Fighting for Birthing People in an Uncertain Future

We are living in a time when “a broad anti-sexual and reproductive rights agenda” is being implemented at the direction of a new administration. As daily damage unfolds, doulas and other advocates do what they can to support birthing people as a matrix of legislation threatens their well-being, and the rights of many are on the chopping block. The next four years—or more— require a concerted effort anchored in legacies of resistance, community care, and new technologies to support the most vulnerable through birth and beyond. 

A spectrum of potential impact.

Mainstream doula depictions take place in the delivery room. But the past and future impact of doulas and other birth workers has never been limited to a hospital. Imani Byers-Quarterman, a full-spectrum doula and licensed clinical social worker who specializes in perinatal mental health, says full-spectrum doulas provide culturally competent care for individuals through many moments, including fertility, birth, postpartum, and bereavement. 

She's mindful of the link between mental well-being and reproductive care, especially for Black birthing people. “We can’t discuss reproductive health without discussing mental health. The journey to parenthood is primarily mental. I tell my clients all the time that this journey is about 10% physical and 90% mental,” she says. “Having the skills to navigate through special circumstances and unplanned changes can make a huge difference with respect to recovery and future outcomes,” she says, noting the well-known reduction in birth trauma, unnecessary interventions, and cesareans for doula-accompanied births. (It is worth noting that we know this information in part through affiliation with the World Health Organization, from which the US is set to withdraw.) 

Many find their mental health disrupted or identities denied by the uncertainty of the moment making the importance of reproductive autonomy as important, if not more than ever. Larada Lee-Wallace, a community organizer, doula, reproductive justice practitioner, writer, and abortion storyteller, reiterates the emotional, physical, and logistical assistance doulas provide. But stigmatized forms of care, like abortion, are often overlooked despite clear parallels with other forms of birthwork. “Abortion care also emphasizes bodily autonomy, informed choice, and compassionate care. And ensuring that [clients] feel supported and respected in their decisions.”

Actions like the purge of content across federal health agencies of information related to abortion, HIV, and racial elements of the maternity crisis; among these shifts, executive orders addressing gender ideology codify the right to deny birthing people's preferred names and gender identity and increased concern about criminalization. Lee-Wallace says Trump 2.0 means even more criminalization, surveillance, and obstacles for people seeking abortion, especially Black, brown, low-income, and undocumented folks. “But the truth is, these institutions never really protected us. They’ve always prioritized control over care. That’s why abortion doulas are more critical than ever." 

"But the truth is, these institutions never really protected us. They’ve always prioritized control over care. That’s why abortion doulas are more critical than ever."

Nora Rasman, a Milwaukee-based organizer and birth worker with aspirations of pursuing midwifery, says much of doula work is accompaniment. This support is especially essential for trans, gender nonconforming, and others who do align with the dominant cis-gender, heterosexual, nuclear family depictions of family as many are witnessing their legal erasure overnight. Rasman notes this work requires mindfulness of how these barriers contribute to isolation. She encourages us to ask, “How do we create an infrastructure that combats the isolation people are already experiencing? “We know in this political moment it is only going to hasten and get worse,” she says. “So much of the grieving anxiety and actual terror people are living under right now is compounded by people being isolated."

Lee-Wallace says despite pushback, many doulas are actively working to challenge gender binaries and make their services more inclusive by recognizing that birth, abortion, and reproductive care are not limited to cisgender women by adopting the gender-affirming language, such as using terms like “birthing people” or “pregnant individuals,” and tailoring their support to the needs of queer, trans, and nonbinary clients. “For those in non-cis hetero family structures, doulas provide emotional and logistical guidance, helping people understand their options and access care in a system that often feels inaccessible or hostile,” she says.

Lee-Wallace says block access doesn’t prevent abortions but does make them less safe and more inaccessible, especially for those who already face structural barriers. Rasman echoes this, noting how new risks leave birthing people and birth workers vulnerable to criminalization. 

Still, Rasman notes the nature of our capitalist systems creates barriers to supporting others and places demands amid unpredictable and chaotic schedules and needs to support their own families and responsibilities.  

“With recent legislation seeking to remove protection of hospitals, schools, and faith spaces, more questions, like ‘what's the ethical responsibility of a medical provider around discretion and protection—are the rest of us willing to fight for them because, like we know that they're gonna be targeted.” She highlights the necessity of building data security awareness and practice to support the most vulnerable to criminalization, like immigrants, trans people, and individuals seeking abortion. She also highlights the importance of “building security practices in a way that strengthens us and brings us towards each other and doesn't further our isolation or our paranoia.” 

Solutions in Community

Rasman anticipates more doulas evaluating their relationship to the state. Lee Wallace knows that doulas across the spectrum of care have long found themselves doing just that. “We’re offering emotional and logistical support, but we are and always have been a part of a larger resistance. We will continue to build larger networks, expand mutual aid support, and make sure people have access to information and resources no matter what the law says,” says Lee-Wallace. “The state isn’t failing us it’s doing what it was designed to do, but we’ve never relied on the state to save us. We save each other. We take care of each other.”

"The state isn’t failing us it’s doing what it was designed to do, but we’ve never relied on the state to save us. We save each other. We take care of each other."

Lack of trust in the larger structure can conflict with calls to provide universal and widespread funding for doula care. Byers-Quarterman sees doulas being regulated more with the ability to accept insurance, namely Medicaid, in the future and notes the importance of a liveable wage. “No doula, whether new or seasoned in the State of Georgia, should be making less than $1700 per birth. We sacrifice a lot of time and energy to answer this calling and should not have to struggle to make ends meet because we're in a helping profession.”

Rasman notes that investing time in local funding and relationships might address some of these concerns. Lee-Wallance notes expanding access to care brings pros and cons, highlighting the Black and Indigenous roots of midwifery and doula support can conflict with the racially oppressive environment of the obstetric model. Advocates worry coverage requires adapting to this model when many intentionally seek midwives and doulas to distance themselves from institutionalized care. Still, many need support beyond the sliding scales many offer to afford services. 

Despite increases in home births to avoid bias in hospitals in Black families—a trend that isn’t frequently studied for queer birthing people but may look similar—the vast majority of births occur in hospitals and are influenced by medicalized perceptions of birth and dominant narratives on race, gender, and parenthood. Rasman notes there will be times when doulas have to advocate directly and adversarially to meet clients' demands. But there will also be scenarios where birthworks can employ skills in emotional intelligence and attunement to tap into networks of providers and community support that will affirm clients' full selves.

“There is having the humility to decenter your own ego as a birth worker that's required to factually be able to deeply hear the needs of the birthing person,” she says. “And that is rooted in a risk assessment that particularly transgender, nonconforming folks, Black and Indigenous folks have a depth of wisdom out of lived experience that can tell people what is like what is actually how we need to show up.”

Often, supporting clients requires developing roots and relationships that exist outside of larger structures with individuals who share labor and values. Rasman encourages these connections as tools to develop support that helps communities establish and maintain nourishing structures amid a harmful world. She uplifts skills, knowledge, and resource sharing to understand this constantly evolving landscape and the creation of co-ops and similar. Lee-Wallace notes the importance of collaboration and breaking down silos between different forms of care. “I definitely see people becoming more interested in showing up and how to do this work for people as pregnancy outcomes continue to be increasingly more criminalized, maternal mortality rates continue to stagger, and abortion continues to be more and more inaccessible across the country,” she says.  

"Doula's future is shaped by its past."

In many ways, doula's future is shaped by its past. Byers-Quarterman says doulas will continue to help “expand access to care by making themselves more known and more active in their community, sharing information” amid limited education and widespread mis and disinformation. “Supporting all family dynamics is an act of resistance to the current societal standards and supports equity in access to care.”