February 4 Forum

Bill B

The reason I use the term doula is that I think it should be centered in healthcare. These are matters of health and I think they should be. The doula has traditionally been part of but on the outskirts (but of healthcare. Doula services were originally focused on childbirth, now they also focus on death. Why not broaden their scope?

Jack

The concept of doula is pretty modern as a word and a construct, starting with natural childbirth during the 60’s. The construction of having somebody around to provide childbirth services is thousands of years old. However, as I have mentioned, some cultures are very family-oriented or have close-knit ties with multigenerational families or small neighborhood communities with neighbors and friends. Did the doula replace these cultures during the sixties?  And I wonder again if the doula role is a mitigation for something we have lost. Because we typically no longer live in multigenerational families. And we no longer live on a street or on a block for sixty years, where everybody in the neighborhood knows everybody.

I’m not saying that late-life doulas are bad. I’m just saying that this role has historically been played by other people.  My wife is Chinese, the intergenerational construct and huge family culture is such that my in-laws are in their nineties, and they don’t need the doula because they have dozens of family members who touch them on a regular basis. It goes back, also, to the Catholic church, where some of these services were provided by priests and by nuns. These services were provided in other settings as well. And none of this is to say that this is a wrong movement.  I would be a proponent of late-life doulas. However, I think we can learn a lot about what the role is by looking at other cultures and other communities where this is being done by an internal family, friend, neighbor, or tight-knit community. I think that those serving in the role of late-life doula can learn from those past experiences and constructs.

Bill B

Just to push back. There are elements, I think, even in traditional communities, that get partitioned off.  There are things you don’t talk about that are often fraught with problems. I used to do a lot of work in Chinese communities. And I know there are some topics that you find are very hard to address.  The fancy word is enmeshed. These are enmeshed communities, where the social norms are very strong and strict. There are certain issues that are not being addressed—and some of them relate to late-life matters.

Jeff

I think there’s great value in the concept of late-life doula; however, I guess I’m a little closer to Jack’s perspective in the sense that, in reality, you can say everything is about health, because what else do we have.  And I think we need to draw some limits, not limits that are bright lines (saying that anything outside of this limit doesn’t have to do with health). However, limits should exist so that we can focus on certain things within the line.  So, while I think the concept of late-life doula is really valuable, I wouldn’t spend a huge amount of time on the subject other than saying that it’s important.