Attuned Consent; Birth Doulas, Care, and the Politics of Consent

Doulas-birth practitioners without medical responsibility who provide support to birthing people-have become popular over the past few decades. Drawing from two years of ethnographic research in the United States during which I trained and practiced as a doula, I argue that they are "consent workers" who do complex emotional labor to facilitate the consenting voice of their client. In effect, doulas serve as a bridge between the intimate care and support for choice-making associated with American midwifery before its professionalization and the "informed consent" of medical institutions and contract law. They do so via what I describe as "attuned consent," which acknowledges ambiguity and complexity, is highly embodied, and is noncoercive without presuming equality. This draws attention to the limits of conventional, defensive models of consent, calling the paradigm of consent into question even as it draws from it to accomplish its work. Attuned consent can shed light on why the rather strange hybrid figure of the doula evolved in this historical moment. It can also provide a productive reflection of other contemporary cultural studies critiques of consent, notably Joseph Fischel's discussion of the limits of sexual consent and Audra Simpson's analysis of Indigenous refusal to either consent to or resist fundamentally hostile relations.