, their strategies for practice tend to be more hands-off than proactive. That is, doulas tend to adopt a particular brand of advocacy that places the doula as a silent partner with her client. Institutional standards of behavior and normative power structures shape doulas\u27 professional practices. I argue that the choice to adopt mainstream approaches and to shy away from advocacy has dual implications. On the one hand, doulas will likely become accepted more widely and the profession will grow. On the other hand, this approach—working from within, rather than challenging from without—will further enable the system of American birth that many label as backwards and counter to women\u27s best interests