Doulas For The State: Intimate Labor On The Margins Of Welfare

Abstract

This dissertation is the principal product of my five-year qualitative research study of a New York City (NYC) birth-support program, which I call “Lean on Me.” Housed in the Department of Health (DOH), Lean on Me uses federal funding to provide free doula, or birth-coach, support to pregnant-people who live in the NYC neighborhoods with the highest rates of maternal and infant mortality. Lean on Me is both a response to NYC’s broken social safety net and exists because of the neoliberal rollback of welfare provision. Today’s welfare landscape is overwhelmingly represented by non-governmental organizations (NGOs) delivering state services such as job training, housing assistance, and food pantries. In contrast, Lean on Me is unique. Not only does the program strive to deliver woman-centered and culturally-sensitive maternal care, Lean on Me is also not contracted out at the level of the organization. Instead, the doulas themselves are the contract workers, granting them liminal status that makes the doulas both vulnerable workers and gives them a significant degree of freedom in their interactions with clients. Even as agents for the state, the doulas push ferociously against the city’s incursion. Ironically, their liminal status and relative autonomy allows them to forgo the city’s monitoring and operate largely on their own. Lean on Me was founded as a city initiative to mitigate the alarming racial disparity in maternal mortality and morbidity in NYC. Investigating these disparities as effects of what Dána-Ain Davis calls “obstetric racism,” my analysis of 101 birth narratives shows how the collusion between the punitive state and the hospital creates a medical environment where physicians use threats of law enforcement and child protective services to control and intimidate laboring-people of color (see Chapter 3). The Lean on Me doulas attempt to alleviate this abuse by arming clients with tools to push back against hospital practice in their 8-week childbirth education series. Based on my two-month ethnography of the birth-education series and interviews with participants, I demonstrate how the class operates as more than a simple birth education. This series teaches “birth self-defense” to clients and explicitly calls out practitioners and hospitals for racist medical care (see Chapter 4). Finally, using my analysis of 24 interviews with the doulas, two-years of participant observation of the monthly meetings, and content-analysis of all public material, I explore how Lean on Me employs intimate labor for the city to bridge the gap between the medical and personal realms (see Chapter 5). My dissertation research contributes to theoretical discussions on the nature of “obstetric racism” and “obstetric violence,” state control and discipline, and the possibilities of reproductive justice and “radical care.” Within an otherwise austere and disciplinary welfare landscape, Lean on Me allows space for the doulas to actively cultivate an alternative birthing atmosphere. The doulas’ alternative culture values compassionate care to support each birthing-person in achieving the most positive birth experience possible, within a system that otherwise devalues her bodily autonomy and humanity. My research is unique in its focus on a public doula initiative, enabling an analysis of how obstetric racism intersects with state discipline, and examining whether radical care can impact change within municipal initiatives. As progressive politicians amplify the call for public doula funding it is critical to show how public doulas actually do their work, and to question whether radical birth services are possible as a provision of a state which prioritizes criminalization over care.