During most major life transitions, there are those who are not at the center but bear witness. While they might go unrecognized, their presence is vital and their perspective often unique.
A doula is someone who, by definition, holds such a role. Greek for the word “servant,” a doula supports a laboring mother and her partner by attending them throughout the process of birth. A doula doesn’t deliver the baby or perform any medical action, yet she facilitates a major life passage, both for the child and the parent(s)-to-be. During the last trimester of my own pregnancy, when interviewing doulas, I well remember how each provided paperwork detailing what she would and couldn’t do in terms of intervention— although their emotional support would be boundless.
It’s rare to find childbirth written about explicitly in fiction. But now there’s a novel that places a doula solidly at its center.
Bridget Boland, herself a doula, spins a tale in The Doula that starts with a family mystery, followed quickly by a family tragedy. Both steer the course of young Caroline Conners, from one end of her family’s business (funeral directing) to the other end of the life cycle (aiding in childbirth). The story culminates, surprisingly, in a trial, after Caro (as she’s known) attends the birth of her best friend from childhood’s baby, which takes a dramatic and unfortunate turn, and Caro’s ethics, as well as the legal limits of her profession, are all scrutinized.
The story becomes more suspenseful as it progresses, particularly as the curtain is pulled back on other losses Caro has endured, often intertwined with the relationship she has with her mother. This subplot leads Caro to confront her past demons and, in her 30s, to determine who she most wants to be. Found among several tender passages is the old trope of a woman “giving birth to herself.”
This book’s strength rests in exploring themes that are not often revealed—the experience of childbirth for one and the world of doulas, for another—a world sometimes still pegged as “alternative” despite its growing popularity. “Childbirth is one of the few experiences in life that still contains many unknowns,” Boland writes, and in her book she explores its mysterious dimensions.
Caro’s own understanding of her field deepens as she connects with a birth center called the Enclave, whose communal commitments sound a lot like the famous Farm founded by Ina May Gaskin in Tennessee, where women are given the opportunity of birthing naturally in a way that is still considered “alternative” to mainstream medicalized care.
When the head of BirthRight, an independent birth center Caro works at, won’t show up for her on the witness stand, she tells Caro that she must sacrifice their connection for the sake of a larger, still-fragile purpose. Her birth center’s standing has been so hard won that she can’t be associated with even a hint of wrongdoing.
When Boland lets Caro ruminate on the process of birth—its physical, emotional and even spiritual effects—her writing is lyrical. “When a newborn’s head crowns,” she writes, “the world shrinks.” Her writing about the passage a woman undertakes from daughter to mother, in just moments, also strikes wonderfully reflective chords.
Less captivating is the rather extended romantic subplot; this is a book that could have easily had 50 pages edited out. The various secrets and acts of subterfuge add suspense, but dilute to what is already a strong central theme.
Some reader commentary questioned the veracity of the processes Boland included, although this is fiction. Yet the author’s positioning of the main character—someone who, by definition, is looking in from the sidelines—is intriguing, particularly as she muses on the processes of birth, its unnecessary medicalization and the experience of power it can bring. These are subjects not often explored yet widely experienced. Of her main character, Boland writes,
The natural childbirths I had attended had taught me how to bear witness to another’s pain, to resist the instinct to alleviate those sensations and instead walk with the laboring mother through the feelings. This offered her a profound passageway into a new sense of herself. It was one of the most difficult aspects of my job, but one I had grown convinced was crucial to the task.
As the book ends, its main character is busy envisioning her own center where women can birth as they need and as they wish, reiterating again that this primal act still holds room for reinvention.
Elline Lipkin is a research scholar with UCLA’s Center for the Study of Women. The author of Girls’ Studies and The Errant Thread, she teaches creative writing in Los Angeles and is active with advocacy groups for girls.