Читать книгу The Doulas - Mary Mahoney - Страница 8
ОглавлениеIntroduction
In October of 2008 the Doula Project—then known as the Abortion Doula Project—held its very first volunteer training. Our mission was to educate a new generation of doulas on a burgeoning model of care: support during abortions.
As far as we knew, this was the first training of its kind; we were starting from scratch. Roughly a dozen trainees joined us that weekend. We made a motley crew: fellow reproductive justice activists, academics, close friends—all of various races, classes, sexual orientations, and gender identities.
The two of us had been attending abortions for only a few months and knew we had a lot to learn, so we invited experts in our field to lead us through workshops that covered topics like diversity awareness and physical and emotional support techniques. Halfway through our last session of the day, the trainer we’d hired, a respected abortion counselor and birth doula, made a startling announcement.
“There are lots of different ways to be doulas, I suppose,” she told the assembled group. “My husband is a great parallel parking doula,” she laughed gently. “But you will have to decide as a group whether or not you think it’s appropriate to call yourselves doulas. I’m not sure it is. Just think about all the things that doulas do.” She lowered her light voice slightly and tipped her chin down, very seriously. “You’re not really doulas.”
The confused trainees shifted uncomfortably in their seats as her words cut through the room. They looked to us, question marks in their eyes.
We swept in quickly, “Yes, we do all of the things that doulas do,” we assured them, glancing at each other with a cringe. “Yes we are—we are doulas!”
We were stunned. We were horrified. We were pissed. We invite her into our home, and she says this?
The trainer left shortly after. “What the fuck was that?” someone called out.
“We are doulas; this is what we are. It’s not a discussion,” we repeated clumsily. Everyone nodded in agreement, unsure what to say next.
As our anger faded, it occurred to us that this trainer didn’t automatically “get” what we were trying to do. Insult aside, her statement raised some important questions of mission and identity for us, ones we would be tasked with answering for years to come: What are we? Where do we belong? What do we want to become?
The Doula Project has always been an organization on the fringe. Since our inception we have struggled to figure out where exactly we “fit.” Are we a healthcare organization? Political advocates? Do we all identify as feminists? Where do we place ourselves in birthing justice? How do we participate in both macro-level activism and individual direct care at once? How can we be taken seriously when we operate under a radical leadership structure and are run by unpaid volunteers? What the hell are doulas anyway?
Let’s start with the easiest question. “Doula” finds its roots in the Greek word for “female slave,” an unfortunate denotation that has morphed over the years into the less embattled “woman who serves.” It’s a word that has slowly made its way into the zeitgeist. Over time its meaning has changed and expanded to include service to women, men, transgender and gender nonconforming people, those giving birth, those having abortions, and those dying.
In the mid-twentieth century, doulas were reinvented to attend to pregnant people in the months leading up to their birth, during the birth itself, and in the days and weeks that followed the birth. They were the nonmedical caregivers in the room, the ones who would give you a massage, introduce you to a new labor position, help you take that next deep breath, offer encouragement to avoid the epidural, and listen while you emotionally processed your experience after the delivery.
In the past decade, the rise of the “abortion doula” has brought a dynamic change to the job description. These doulas took the same model of continuous, nonjudgmental support that birth doulas had become known for and moved it into the abortion clinic. In doing so, an entire population of people who had previously gone without support became recipients of a dedicated, caring presence.
Following quickly on the heels of the abortion doula came the “full-spectrum doula,” a term we coined to describe a person who supports a pregnancy no matter the outcome—whether it is birth, abortion, miscarriage, or fetal anomaly. This brand of doula care typically consists of physical, emotional, educational, and spiritual support and almost always involves being present during an abortion or birth. Many full-spectrum doulas approach the work, not only from a stance of individual care and respect, but also from a deeper political conviction that anyone who becomes pregnant deserves bodily autonomy, meaningful support, and full access to quality health services. The Doula Project would come to identify as a full-spectrum organization and help define this term and its role within reproductive justice.
As legions of people around the country became interested in the work of the Doula Project, and in becoming doulas themselves, we began to ask why. What we found was a new movement in feminist activism. Young people were increasingly connecting to reproductive rights through direct service work, not just policy-advocacy methods. New pro-choice organizations and collectives were extending beyond traditional feminist advocacy groups like NARAL and NOW. Groups like Social Workers for Reproductive Justice, Nursing Students for Choice, and Medical Students for Choice, among others, were making strides to unite micro direct-care programs with macro policy initiatives.
Direct service workers have often been left on the outskirts of advocacy and social-change movements—not for lack of purpose or importance—but because they do not have a vehicle through which to channel their activism into a greater political movement. This new generation of abortion activists and service professionals was thirsty for the kind of work that could bridge the gap between local social service and broad-based social change. Full-spectrum doulas started to fill this gap; to many, the simple act of literally standing with someone during their abortion felt like a powerful political statement.
As we further investigated the sudden surge of full-spectrum doulas, we also found a group of young people longing for human connection. While much feminist and social-justice activism was taking place online, the doula movement allowed activists to connect face-to-face with people confronting the realities of what the “spectrum of choice” really means. The doula movement could be seen as a counterpoint to the online activist movement—a way to physically connect in a world that is increasingly reliant on virtual connection.
The human connection most doulas seek, however, comes with a price—being exposed to the underbelly of what pregnancy and reproductive healthcare truly look like in this country. Pregnancy, and the decision to become a parent or not, are realities that most families will confront. Yet for some people—particularly low-income people and people of color—these experiences are often silenced. Worse still, they suffer the loss of personal agency as decisions that should be private become politically and bureaucratically charged. In the current sociopolitical landscape—which features oppressive new state laws around abortion instituted by antichoice governors, high rates of cesarean sections and maternal mortality, and prohibitive healthcare costs—doulas are providing crucial support to pregnant clients and medical staff alike. Furthermore, we help give voice to the experiences of pregnant people that may otherwise go unheard.
Because of our unique hands-on relationship with healthcare institutions, full-spectrum doulas have an opportunity to challenge dominant medical and social paradigms. Ours is a quiet brand of activism: an advocacy of compassion, a watchful eye over the medical industrial complex. Most of the Doula Project doulas come to this role from the perspective of activists, both in the clients they seek to serve and in their capacity as unpaid volunteers. People frequently refer to us as “advocates.” While we would not argue that point, we hope this book will show you how advocacy as a doula looks different from advocacy in other realms.
Often it simply means this: we are “holders.” We hold space by creating safe, comfortable environments where our clients can be heard. We physically hold our clients through supportive and nurturing touch. We hold stories and experiences and reflect them back to our clients to help shape a memory that is meaningful. We hold abundant love for our clients and each other in times of crisis and in times of joy, even when we are little more than familiar strangers.
Telling Our Story
Our practice as doulas is a daily expression of the union between compassion and advocacy. Our story, shaped by our position as founders of the first full-spectrum doula organization and by years of experience in clinics, is both harrowing and beautiful. It is tinged with as many moments of social justice acumen as important lessons about life and love, all set within a medical framework that can feel both archaic and chaotic.
Above all, when we speak of our work, it is our stories of providing care that move and inspire people. We realize that people are drawn to personal narratives, and we recognize that these narratives are crucial to our ability to create awareness around this work and wider access to doula care. Robert Coles, author of The Call of Stories, writes, “Stories are renderings of life; they cannot only keep us company, but admonish us, point us in new directions, or give us the courage to stay a given course.” Our stories as doulas are a window that most people don’t have—stories that can give a glimpse into realities many cannot otherwise articulate, or choose to ignore, or have been too busy to notice.
Our book is a narrative about doulas and miscarriage, stillbirth, adoption, and abortion. The chapters that follow give voice to the kind of pregnancy that people don’t want to talk about, the kind that is considered painful, shameful, and complicated—and, therefore, is silenced. From KCl (potassium chloride) injections in the twenty-fourth week to court-ordered C-sections in the forty-fifth hour, from tears of grief to joyful relief at the end of a first trimester abortion, it is through personal narrative that these experiences are humanized.
Though understanding systemic oppression is crucial to the way we approach doula care, we believe that individual stories have the ability to pierce the veil covering systems that affect millions of people; they are unique but universal. We recognize that in telling the stories of our doulas, we are also telling the stories of our clients. The nature of our role means that our stories have become intertwined. As we wrote this book, we had hoped to reach each of the clients in these stories so that we could include their perspectives on the experience. When we had no way to find some of them, we struggled with including them in the book. While it’s common for direct-care professionals to incorporate “case studies” into their writing and change identifying information, this practice made us uneasy.
Ultimately we consulted with trusted colleagues in the field—particularly those who have experience helping others tell their abortion stories—about how to navigate our concerns. Reproductive justice advocate and writer Renee Bracey Sherman, author of Saying Abortion Aloud, a guide to abortion storytelling and supporting storytellers, says:
Sharing stories, especially abortion stories, can be an ethical gray area. Doulas want to and should be able to share their experiences of supporting people through their abortions. It’s powerful to hear firsthand how to show up for someone else with compassion. However we must remember to put the needs of the patients first—we must prioritize their confidentiality, rights, and desire to share their own story on their own terms. But stories build community and alleviate isolation. That’s how they serve the movement—by reminding people that they are not alone.
Storytelling, we learned, has an adhesive quality; as we share our stories, we move beyond a partnership between doulas and their clients and start to include everyone. Doulas do not approach their role in isolation. An entire lifetime has inspired us to become caregivers. When we do this work, we think about our families, our friends, the people we love. For clients, it is often the same. Melissa Madera, former full-spectrum doula and founder of The Abortion Diary Podcast, reminds us that the ethics and anxieties of storytelling reach clients, too—because telling a story means your narrative is documented as a kind of truth. As people describe their own experiences with abortion during Madera’s interviews, they raise concerns about talking about their loved ones. They frequently ask her, “Do you think it’s okay?”
When writing this book, with a few exceptions for which we received consent, we’ve intentionally made the dominant story and point of view that of the doula. Why is it important that we tell the stories of doulas? Because doulas are caregivers, and caregiving takes a toll. Stories from the caregiver perspective are often left out of conversations; we are supporting actors to the client’s leading role. When we sign on to be caregivers, we are giving up a part of our identities for the sake of another person. Our work means that we are engaged in a deep intimacy with other people daily—the grief and joy of our clients, the doctors we work with, and each other.
As we were collecting oral histories, we realized that people rarely, if ever, have the opportunity to share their stories. The process became mutually therapeutic: we were given the privilege of listening and holding the stories for those who spoke, and in turn they often felt emotional release in letting their stories go. When we spoke with Madera about this, she articulated the symbolic gesture that happens in these exchanges, “You release the story to me, you create space for relief, and I take the story away with me, and in that way I become a part of the story, too.”
So much of doula work is that transference of story and the transference of emotional burden that goes with it. Physician David Grimes has written at length about the emotional transference exchanged between patient and provider during abortion. According to Grimes, in the act of providing the abortion, the provider accepts and takes away the patient’s emotional burden. This book represents a narrative version of that exchange—doing doula work all day, every day, means that we become filled with stories. At the end of the day, we do not just bear witness to someone else’s story, we become a part of that story and that story becomes a part of us. We try to receive emotional burden for as long as we can, but the relief of that burden comes with our own sharing. It’s cyclical. We found that writing this book became more than a process to document our stories—it was accidentally therapeutic. Ultimately, writing and listening to these stories and to one another gave us a new space to give and receive compassionate care.
How to Read This Book
Our hope is to bring readers into the world of care where we exist. We want to engage you with the narratives of our beginnings, our moments of greatest success, and the places where we’ve learned our most valuable lessons. To do this, we have woven together our own narratives as the Doula Project founders with those of other doulas, former clients, medical providers, and allies.
In order to gather the stories of those who have helped shape the organization, we conducted dozens of interviews. Many were done in the tradition of “oral histories.” A few of these oral histories would become the basis for entire chapters in the book. For these histories, we spent time gathering intimate details and engaging the storytellers in sensory exercises to craft a rich and accurate narrative. We then read the text aloud with them, inviting them into the editing process. We have used first-person narrative, third-person narrative, and direct quotations to write this book—following the style of creative nonfiction, a genre that merges literary elements with factual, biographical information.
We have changed the names of some of our clients, allies, and partner organizations, as well as certain locations where stories take place. We’ve also changed the names of most of our clinic sites to protect the availability of their services. (When it comes to abortion care, fame rarely brings anything good.)
We believe you will get the most out of the book by reading it in order from front to back. Descriptions of medical procedures and interventions, laws and policies, and introductions to recurring doulas are sequenced in this manner. Should you need this book as a reference guide, however, we have also created multiple sections with different topics so that you can easily flip to what interests you most—doulas supporting other doulas, birth stories, or direct-care activism, for example. In every section, multiple themes are covered, ranging from adoption politics to ambivalent feelings about abortion to provider burnout and more.
This book is the creative memoir of an organization—a story of what it means to be a doula, a story about giving love and getting it back through this rare, uniquely beautiful exchange. At its core, it’s a story about humans trying to take care of each other in a world where that often gets lost. Those who have ever cared for anyone will relate.
