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The Labor of Labour Support: How Doulas Negotiate Care Work


Doulas are specialized caregivers who provide emotional support, information, comfort measures, and advocacy to women during their childbearing year, with a focus of continuous companionship during labour and delivery. This dissertation is a sociological study of the emergence of birth doulas as an occupation seeking legitimacy within maternity care. Findings are drawn from in-depth, semi-structured interviews conducted with twenty birth doulas from the same Midwestern metropolitan area in 2012-2013. Doulas in this sample, both volunteer and paid, ranged in certification status, birth experiences, and encounters with medical staff. An interview was also conducted in 2011 with two key informants from the largest doula membership organization.

This study addresses a gap in the literature on professionalization to account for the expanding doula occupation seeking legitimacy. The findings demonstrate many ideological tensions and paradoxes of how doulas strive to establish themselves as professionals. I find that the demands of professionalization may contradict the very essence of doula work. This creates tension between pursuing legitimacy while still desiring autonomy and self-regulation. Another paradox is how doulas need support in order to give support. Inadequate theories of worker emotion management provide an opening to discuss doulas' needs for peer support. I find that although doula work is mostly solo and isolating, there persists a strong need for collegiality. Doulas especially find benefits to debriefing with other doulas or birth workers when they are no longer with a client. I expand Goffman's concept of teammates, who co-operate on stage in performance and gossip back stage, to include doulas need for such support when they are not working in order to be successful caregivers.

Clinical research has found the presence of a doula is associated with more positive birth experiences and outcomes. However, very little is known about which types of social support that doulas provide contributes to improving health outcomes. I analyzed a sample of 198 clients who received one of 85 volunteer doulas in 2005-2007. I ran logistic regression to demonstrate that when volunteer doulas of similar training provide massage and visualization/relaxation, women have a significantly lower risk of having an unexpected c-section.

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