Supporting Her Journey: A Full-Spectrum Doula’s Look at the Politics of Motherhood


This commentary is part of a Mama’s Day series by Strong Families, published in partnership with RH Reality Check in our Mother’s Day 2011 series.  Follow Strong Families on Facebook and Twitter.  See all articles in this series here.

Motherhood isn’t exactly what comes to mind when many folks hear the term “reproductive rights.”  Even in our own movement, we sometimes forget that the right to become a mother (and to do so on one’s own terms) is inseparably tied to what it means to be pro-choice.

Of course, I’m part of a community that focuses on it plenty: as a doula, I accompany expectant mamas and their partners during labor, childbirth, and the immediate postpartum period.  Not being a mother myself, what led me to pursue doula work was my background as a reproductive rights activist.  However, like many of my pro-choice sisters, it wasn’t something I immediately equated reproductive rights with, either. 

To be sure, the rights of childbearing women are not as publically threatened as they are for those seeking abortions.  By which I mean, the limitations on the right to be a mother don’t have their own rallies and pickets; no, these are contained, politically, within the crowds of protesters expressing their opposition to health care access, inside Congress’ bargaining sessions, and in state and local governments that restrict access to certain facets of reproductive events, from contraception to laws about where women can and cannot give birth. 

I think the pro-choice movement and the birthing community alike are waking up to the fact that abortion rights and the rights of childbearing women are inextricably linked.  There is something to be said, too, for the fact that 42% of women seeking abortions live below the poverty line.  While this most certainly indicates that living below the poverty line puts one at greater risk of unintended pregnancy, it also means that financial instability – and not a woman’s autonomous choice – plays a major role in the decision to terminate a pregnancy.  That’s the point here… it’s a question of autonomy.

Granted, many women will give birth simply because they cannot afford an abortion.  Let me rephrase that… many women will want an abortion, but restrictions on state funding for the procedure make that option impossible.  My first doula client comes to mind.  She was a young woman who already had a three-year-old daughter.  She confided in me that she had wanted an abortion early on, but that she was now committed to raising her new baby with fervent devotion.  Because our state restricts the funding of abortion, she was receiving public assistance for (very limited) prenatal care and would be able to procure additional help once the baby was born, at least for a little while.  At least until her safety net ran out.

While her story brings to light the many intersections of abortion, motherhood, race, class, and gender, what sticks with me most was the way she was treated in the hospital.  Though I would not see the full difference until I later attended a birth with a thirty-something married woman with private insurance.  There was something about the fact that my first mama was on public assistance that seemed to radiate in the room.  As in, the caregivers had somehow paid for her care, so why should she have any say in what goes on?  It was heartbreaking to witness, and even more heartbreaking to realize that her situation was the reason for the way they treated her.

Even for white, middle-class women, the path to motherhood is often fraught with restrictions and guilt.  Anyone who has experienced childbirth in this country is acutely aware of this fact.  While the US spends more per birth than any other industrialized nation, we continue to see an appalling rise in maternal and infant mortality rates. Routine interventions (IV fluids, artificial rupture of membranes, artificial induction/augmentation of labor, epidurals) create a cascade of interventions and often lead to cesarean birth.  Far from being a minor surgery, cesarean birth rates in the United States are now above 30%, over twice the percentage recommended by the World Health Organization.  This procedure is linked with more postpartum complications, longer recovery periods, a later establishment of breastfeeding, and heightened risk of infection.  And through it all, the midwifery model of care (known to decrease rates of unnecessary intervention and boost positive birth outcomes) continues to be demonized or completely criminalized. 

Of course, these restrictions and complications are compounded when issues of race, class, documentation status, and gender identity come into play.  The midwifery model of care rarely qualifies for Medicaid reimbursement, leaving a large percentage of lower-income mamas at the mercy of a highly medicalized obstetric model.  Pregnant folks who do not conform to the gender binary continue to face discrimination in their most private moments.  Pregnant women who use street drugs are faced with discrimination, criminalization, and punishment instead of receiving the treatment support that they need and deserve.  And undocumented women continue to be denied life-saving medical care during their pregnancies and birthing experiences,      

If my experiences in the personal, the political, and the vast intersections of the two have taught me anything, it’s that sex, abortion, adoption, birth, miscarriage, etc all exist within a continuum, and while few women will experience the whole spectrum, many will experience a handful.  There is no singular reproductive experience, and so we as advocates for reproductive rights cannot afford to ignore any of them. 

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  • lgm

    Oh wow, please forgive my unfortunate misspelling of the word “publicly” here!  i was at a birth late the night before this was due in, and for some very strange reason Microsoft Word failed to alert me to the error!