Where Somebody Says Doula, We Say "Auntie"

Tracing the Black & Indigenous Roots of Doula Work

Midwives meeting at local church. (The Caroline H. Benoist Collection)

It’s nearly impossible to discuss solutions for the maternal health crisis— one that leaves Black and Native women 3 - 4 times more likely to die in childbirth— without hearing the word “doula," a birth worker who nurtures birthing people as they navigate pregnancy and postpartum. Advocates like Ericka Dorsey, a doula, maternal and infant health consultant, and Co-Founder of Flourishing Families, Inc., affirm doulas as frontline support to ensure birthing people have agency and autonomy in their birth. She says doulas represent a “Sankofa”—a principle from the Akan people of Ghana reminding us, if necessary, you should go back "to retrieve" and get what you forgot to move forward—toward traditional pregnancy, birth, and community-based mothering customs. However, whitewashings of history mean birthwork–and doula history–are often hidden in plain sight.

Despite moments of overlap, Dorsey asks folks to understand that doulas and midwives aren’t the same. ”They both have a significant piece in the fabric of who we are as African Americans,” she says. "It's okay and good that they're different—there's a symbiotic relationship between doulas and midwives that we want to keep without diminishing the role of each.”

"Where somebody else says doula, We say auntie, grandma, sister, friend."

Modern interpretations of “doula" emerged in the 1970s as a nonmedical support person. But its precolonial history lies in the Greek word “doule,” which designates indentured servitude and occasionally enslavement. Dana Raphael, the anthropologist credited with modern use of the term, did so without concern for its oppressive origins. Some might say this context-free reframe connects to the Western practice of repackaging traditional Black, Indigenous, and other communal cultures without giving credit or access to the communities they came from.

Brandy Bishop, the CEO of the National Black Doula Association and a birth worker for 13 years, says there’s a misconception that “doula” is a new role. She notes much of doula history was solidified during slavery.

“They were there to ensure the next generations of life continued,” she says. “You see that continuing today, but definitely starting way back when we were in the throes of slavery.”

Historical records, like those within The Lowcountry Digital History Initiative, a digital public history project hosted by the Lowcountry Digital Library, highlight the importance of words like "granny," "aunt," and "sister" in demonstrating the significance of “fictive kin"— nonbiological networks among enslaved communities. It notes these women actively provided information for navigating the reproductive spectrum, including sexual abuse, fertility control and termination, and navigating pregnancy and childbirth. "Enslaved mothers in particular often relied on other women to care for their children while they worked for enslavers or performed family chores, especially those who were single parents or who had abroad marriages."

For Dorsey,  the support role one occupies is more important than the name: “Where somebody else says doula, We say auntie, grandma, sister, friend,” she says. “It was just the folks sitting there saying, Come on, baby, go. You're almost there.” This encouragement continued in labor and navigating mothering.

“Her water broke, she went into labor, and there was no hospital to go to.” 

Firsthand freedman accounts, like Ryer Emmanuel's, who was interviewed with the Federal Writers' Project in 1937, describe an old woman who would watch and feed the plantation children while the younger women worked from sunrise to sundown. 

“Yes’um, dey would carry us dere when de women would be gwine to work. Be dere fore sunrise. Would give us three meals a day cause de old women always five us supper fore us mammy come out de fields dat evenin.”

Like the original Greek doulas, these women likely had little agency in this role. Still, their care work provided essential support and stability for the mothers and children on the plantation. The existence of these caretakers reveal enslavers knew the importance of childcare, even as they prevented their mothers from providing it. 

Pānquetzani, a traditional herbalist, healer, birth keeper, and author of Thriving Postpartum: Embracing the Indigenous Wisdom of la Cuarentena, says that, long before the word doula was used, Indigenous birthing and childrearing customs had always been intergenerational and communal. 

“If someone gave birth, the older women who've already given birth support this person and guide them through various rights of passage so that they could have a smooth postpartum,” she explains. 

She notes that during “La Cuarentena,” a 40-day right of passage, those who gave birth received regular postpartum support and the opportunity to receive knowledge on birth and care work from older generations. 

“This is how they learned how it feels and what it looks like to birth to be pregnant and postpartum. This is how the younger folks in the family and community learned what it was like to body feed to recover and how to treat babies.” 

Both Black and Indigenous communities experienced familial deconstruction and few places to receive medical care that emphasized the importance of communal support from the 1800s to the early 20th century. Granny midwives were essential, even post-emancipation, as Black communities transitioned from slavery to sharecropping. Loved ones supported this process as well. 

If one focuses on modern birthwork titles, it’s easy to miss the forced fluidity required in Black communities. Yolande-Clark Jackson learned her mother, Mamie Clark, now 83 years old, had to help deliver her sister because there was no access to doctors or hospitals in rural Tunica, Mississippi. “When she was fourteen, she was tasked with delivering her youngest sister because the midwife didn’t arrive in time,” she explained “Her water broke, she went into labor, and there was no hospital to go to.” 

"You can't have a better future when you don't address the past,"

Dorsey highlights how institutionalizing birth care was weaponized against practitioners of color. The Sheppard–Towner Act of 1921 obliterated midwifery, especially in Black communities. Still, care work continues. Despite gaps in records, elders reveal the collective responsibility of birth, even when involuntary. A barrage of legislation—including but not limited to the Indian Removal Act, The Dawes Act, the Civilization Fund Act, and The Code of Indian Offenses—displaced Native communities from homelands, prohibiting cultural practices, and obliterating their birthing customs.

These early experiences contributed to what Bishop calls “the shuffling through,” Black, brown, and Indigenous people's experience in a medical system without ever being asked about their needs or preferences. Certainly, this includes the mass sterilization of Native and Black women during the early 20th century. “We just kind of shuffled around, as if we can't think for ourselves. So that we don't know our bodies well enough, we have to be told what to do,” she says, noting clients are surprised when she asks what they wantt from their birth. By introducing “choice, education, and being there to support the physical tasks of labor,” doula interrupt this "shuffling through."

Dorsey likens the work to “promotoras,” Latin American and Mexican community health workers who served as patient advocates, educators, mentors, and more since the 1960s. “Doulas are like our African American promotoras.” 

Pānquetzani says Indigenous women reclaim their humanity when they reject colonialist norms of doing it alone and in silence. “When we support one another as parents, we find the parts of our culture that preserve our hearts and mental health,” she says. “These are the parts of our culture our ancestors intentionally left behind. This is the structure of community care and kinship that we need not just for our survival but for our thriving.”

Dorsey calls this work an “extension of the village”—an essential tool for navigating systemic racism and colonization. 

Birth workers like Bishop, Dorsey, and Pānquetzani support Black and Indigenous birthers mindful of the cultural and systemic realities.  They continue the tradition through community responsiveness,  problem-solving, and creating sustainability for laboring families and birth workers. 

“It was answering a problem, and that's going to continue to lead our work: Our goal, vision, and mission is to listen, educate, and support,” she says, acknowledging Flourishing Families past and future. And when the women and the families in our community ask for something, we're always trying to find out how to get that resource to them.” 

The resurgence of Black and Indigenous birthworks paints a complete—and historically accurate—narrative. “You can't have a better future when you don't address the past,” Bishop says, noting these broken systems work as they’re meant—to deny Black and brown birthing people's humanity.