Why I Don’t Use The Word “Doula”

Four (and a half) major issues concerning the etymology, modern history, appropriation, connotations, associations, and impact of the word “Doula” in reference to birthwork, deathcare, and other similar care fields.

(Updated 2023 Version)

Hello! A few things before we start.

This essay is not a definitive source of linguistic history or evolution, nor is it an exhaustive list of all of the issues I have come across with the word “doula”. There are over three dozen separate articles and essays like this one that I have seen so far, so if you’re interested in other individual yet echoing points of view on the matter, please do seek them out (though, most of them only focus on the same 2–3 points). I want to offer up some my own thoughts on the matter though, and try to explain the major issues and concerns I have with the word “doula” as the most commonly-accepted term (in western countries) used to refer to people who offer the same types of professional support services as I do.

Some context about me and where I am coming from: I am a mixed-Indigenous, disabled, neurodivergent, queer, nonbinary woman. Professionally, among other things, I offer postpartum and “fourth-trimester” support, parenting consultation, and parentbirthing/reparenting counseling. I provide these offerings on a “green bottle” sliding scale, through an anti-capitalist, radically holistic, and radically intentional lens. I weave various modern-scientific and Indigenous approaches together, with evidence-based information and community-sourced wisdom. I aim to create a practice that —I hope— provides my clients with care that embodies professional and personal integrity surrounding the values which I hold most dear; two of which are language justice and decolonization. Intentional language practices are a core element of my work, in every interaction I have with both adults and children in my life.

All I ask of you here is that you take a moment to read this with an open mind and re/consider your stances on the matter — especially if you currently use this word in your own professional work, and especially if you actively benefit from privileges afforded to you by dominant culture systems. The goal of this essay is bring this issue more into light; to acknowledge and address some of the associated ignorance and where it comes from; and hopefully to help prevent future instances of associated harm.

Thank you for your consideration.

So, all this fuss about a word. Just a simple, innocent word. A term that is beloved by nearly all who encounter it; beautiful, inspiring, hopeful, and all around just swell. That is, if you’re a member of the dominant culture in western society — especially within the US. If you identify racially as white and professionally as a doula, and had never even considered anything could be wrong with the word “doula”, this article is definitely for you. If you identify as a member of a non-dominant, systemically-marginalized, and/or historically-excluded community within the world of birthwork, deathcare, and other similar “doula” fields — especially those who are Black, Indigenous, and Greek, then you’re probably only reading this to see if I’ve included something you don’t already know. Either way, let’s go ahead and explore what all the fuss is about, shall we!

This is the current, modern, English definition of the word “doula”. This is version that we have all been led to believe is entirely true and correct.

dou·la /ˈdo͞olə/ f. noun.
A woman, typically without formal obstetric training, who is employed to provide guidance and support to a pregnant woman during labor.

Now, before I jump in to the major issues, I want to point out that first and foremost, this definition doesn’t acknowledge the full scope of services offered by people who use the term “doula”. There are labor & birth doulas, postpartum doulas, bereavement doulas, death doulas, abortion doulas, gender transition/affirmation doulas, adoption/surrogacy doulas, and many more types of support work that don’t involve childbirth at all. So in fact, this expansive professional realm already lacks an adequate all-encompassing term. I actually don’t offer childbirth support services at all — so given that one specific definition, could I even call myself a “doula” then? Surely there must be a better way to correctly distinguish these support persons and caregivers than with such a narrowly-focused —and as we’ll explore soon enough, highly problematic— term. But I digress…

On to the real issues. Because honestly, this one is the least of the problems, by far. This issue becomes null when we start discussing the reasons why the word “doula” itself, as a name for this profession, needs to die entirely.

1. The Gender Of It All.

Let’s look at this definition here from above…
“A woman, typically without formal obstetric training, who is employed to provide guidance and support to a pregnant woman during labor.”

There are many systemic issues at play here, most notably are misogyny, sexism, and gender-essentialism. Given that issues like these are often on my mind, the official modern western English definition of the word “doula” waves a big red-flag with me here. There are three parts to this that I want to expound upon.

I’ll start with the lesser of the evils.

1. It not-so-subtly implies that doulas are untrained in general, from the tone of the phrasing and the specific terminology and phrasing chosen. Choosing your words carefully — especially in such a sensitive field as caregiving, birthkeeping, death support — is so very very important. Think about if you were a nervous first-time pregnant person, trying to decide if you wanted to hire something called a “Doula” — whatever that is. Then you see that the definition contains the phrase “without formal…training”. Would that make you feel very confident? Hmm, probably not.
   Birthcare workers may not have had “formal training” by modern, Western, patriarchal medical standards as of the era when this particular definition was written, but that’s not even true anymore. Thanks to credentialism culture, and certification standards born from DONA (Doulas of North America; we’ll get to them later), almost all “Doulas” actually are “trained” and “certified”!
2. This definition is highly gendered and gender-essentialist. By insisting that all persons involved identify as “women”, and especially that the birthing person must also be a cis-gendered woman, this definition is inherently discriminatory against all transgender and intersex birthing people.
3. The term is inherently alienating and exclusionary against people who identify as men, trans-masc, masculine, and/or nonbinary who may want to enter into the profession.

The undercurrent of the various archaic forms of gendered gatekeeping among modern professional terms is entirely worthy of criticism in the year 2023. Gendered terms like actress, heiress, hostess, seamstress, especially words like millionairess, murderess, and adventuress were not gendered titles to begin with! (How utterly silly and demeaning are those words!) But it was deemed necessary to put women in their own little sub-categorical labels. It was deemed necessary to keep “the sexes” separate …. “but equal”, right? Given this issue, the above-mentioned definition of the word “doula” is no exception to the rule of gendered professional terms — which is an outdated, misogynistic, and ridiculous rule that needs to be put to sleep.

But even knowing that there is a “male” version of the word, “doulos”, does not help at all. In fact, “doulos” has nothing whatsoever to do with supportive care, birthkeeping, and other similar occupations.

Learning about “doulos” leads to learning about the real origins of “doula” — origins which far precede the western co-opting and coinage of the 1970s, and which shed light on still more problematic aspects…

2. Linguistic Etymology and Poisoned Roots; Some words are simply not eligible for reclamation.

Here are the original — and common, current, STILL USED — definitions of the words “doula” and “doulos” in the language these words come from. Not merely ethereal figments of the distant past, but words that are still in use today by the very language and people that actually invented the words a millennia ago. Spoiler Alert : it was not Dana Raphael, and it’s not the bible.

δούλη (doúlē) /ˈðula/ f. noun.
1. slave (female) ; 2. (obsolete) maidservant

δοῦλος (doûlos) /ˈðu.los/ m. noun.
1. born slave or bondman

The Greek definition of both “doula/doulos” means “born slave”. Both terms share the same roots as the Greek word “douleiá” (δουλειά), a word that is still used in the modern iteration of the Greek language today. It can mean either “slavery” when the accent is on the ‘i’ in “douleía” (δουλεία), or “work” when the accent is on the ‘a’ in ‘douleiá’ (δουλειά).

I don’t know much about their culture and language, but I do know that I’ve heard and read enough about modern-day Greek people being profoundly uncomfortable with this novel Western version of the word “doula”, and absolutely refuse to use it as the name of this profession in their culture. I know that many Greek birthworkers have approached and petitioned various [Western doula] communities, multiple times over the past several decades, begging them to change it and replace it with a less problematic alternative. As we can plainly see, all of those efforts have gone unanswered — but we’ll get to that later. Unfortunately, I still have yet to learn about their alternative terms, but I assume they suffer from the same linguistic conundrum I face here — going against the grain of dominant Western culture, and struggling to find that perfect all-encompassing title.

Although one doesn’t need to know very much about human history to understand the levels of horror, anguish, and rage caused by human trafficking and enslavement, both past and present; it seems this superficial understanding of history is not enough to stop us in our tracks and come up with a new term. Terminology that is directly — or even indirectly — associated with slavery is incredibly harmful, no matter how you try to spin it. Harm is harm, regardless of time, and regardless of association or intentions.

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White people reading this,

I’d like to ask you to consider that many Black and Native American families had their ancestral Indigenous culture(s) stolen and erased by way of the inhumane brutalities of colonization, genocide, and/or enslavement. Nearly every single aspect of those cultures have subsequently been unceremoniously “discovered”, examined, and/or pathologized by the dominant society...
and either blatantly belittled, mocked, demonized, criminalized, called “savage”, “primitive”, “animalistic”, “ghetto”, and worse…
or blatantly stolen, fetishized, repackaged, commodified, commercialized, mis/appropriated, and consumed on a daily basis through mainstream media and capitalist culture…
by the very people who are responsible for the genocide and enslavement of these cultures, and their children, and their children, and so on. You don’t need to understand -or even agree with this information, but be aware that it is a widely-known understand fact of life for Black and Indigenous people in the US.

Now, imagine being a person from Black or Indigenous heritage who is deeply drawn to the profession of caring for birthing families, guiding new parents and caregivers, supporting transitioning people, caring for the dying, and so on. Being called to take your place in an important and vital community seat, which may also hold deep, traditional, cultural value for you as a surviving descent of your ancestors…
Imagine being told that the only word for your heart-chosen path that is professionally recognized by all of the official certificying organizations in that field (certification which in itself is inherently anti-Black and anti-Indigenous), and even the medical health care system itself, is a term that is historically and currently synonymous with the word “slave”.

Imagine knowing that fact, and still seeing it ignorantly praised and amplified by the dominant culture. Imagine not having the privilege of being able to just suck it up, because your ancestors are writhing with horror and anguish inside of your very bones about it. Imagine knowing that repeated formal requests and largescale petitions for an alternative term wasn’t taken seriously by the people who intentionally appropriated and monetized the term, simply because they don’t see it as “that big of a problem”, or even a real issue.

~

I personally can’t even fathom the cognitive dissonance of being someone in a objectively supportive caregiving field of work, and having so little care for how one’s direct, global choices negatively impact our most vulnerable community members.
I don’t ever want to undermine, ignore, belittle, dismiss, invalidate, or otherwise disrespect the realities of slavery, nor the realities of cultures and languages other than my own. As someone who now knows that the word “doula” both historically and currently means slave, I have no choice but to entirely reject and denounce the term as a professional title.

This term was never mine —or yours— to use, anyway. It was never any of ours to use in this way. This alternate, secondary definition —which is isn’t even sixty years old now— isn’t one that was given to the professional field from the culture and language that invented it. It wasn’t a term given by those whose Indigenous ancestral medicines and traditions were stolen and appropriated to create the very foundations of the profession itself. It wasn’t one given to the profession with integrity, moral ethics, love, respect, or even the most basic forms of authentic consideration.

So why do we use the word “doula” as we do? Where did it come from?
It might not surprise you to learn that a white woman from America, named Dana Raphael, took it upon herself to coin it in the 1970’s in a book she wrote herself about postnatal support…

3. Linguistic Responsibilities and Mis-Appropriation.

Keeping in mind that languages are living, breathing organisms that are ever-evolving through mass media, generational context, notable events, popular figures, and immigration; we must also keep in mind our obligation toward understanding and acknowledging established linguistic base rules — such as, oh how ironically, words that have Greek roots. These linguistic rules not only provide a common understanding of vocabulary — useful for efficient, accessible, and ethical translation; they also, and possibly more importantly, provide bridges to linguistic pasts that directly affect current and future word associations, connotations, and inherent definitions — especially those which have potential to cause harm.

In reality, “doula” is a word, like many others, that happens to have a Greek root, therefore confusing and poisoning its secondary definition. In fact, the western English iteration of “doula” is a totally brand new term, with a borrowed existing external form. To my knowledge, the unwarranted “reclamation” of “doula” that happened in the 1970s, modern day English was done entirely ignorantly. One might even argue “innocently”, but ignorant and harmful nonetheless. (Intentions do not outweigh harm, ever.) Regardless, “doula” was already — and still is — an existing word in the modern world — one with a rather severe and harmful definition that cannot be ignored. And that definition, unfortunately, is not the definition that was told to the creator of this new term.

The western world, in which it is most popularly used — most notably, American — is not likely to change it any time soon, because it is so successfully integrated into the dominant birth support work and parenting culture, as well as the fact that organization like DONA have undergone extensive efforts to get the American health care system to formally recognize is as a valid profession within hospital walls. Dominant culture wants this word, and it’s putting everything it has into making sure the rest of the world respects their version of it.

Dominant Culture; cisgender, heterosexual, white, thin, tall, able-bodied, middle or higher class, people, whose first and often only language is English. Those who have never been told by their government that any part of their identity was immoral or criminal. Those who have never had their government create and pass laws which threaten to take away rights that others are given freely and proudly. People who are often so swaddled by their privilege, they are completely unaware of the systematic and incessant marginalization and oppressions that others face.

Dominant culture — and especially those who have never been directly or generationally harmed by slavery— has no dogs in that particular race. It just does not affect them in the ways that it does all Greek-speaking people, descendants of enslaved people, and all others who bear generational witness to such inhumane atrocities. Members of dominant culture do not nurse the deep intergenerational wounds associated with human trafficking and enslavement; they do not feel the same burdens and cultural obligations as those who stand against the injustices done to their ancestors.

Dominant culture loves to have its cake and eat it too, and often that means going with it’s own flow and staying within its comfortable, self-appreciating, and infallible echo chambers. This fragile egocentric reality relies heavily upon the habit of ignoring, invalidating, and even challenging other points of view — especially others who tell them they are being more harmful than helpful. They are told “your actions are hurting us”, and they can’t help but defend their good intentions; mistakenly assuming that anyone standing up against against their behavior to be directly attacking their character.

( P.s. I feel the burning, seething need to mention that human trafficking and enslavement still exists today; Yes, even here in America. It never ended. It just took on new names and forms. Un/intentional ignorance and in/direct perpetuation of the status quo are the one constant aspect of these atrocities that help them to continue. To me, these two aspects are also the same reason why Dana Raphael’s coined iteration of the word “doula” is still being used. )

4. Dominant Culture, and further Marginalization of “Minorities”.

(or, “ The nice privileged people are trying to enjoy their dinner, can you please stop bleeding all over their carpet — it’s gross, and it’s distracting. Thank you.”)

There have been countless requests across the last few decades for the term “doula” to be relinquished, abandoned, and replaced due to its negative associations, but its wide-spread usage and popularity among western dominant culture has consistently undermined and inhibited these attempts. In my own solidarity with ESL people, and in the name of Language Justice, this is another major reason why I reject the term.

If something is harmful to any specific group of people, it is harmful. Period. It’s not my place to debate that fact, nor am I required to fully understand it, but I do have an ethical duty to acknowledge and respect it. Especially as someone who describes themself as one who provides radically holistic, intentional, and trauma-informed support and care during my clients most precious and sensitive moments in life. Especially as someone who works with clients of traditionally-marginalized identities. Especially as someone who lives at various traditionally-marginalized identities, myself. I would be wholly remiss in my professional duties and go against my personal ethical values to ignore such a blatant fact that the term “doula” is harmful.

If dominant culture is being told by traditionally-marginalized people that they are being harmed, and that harm is coming from dominant culture itself, and if dominant culture doesn’t take it seriously, then that compounds the harm by making it both complacent and overt. It’s no longer covert and insidious. The emperor absolutely is naked. And now we all know it.
Unfortunately, though, it’s never that simple.

The sad fact is that most white people I come across in the “doula” world have no clue about any of the issues mentioned above; that the term was unethically appropriated by white people, does currently and has always meant “slave”, directly harms Black and Indigenous people, actively excludes trans and intersex people, and perpetuates white-supremacy, privilege-centering, and Indigenous genocide. They have no idea at all. This is one of the many forms of harm that people don’t automatically think about when we talk about perpetuating white-supremacy. The ignorant, misguided, or skewed cultural appropriation of terms, practices, and sacred symbols by members of dominant culture has always been a painful, frustrating, and toxic aspect of intersectional life in western society. The only thing worse is when it’s done complacently.

Words have power, and must be given a standard of respect and understanding. The words we think we choose for one intention or connotation, are purely subjective, and because language is so alive, it is irresponsible to pick and choose definitions and connotations. It is wildly inappropriate and egotistical to think that our personal intentions and our own definitions could ever be more important or more valid than all else. Just because you have good intentions and consider yourself to be a good person, doesn’t mean you are infallible and incapable of doing harm.

Risky opinion: Claiming to be an expert in your field — especially a field that exists in service to and care of others — but not being aware of or giving proper attention and respect to the harmful connotations of the very word that you call yourself and insist that others call you, is morally and ethically irresponsible and harmful.

We have a moral and ethical obligation to do right by our traditionally-marginalized and oppressed clients, peers, coworkers, neighbors, friends, partners, and so on. A word adopted by dominant culture, which should not have been, has been found to be harmful and toxic. What are we going to do about it?

What can we do about it?
Well, as it happens, a lot actually…

Less Toxic Alternatives and Our Duty as Care-giving and Support Persons

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**Update: I have settled most definitively on the term “Support Specialist” for my own practice. Depending on the context, I use Postpartum Support Specialist, Parentbirthing and Reparenting Support Specialist, Family and Individual Transition Support Specialist, and so on. I believe the term “Support Specialist” yields an appropriate amount of professionalism and gravitas, without being exclusionary to those who intentionally choose not to pursue “doula certification”, without interfering with any terms in the medical profession, and without feeling inaccessible to ESL and other non-dominant-culture identities. I am passionate about this term as being an effective, ethical, and future-proof replacement as the official name for this particular field of specialized caregiving professions currently know as “doula” work.

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I am still exploring other possible terms that have no notable historically or current negative definitions or connotations, such as Caregiver, Childbirthing Steward, Transitions Companion, Birthkeeper, Support Person, Postpartum Companion, Caregivers Companion, Parenting & Caregiving Guide or Consultant (I personally avoid the term “coach” here because I do not “train or instruct” my clients; rather, I support and collaborate with them), and more.

I have even considered the task of finding others to help in founding new terminology, with the explicit consultation and permission of that culture, of course. There are some beautiful word from North Sámi (one of the languages that is spoken by the Indigenous people of Northern Scandinavia, and is where my first name comes from), such as “Váhnen” which means “parent”, or “Fuolki” which means “relative; kin”. I am so inspired by the idea of replacing “doula” with something utterly devoid of a problematic past, that can be claimed and reclaimed for all future generations as a word that has only positive meanings and associations.

I have yet to come across something that fully encompasses the tone of all that my own practice has to offer our myriad intersectional clients and community, or any word from another culture whose definitions and connotations strike significant cords with me. I am not quite sure how to go forward in my support practice with such ambiguity and uncertainty in what, of all things, to call myself professionally. However, I do hope that in my lifetime, a radical shift is made from one of ignorance and complacency, to one of unconditional radical respect and authentic, effective allyship. My hope is that maybe we can find a term, that is devoid of even the slightest twinge of toxic connotation —one that inspires connotations even more powerful and beautiful than the current options — and that we can step forward into the future with our hearts and minds in a more healthy direction.

Until then, though, it our humble duty and ineffable privilege to continue to unearth and explore and challenge the status quo, both in society at large as well as deep within ourselves.
Until then, that’s where I’ll be.
I hope to see you there.

Thank you for your time and energy, and your consideration of my words here. I hope this has been a learning and inspiring experience for you. It has been very cathartic and healing for me to get out.

Live long and prosper,
and Party on, Wayne.

Post Publish Edit:

Issue Number Five: The Gatekeeping Credentialist Invention of the “Doula Certification” by Dominant Culture

While the birthworker-related definition of “doula” was originally only coined in the US in the 1970’s by Dana Raphael, it was heavily urge to be popularized and normalized through government and medical lobbying by various members of dominant culture. These efforts were made by people who — both knowingly and ignorantly — appropriated both open and closed practices from Indigenous cultures.

The entire aspect of mainstream certification of professional support persons and birthworkers under this title, as defined by and gatekept by predominantly white, non-Indigenous, non-Black, cisgender, heterosexual, middle+class, able-bodied individuals, is highly problematic in and of itself. “Doula” certification has only existed since the 1990’s at earliest, and began in the United States of America, a country which was founded on genocide and slavery, the criminalization of Indigenous practices and culture, and perpetuates and enforced settler-colonist-centered consumer-capitalist ideals.

“Doula Certification” has only existed for less years than I have been alive on this earth, for a profession which has existed since human beings have existed in any forms of society. For as long as there have been birthing people in communities, there have been dedicated community members who provide care and support with passion, love, trust, and wisdom. This profession existed and thrived long before the inventions of the capitalism or credentialism. It wasn’t until well after WEIRD societies rose and the health care industry became unhealthily obsessed with pristine, clean, white, sterile birthing approaches, that all ancestral birthing practices were made illegal, and smear campaigns against them were injected into society at an alarming rate.

Many birthing and postpartum [doulas] today intentionally choose not to “certify” through any organization, even with ones they do choose to train through. As someone who holds traditional* birthing and postpartum care and support to be a sacred calling and responsibility, I abhor the entire act of credentialist gatekeeping, as well as other highly capitalistic aspects that the greedy, paranoid, capitalist mentality has seeped into this profession; such as trademarking certain universal birthing and postpartum terms, copyrighting of private practice names which contain key terms of the profession, operating ones practice primarily in terms of marketing and branding instead of the sacred privilege of providing care for parents and future ancestors, and more.

And so this last segment is an “homage” if you will to exactly why I refuse to “certify” as a member of this profession, especially while “doula” is still being used as the official professional title. And especially while most forms of credentialism in WEIRD societies are systematically anti-Black, anti-Indigenous, anti-Trans, and anti-immigrant. No thanks.

For more information on the problems of Credentialism:

Credentialism and educational inflation

The Curse of Credentialism

Explainer: what is credentialism and is a degree more than just a piece of paper?

https://www.theatlantic.com/magazine/archive/1985/12/the-case-against-credentialism/308286/

13.5C: The Credentialized Society

• The Credential Society: A 1979 book by Randall Collins which argues that public schools are social institutions that teach and reward middle class values of competition and achievement.

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* (The original meaning of the word “traditional”, as in pre-colonized, authentic, Indigenous, traditional. Not the post-colonial “the way things are done now” version of the word “traditional” which regards Indigenous ways to be antiquated, ridiculous, uncivilized, and other reasons for not being worthy of respect in any form.)