A Philosophy of Care and Justice: Honoring the Many Labors of Full Spectrum Doulas

Before becoming one, the first time I’d heard the word “doula,” or read about them in print, I was in a political philosophy course taught by the political philosopher and feminist theorist Serene Khader. We were reading the work of Eva Kittay who, in that particular article, argues that in order for a society to be just and fair, there must be a fundamental, underlying ethos of care that accounts for dependency relations: relationships defined by caregiving in which one person is or becomes dependent on another’s labors. She continues by stating that society must also ensure that people who enter dependency relations are able to survive and thrive. While explaining her argument, she offers the example of a post-partum doula to illustrate how dependency relations work while also highlighting the special needs required of people in vulnerable states.

Kittay then advocates for “the extension of the notion of the service performed by the doula” which she refers to as doulia: “just as we have required care to survive and thrive, so we need to provide conditions that provide others—including those who do the work of caring—they receive the care they need to survive and thrive.” In short, Kittay is arguing that caregivers be guaranteed a living wage to do the work that they do. Not only because the work of caregiving is important but also because it could lead to a paradigm shift in the way that society views caregiving.

What is a Doula?

When most people think of doulas they immediately think of childbirth. That is most likely because birth doulas are arguably the most popular and talked about type of doula in mainstream media. But what do doulas really do? They are professionals who offer emotional, physical, and educational support to their clients while also helping to foster an environment of empowerment and safety. Sometimes they serve as an advocate for their client, amongst other things, depending on what the doula and client agree upon with respect to the client’s wishes and doula’s capacities.

Outside of birthing spaces, doulas can also offer support to people seeking abortions, coping with infant loss, transitioning to post-partum life, grieving, or who are nearing the end of their life. There is even a growing community of doulas who support trans people through their journeys.

Benefits of a Doula

The benefits of having a doula during transitional and/or vulnerable life phases are well-documented by countless sources. According to studies, doulas can help improve birth outcomes and lead to more positive childbirth experiences. Further, the American Pregnancy Association states that have a “doula as a member of the birth team decreases the overall cesarean rate by 50 percent, the length of labor by 25 percent, the use of oxytocin by 40 percent, and requests for an epidural by 60 percent.”

When it comes to end of life doulas, in 2018 the National Hospice and Palliative Care Organization formed a council devoted to informing the public about their importance, explaining that they offer “non-medical, holistic support and comfort to dying people and their families.

Full Spectrum Care

Organizations like the Doula Project, an NYC non-profit that trains doulas and partners with clinics and hospitals to make doulas more accessible to the community, helped to redefine the concept of a doula by educating others about the importance of full-spectrum doula work. They provide “free compassionate care and emotional, physical, and informational support to people across the spectrum of pregnancy” and are committed to pregnant people within a framework of choice and healthy decision making.

Similar organizations across the country also seek to help people feel supported and empowered during transitional and vulnerable life phases while also addressing health disparities that are negatively and disproportionately impacting the Black community and other communities of color.

Infant and Maternal Health Disparities

While doulas are caregivers to more than pregnant people, they also offer services to communities who are facing a growing health crisis. We’ve seen many examples of the ways in which doulas, particularly Black doulas, are addressing health disparities in childbirth and the post-partum period that are deeply impacting Black women and birthing people. Alarming rates of maternal and infant deaths in Black communities are resulting in rising rates of doulas who seek to prevent these tragedies. In some states, there is even a push for legislation that would ensure that doulas are better compensated for their necessary and important work while also ensuring that pregnant people in underserved and underfunded communities have the option of a doula.

This is important because these initiatives help to change the narrative about doulas by highlighting that doulas aren’t just for wealthy, white, “crunchy” moms. In fact, they should be an option for everyone, pregnant or otherwise, who needs support and care during vulnerable and transitional life phases.

Everyone Deserves A Doula and Every Doula Deserves a Living Wage

When Eva Kittay argued for the right for caregivers, and the cared for, to have the conditions of possibility necessary to survive and thrive she was raising an important point. Not only is it important to establish an ethos of care that underlies all of our conversations about justice, but it’s also necessary if we want to ensure that caregivers and people in dependency relations can survive and thrive. Doulas, in particular, offer care and support to people going through different difficult experiences and, for the sake of the caregiver and the person being cared for, their jobs and emotional labor should be respected and available to people who need it.

Featured image by Jesús & Gaby Repilloso

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