Doula Support During Childbirth: Genesis, Discourses, and Practices of Emotional and Physical Non-Medical Care

Abstract

The article regards the practice of paid emotional, informational and physical assistance to women during pregnancy, childbirth and the postpartum period, as well as the Russian-speaking providers of these services: perinatal experts independent of obstetric institutions, self-presenting themselves mainly as «professional», «partum», or «postpartum» doulas. Using a neo-Weberian approach to (para)medical knowledge, jobs, and professions, the author illustrates influence of the state and market on the spread of non-medical emotional and physical care practices in the modern Russian maternity hospital.

Despite the informal status of non-medical assistants and the associated risks, the educational and digital activism of the doula network leads to the construction of special competence, standards, ethics, and language, but also to an increase in the number of «certified» doulas. Labor and educational mobility, family and digital everyday life of care agents with no official status involved in precarious and paid maternal self-employment also contribute to autonomous self-regulation of the community, reception and standardization of approaches, reassembling the boundaries of activity, local volunteering and popularization/broadcasting of doula discourse.

The phenomena described in the article contribute to an accelerated change in the entire medical landscape, biomedical knowledge and discourse towards further humanization (mainly commercial) of modern obstetrics. In particular, the author records the emergence of patient-centered communication, informed coordination of medical interventions, partial demedicalization, taking into account evidence-based medicine data in new protocols and routine practices, expanding the agency of women in labor when choosing participants, place, and method of delivery.

The research is based on a communicative analysis of discourses and narratives that have been collected since 2017 in the field ethnographic study of perinatal practices and their representations in various contexts and sources. The database includes semi-structured in-depth interviews, information from social networks and media resources, and regulations.