Birth Work as Care Work presents a vibrant collection of stories and insights from the front lines of birth activist communities. The personal has once more becomes political, and birth workers, supporters, and doulas now find themselves at the fore of collective struggles for freedom and dignity. Articulating a politics of care work in and through the reproductive process, the book brings diverse voices into conversation to explore multiple possibilities and avenues for change. At a moment when agency over our childbirth experiences is increasingly centralized in the hands of professional elites, Birth Work as Care Work presents creative new ways to reimagine the trajectory of our reproductive processes. Most importantly, the contributors present new ways of thinking about the entire life cycle, providing a unique and creative entry point into the essence of all human struggle—the struggle over the reproduction of life itself.

“I love this book, all of it. The polished essays and the interviews with birth workers dare to take on the deepest questions of human existence.” —Carol Downer, cofounder, Feminist Women's Heath Centers of California; author, A Woman's Book of Choices

“This volume provides theoretically rich, practical tools for birth and other care workers to collectively and effectively fight capitalism and the many intersecting processes of oppression that accompany it. Birth Work as Care Work forcefully and joyfully reminds us that the personal is political, a lesson we need now more than ever.” —Adrienne Pine, author, Working Hard, Drinking Hard: On Violence and Survival in Honduras

“This book places the doula—as a caring birth activist—at the heart of reproductive care work in our modern society. Doula, a new name for an ancient traditional role, reappears today as women daring to reclaim their power through birthing and caring for their children.” —Valérie Dupin, cofounder and cochair, Association Doulas de France

Alana Apfel holds graduate degrees in anthropology from the California Institute of Integral Studies and the University of Edinburgh. Alana teaches on ways to radicalise birth work and continues to support people through birth in Bristol, UK. Silvia Federici is a feminist activist, writer, and teacher. She is the author of Revolution at Point Zero: Housework, Reproduction, and Feminist Struggle. Victoria Law is a mother, photographer, and writer. She is the author of Resistance Behind Bars: The Struggles of Incarcerated Women and coeditor of Don't Leave Your Friends Behind: Concrete Ways to Support Families in Social Justice Movements and Communities. Loretta J. Ross was a cofounder and National Coordinator of the SisterSong Women of Color Reproductive Justice Collective. She is one of the creators of the term “Reproductive Justice” coined by African American women following the International Conference on Population and Development in Cairo.

Birth Work as Care Work

Stories from Activist Birth Communities

PM Press

Contents

Birth Worker as Activist

We cannot build an alternative society and a strong self-reproducing movement unless we redefine in more cooperative ways our reproduction and put an end to the separation between the personal and the political, political activism and the reproduction of everyday life.

— Silvia Federici

There is no such thing as a single-issue struggle because we do not lead single-issue lives.

— Audre Lorde

This anthology gives voice to the activism of birth workers within radical reproductive struggles. You will read stories from the front lines of activist birth communities, hearing from birth workers, midwives, doulas, herbalists, and those who choose to align their labor with the production and reproduction of everyday life. Birth holds many possibilities for transformation and birth workers, as activist caregivers, frequently find themselves as key political mediators in this process.

The aim of the anthology is to provide a platform for activists to reflect on and articulate the political and social dynamics of birth work within the context of larger liberatory movements. The featured stories herein envision the reproductive process as a unique moment that enlivens, and indeed is grounded in, the very essence of social and political life. The anthology will appeal to all those interested in the dynamics of human struggle, reproductive labor, and birth. It speaks, in particular, to birth workers and activists in the hopes of strengthening birth and Reproductive Justice struggles and reminds caregivers of the immense potential for personal and systemic transformation inherent in this work. It also speaks to radical theorists and those with an interest in social movements with the intention of expanding recognition of care and care work as direct forms of political engagement.

What do we mean by "care work" in the context of birth? Care work has long been identified by feminists as an essential, yet highly undervalued, form of labor to capitalist society. It may involve the provision of emotional and social support, sexual intimacy, companionship, and looking after children as well as more mundane daily tasks such as cooking, cleaning, shopping, and running a household. The majority of these activities take place within the imagined "privacy of the home," which has the effect of masking their true significance to the continuation of every social and economic system. Care work is by nature reproductive — it is the labor that ensures that the individual and community are properly sustained, nourished, and reproduced anew each day. It is a necessary precursor to all forms of capitalist (re)production. But within an environment that associates "real work" with labor that takes place outside of the home, the result is a degradation of the labor of caregiving communities whose struggles are contained and importantly depoliticized within the so-called private sphere. Yet the climate in which both reproduction and caregiving unfolds remains anything but "private." The terrain of reproduction continues to be highly contested and itself a site of resistance — for wherever capitalism exerts control over how we seek to reproduce ourselves and our communities, we find acts of rebellion, however small, that bring us closer to a collective re-appropriation of reproduction from capitalist patriarchy. Where better to begin than with birth itself?

Starting from this premise, and with a specific focus on the care that accompanies birth, the contributors to this anthology explore the political and politicized relations that run throughout all reproductive experiences including fertility, abortion, birth, miscarriage, and rape, as well as between birth work and other forms of social struggle such as prisoner rights, racial justice, or environmental activism. In so doing, they break down the distinctions between public/private and personal/political and embody the logic of what Silvia Federici calls a "self-reproducing movement." This means that they do not view their "political work" as separate from the work they do in supporting the reproductive experiences of others and in reproducing the collective body as a whole — for what is a social movement if not a struggle over the texture and reproduction of life itself?

In collapsing the personal and political, the figure of the activist birth worker emerges shedding light on the book's central theme: to highlight the unique contribution of birth work within intersectional struggles for self-determination and justice and to draw attention to the politicized nature of caregiving under capitalism. Birth workers, particularly those who work independently, dramatize the intersection of the personal and political because they occupy a space that is at once inside and outside of medical authority. This is because while they work, most commonly, within hospitals, they work for themselves, enabling them to bring a certain degree of subversive freedom and institutional critique to their practice. From this position, as expert caregivers and mediators of reproduction, they can avoid being "medicalized," leaving them with the potential to confront and redress institutional forms of violence that are inflicted upon reproductive and birthing bodies. Fashioning the birth worker as activist in this way casts caregiving itself as a potentially radical form of activism that holds the ability to literally reimagine our life beginnings. Activist birth work here joins with other liberatory movements resonating beyond hospital walls to reinvigorate the commonalities of our human existence. As Molly Arthur states in this anthology, "We are all born through birthing bodies and we are all part of the physicality of this world." Birth and death are what bind us together.

In critically engaging medical institutions, activist birth work also sheds light on the complex systems of power and privilege that are often at play in the reproductive context. Institutionalized privilege goes hand in hand with institutionalized oppression leading some to benefit and others to be harmed. This gives rise to huge reproductive health disparities and a frequent silencing of the specific needs of a person in labor. In these situations, some or all of a person's intersectional identities may be disregarded, leaving medical staff with more authority in charge of the unfolding reproductive experience.

Here contributors draw on the teachings of Reproductive Justice in broadening the political discourse of childbirth reform. They seek to demonstrate that all discussion of sexual and reproductive "rights" must also always address the intersectional context in which rights attached to people might be exercised. This means acknowledging the effects of historically oppressive structures and their role in shaping sexual and reproductive oppressions across time. Without enough emphasis placed on this analysis the result is a movement which predominately reflects and upholds the demands of economically privileged and female-bodied white women while overlooking the reproductive experiences and injustices of marginalized communities and communities of color within political organizing. This is not to underestimate the hard fought victories of feminists and reproductive health activists in gaining the level of reproductive freedoms enjoyed by some today. The changes that arose in the aftermath of the "scopolamine era" and the radical political movements of the 1960 and '70s have had a profound effect on the revival of midwifery, women's sexuality and health education, and the rights and well-being of birth givers the world over. The intention here is to build on this history yet also to go deeper in understanding the effects of intersectional oppression on childbirth and following from this, to expand and diversify approaches to birth activism as a result. As Jeanne Flavin reminds us, the fight for all birth givers to be considered "fully human" rages on.

With this in mind the anthology approaches birth and reproductive activism with historical awareness of the particularities of reproductive injustices and with the intent to confront narratives of birth that mask and perpetuate reproductive injustice. One such problematic narrative relates to the language of "choice" within modern maternity care. The danger of celebrating the rise of choice within transactional birthing environments lies in masking ongoing forms of coercion that result in a denial of choice for marginalized communities and those with less access to the kinds of choice-making power enjoyed by more privileged counterparts. This framework suggests that the individual retains full agency in decision-making over their health while overlooking, and therefore masking, intersections of race, gender, sexuality, physical ability, citizenship, and economics that differentially affect health outcomes and determine the quality and extent of care that is given. Health care in the United States is far from "choice-based"; it is deeply embedded within existing systems of social and racial stratification that produce highly variable birth outcomes across a diversity of reproductive communities.

In the United States, women of color experience the highest rates of cervical cancer, HIV/AIDS, sexually transmitted infections, diabetes, and unintended pregnancies, and regardless of socioeconomic background are more likely to die in childbirth than white women. Here, we see that although the physical experience of pregnancy and birth may hold similarities across different communities, the systems of governance that shape and often determine how individual births unfold are clearly not the same. Economically disadvantaged communities, communities of color, and queer and gender-nonconforming communities in particular bear the brunt of institutional forms of violence. Sophia Perez, for example, demonstrates how systemic forms of oppression as well as health and economic disparities felt in the outside world are also present in the labor and delivery ward. This is particularly evident through the "managing" or pathologizing of black and brown bodies in the birthing process. Rather than being purely biological, individual birth outcomes emerge out of a myriad of racial, sociopolitical, and economic forces that are structurally produced and reproduced throughout time. These forces collide, often violently, in determining the sexual and reproductive trajectory of entire communities. Breaking cycles of oppression means directly engaging these systems in order to reimagine a language of birth that creates room for all birth givers to have supportive reproductive care. In so doing, activist birth work interrogates institutionalized oppressions and critiques profit-driven health care models while reinvigorating a conversation about body-autonomy and sexual and reproductive freedoms throughout society.

A central element of the activism represented in this anthology herein focuses on broadening the nature and language of care to incorporate a greater diversity of reproductive needs. Not everyone experiences their sexual and reproductive bodies in the same way and to subsume all birth givers within the same form of reproductive care is often to erase individual identities and lived experiences. Different histories require different forms of attention. Here a politics of social change is rooted in the particularities of lived oppressions while still maintaining affinity to a larger common struggle for human rights in birth. This leads to the emergence of differentiated forms of care as well as community-led birth and reproductive support that we see addressed in this anthology. The anthology also makes a conscious effort to break with definitions of care that are articulated within a "provider" framework. This is seen to reproduce relationships of inequality in which those who may have more knowledge in a particular field, like birth, are deemed legitimate in taking charge of other people's reproductive experience and thus of forcing onto others their own version of how bodies should or shouldn't behave. Birth workers hold space for others to discover their own inner potential, helping facilitate but never taking charge of the trials, joys, and beauty that come from navigating one's own reproductive journey.

In supporting birth givers to realize their own strength through birth, birth workers help destabilize the fear-based foundations upon which the modern labor and delivery ward is based. This not only serves as a challenge to and subversion of traditional spheres of "reproductive labor" (both literally and figuratively) but also undermines the very structures of capital that differentiate and ignore these spheres of work. As Silvia Federici notes in the introduction, the effect of capitalism is a continued appropriation of all aspects of our reproduction, which become subordinated and devalued to the needs of the profit-driven market. What this means in the reproductive context is not only control over how, where and with whom we give birth but also control at the level of imagination — foreclosing the ability for people to literally imagine alternatives to, say, lying flat on your back or having your baby separated from you at birth. We need a collective re-appropriation of the constraints capitalism places on our imagination around birth and hence on our capacity to reproduce ourselves and our children in ways that would support our collective well-being. In order to move closer to this we would necessarily need to enlist the direct participation of all caregiving communities — especially those who have been historically silenced. This would mean far more decision-making power granted to those whose bodies serve to sustain, reproduce, and literally give life to all others, yet who are also most often disenfranchised at the moment of reproduction. If we revitalize anti-capitalist modes of relating — weaving cooperation, liberatory politics, and respect for all beings together with the immense physiological capabilities and spiritual power of birth givers — we might have the beginnings of a truly revolutionary birth movement.

A Note on Organization

Birth is neither a linear nor predictable narrative. What follows is an attempt to capture a sense of this dynamic motion through an assemblage of intersecting thoughts, embodied experiences, remedies, and recipes that come together to weave a web of subversive change and attempt to tell a story of contemporary birth under late capitalism. Not all contributors agree with each other, nor are they encouraged to do so. The diversity of approaches within birth worker activism is honestly reflected. The intention of this collection is to turn relationships of perceived difference into politically productive partnerships capable of destabilizing dominant narratives of birth. In so doing, the anthology aims to elaborate new ways of thinking, acting, and relating, mediated and given shape through our reproductive experiences. The anthology opens with "Birth Story," a short tale of remembering that weaves birth work together with maternal lineage. "Organizational Practice" presents a recollected conversation with two activist birth workers exploring the essence and texture of social justice organizing within the context of birth and reproduction. "The Labors of Birth Work" makes up the majority of the text and presents a series of collaborative and co-created interviews that explore a diversity of perspectives and approaches within the field of birth and reproductive activism. All examine dynamic and creative ways to reimagine collective engagement with birth and reproduction centralizing birth work and birth workers as key political mediators in this struggle.

"Tales from the Birth Field" presents four birth stories, inspired from real life events and told from the perspective of a doula. The stories are included to paint a picture of birth work as it is experienced in the moment, with all the smells, physical feats, and transformation that both giving birth and supporting birth entails. The hope is to transport readers directly into the surreal, and often mystical, world of birthing, bringing context and real-life experiences to some of the more abstract themes addressed throughout the anthology. This is followed by "Herbs for Pregnancy, Birth, and Beyond," a practical resource of remedies specifically geared towards supporting pregnancy, birth, and postpartum. Readers are encouraged to think of these plants as their supporters, teachers, and friends during these transformative times. Herbs are included to highlight the importance of exploring alternatives to mainstream medications, emphasizing solidarity with our natural environment. Finally, the "Political Dictionary" is included as a way to unpack the political language and terminology of birth and reproductive activism with the intent of uncovering deeper meanings and significance. It is intended as a reference that can be used throughout the anthology.