This dissertation is an investigation of doulas as agents of social change through the lens of feminist theory. Doulas are nonmedical health care workers who provide physical, emotional, and informational support during pregnancy, childbirth, and/or the postpartum period. Because of doulas' willingness to work within the structures of the hospital setting, some have questioned the effectiveness of doulas as change-makers. While much feminist scholarship on the politics of birth centralizes the issue of medicalization, I demonstrate that expanding this line of analysis aids in better understanding the cultural impact of doula care as part of a larger picture of reproductive health advocacy.
Through discourse analysis, participant observation, face-to-face ethnographic interviews, and online surveys, I track the goals and effects doulas ascribe to their work, both activist and professional, and on both an individual and group level. Rather than asking whether doulas can successfully challenge the medicalization of birth, I seek to understand how the doula movement contributes to social justice through challenging various overlapping axes of inequality, related to race, class, gender, and sexuality. This analysis highlights the work of doulas in marginalized communities that is, as yet, under-researched and under-appreciated, while also illuminating the multifaceted effects of the dominant medical model of birth. I observe that doulas are increasingly working to empower people in multiple facets of their lives, beyond the birthing room. Rather than being incapable of, or uninterested in, creating social change, doulas are increasingly bringing a new political consciousness into birth work, as evidenced by the emerging designations of "radical doula" and "full spectrum doula." I argue that this movement among doulas represents a new paradigm in birthing rights activism, which connects childbirth choices to a larger reproductive justice agenda and forges connections between birthworkers and activists for causes such as LGBT rights, abortion rights, prisoners' rights, and economic and racial justice. By reimagining the reach of their work, many doulas are drawing necessary connections to social justice issues that are often overlooked in the childbirth reform movement, which tends to focus on medicalization as the primary issue.