In this conversation, Kristin Gupta sits down with Andrea Ford to discuss her ethnographic engagements with birth doulas and elite childbearing people in the Bay Area. They discuss agency, design thinking, whiteness, and the ways in giving birth in Silicon Valley has become a project of self-actualization.

Kristin Gupta: In the opening scene you describe a private session with a doula client in her third trimester, and a childbirth educator presents a memorable example of how knowing in this context is taught as part primordial, part modern, and located in the self. Given this focus on the childbearing person's selfhood, how is this tripartite epistemology imagined in relation to the creation of a new person, both before birth and postpartum?

Andrea Ford: As with childbearing people, babies’ needs could be talked about using terms of instinct and innateness as well as biomedical management and risk mitigation—that is, both “nature” and “technology”—though babies’ self-knowledge was largely absent. I did encounter baby and fetal personhood in numerous ways during fieldwork, though they tended to appear in more peripheral discourses like perinatal psychology. Most people I encountered named their baby before they were born, though some waited to see what kind of person the baby would be outside the womb. People would explain the factors influencing birth using “the Ps,” which include “passenger” along with pelvis/passage and power/pushing (there could be up to nine “Ps”). In obstetrics, passenger just referred to the baby’s physical size and orientation (as passive as the term suggests!), but in more spiritually oriented circles the baby’s contribution could include psychological factors like fear, stubbornness, and cooperativeness, particularly in preterm or overdue labor. Sometimes this was a joke, but other people were extremely serious about it. Childbearing people I worked with certainly wanted the best for their baby, to care for them and ensure their health, and they made decisions with this in mind, but they didn’t often describe the baby as an agent in the process. Concern for the baby did, however, add emotional weight to their own negotiation of agency and self-design.

KG: You vividly describe how design thinking permeates almost every aspect of childbearing in Silicon Valley—from overt settings such as a UX meeting for a breast pump prototype to more personal ones like making “birth wishes” with a doula. Here, we are all “users.” How do these attempts to manage the liminal period between nonparent and parent express broader epistemic infrastructures that increasingly individualize human life through personalized apps, products, or experiences?

AF: You’re absolutely right to point out that design thinking permeates this process. As to how this expresses broader epistemic infrastructures, it was overwhelmingly evident to me that the “management” of the liminal state is an individual responsibility. As I point out in the essay, this can be highly appealing as well as troubling, which is the case for many personalized approaches to life. In this design-saturated environment, which draws from American and Californian takes on individuality, there is moral satisfaction in being the author of your life. This was so obvious in the largely white, upwardly mobile classes that it was most visible where it broke down. New parents reacted against the pressure to do everything perfectly and turned to things like the personalized coaching of doulas to reassure themselves. Anxiety was evident in personalized fertility trackers and baby-growth apps, prenatal or mommy-and-me yoga to seek spiritual grounding (in oneself), or encapsulating and consuming your placenta (the ultimate personalized medicine as it’s one’s own tissue!). There was a real struggle to find and form communities, though of course this did happen to some extent. Two San Francisco moms made a “dating app” for new parents to find each other. In Santa Cruz, a childbearing center was called “The Village,” as in, it takes a village to raise a child, yet it mostly offered classes through which you could inform yourself to make empowered choices, or services like massages-plus-childcare. There’s a sort of see-saw between people not seeking to publicize or accept input on their choices on one hand, and feeling ignored and isolated on the other, especially in the first months after the birth when “the event” is over and they are confronted with the bewildering task of caring for an infant. One of the most important “tools” a doula in this community has is reassuring the new parent that they are already doing everything fine. Negotiating a liminal period while being told the answers are inside of you is precisely the act of becoming that is suited to design culture. It seems sensible and satisfying, if challenging. Which of course hides from view all the structural conditions that allow or prohibit such self-authorship!

KG: Discussions of spatiality and how the preexisting self is emplaced (both in the material body and in “labor land”) are threaded throughout this article. In some ways, these figurative mappings seem to gesture toward dominant Western narratives of discovery and conquest, albeit in the language of “optimization.” Is this rooted in a desire to control what might sometimes feel like uncontrollable processes (i.e., pregnancy and birth), or something else entirely?

AF: I think you’re right to point out the resonance with American settler-colonial themes of discovery and conquest, which usually feature the autonomous hero. Especially in Silicon Valley since the 1960s, the “final frontier” of self-discovery and self-mastery has been wedded to technological frontiers. This is the optimized-self movement in a nutshell, alongside Big Data in medicine, wearable tech, and rhetoric about the “future of humanity.” The desire to control is absolutely present here, but in birthing communities, part of the process of becoming self-actualized is learning to relinquish control. I have thought about control and trust as a dyad through which this process can be read. People marshal knowledge of various kinds and make claims about bodily capacities to negotiate who or what can be trusted, and who or what is in control. Here, trust and control are inverses: trust requires relinquishing control, and control comes from mastering that which is not trustworthy. Are women’s unruly bodies trustworthy? Can you trust a doctor who is embedded in institutionalized medicine and its misogynistic, racist underpinnings? Is diagnostic technology a misguided illusion of control? Do you, the childbearing person, have enough confidence to trust yourself and your decisions? Whether deciding where to birth, which professionals to have nearby, or which procedures to undergo, negotiations of trust and control are in the forefront. The simple desire to control via technology might result in something like a scheduled cesarean, which in the communities I frequented was a disciplinary figure that represented (ironically) being out of control, wrongly or harmfully controlled. This is interesting because it reminds us that the cultural history of Silicon Valley is not simply about trusting and elaborating technology, but that this evolved alongside a counterculture that valued natural living, questioning institutions, and spiritual self-cultivation.

KG: The ways in which animality is understood as an innately human primordial power that can be harnessed for self-actualization raises many potent questions. As you note, it is imagined as universal and inherent to all individuals, rather than something that is cultivated through particular experiences. Are there tensions between this universalism and the numerous choices presented by doulas and medical providers to childbearing people? Did you ever encounter situations in which this configuration of animality was contested or experienced differently?

AF: Actually, I found animality to be posited as both universal and cultivated. That’s the really interesting paradox, and what gives judgments around childbearing their uniquely biting power. Human animality, in my fieldwork, was ambiguously positioned as something you should “innately'' know, yet also something you can and should “do.” For example, producing breast milk, or interpreting a cry, or grunting during labor. Because of this ambiguity, a childbearing person can be faulted and blamed in numerous directions: your body failed you, you failed your body. The locus of cause here is really slippery – what enables animality, versus what does animality enable. There were certainly situations where people avoided or rejected cultivating their animality, but they still grappled with it conceptually, and subordinated it to their own self-cultivation in which they decided it would play a lesser role. In these situations, the self is still paramount and articulated vis-à-vis both rational management and inherent embodied capacities.

KG: The role of culture occupies an interesting place in these birthing practices, especially in a place as diverse as Silicon Valley. You write that few childbearing people cite cultural heritage when making decisions—rather, they are subject to significant pressure to “self-invent” in an environment where claims that are “innovative, disruptive, and original” are seen as more authoritative (620). This is juxtaposed with moments such as a start-up providing a South Asian tea that stimulates milk production or a doula ceremony appropriating a Navajo custom. To what extent is this made possible by the whiteness at the core of American birth movements, wellness culture, and the technological sector? How are these racialized dynamics and privilege acknowledged or silenced by childbearing people and birth doulas?

AF: This is a great question. Wellness culture, the tech sector, and a number of my clients, friends, and interviewees were indeed highly shaped by whiteness, and not just demographically. Whiteness in an expansive cultural sense is very much a factor in the authoritative, aspirational birth culture in Californian cities, such that people who are not themselves white also participate in it. This culture of whiteness is deeply informed by settler-colonialism and presumes a kind of a frontier logic of escaping constraints and self-reinventing upon a “blank slate.” The blank slate has a dual aspect. First, in positioning oneself as loose from cultural ties and responsibilities. Second, in taking the “resources” to enable this personal self-invention in a way that does not account for or sustain reciprocal ties to the people, places, and cultures from which these resources derived. The article I wrote is focused on white and privileged communities, but there is a vibrant presence of race-aware reproductive justice advocates among doulas and Bay Area birth communities, such as the Black Women Birthing Justice collective and Bay Area Doula Project that serves incarcerated communities. Social institutions stemming from the white birth movement are grappling with racism, allyship, and privilege, with mixed results.

It seems to me that the value given to animality and “the primordial” in childbearing communities is related to the fetishization of “authenticity” often found in white gentrification. It’s a way of seeking an anchor in a context of uprootedness—of counteracting a generic, disconnected, institutionally-produced experience that has in fact been quite exclusive historically, whether a technologically-mediated hospital birth or new-build housing development. There is a very troubling strain of these animality discourses that locates the justification for “paleoparenting” in the practices of primates and human societies presumed to be “closer” to them, reinforcing a racist civilizational evolutionary hierarchy. This strain seeks to short-circuit the cultural nature of literally any human childcare practice by classing some of these as more or less biologically “authentic,” and this is a concern that is deeply shaped by whiteness and its colonial history.

KG: One of your central arguments is that self-actualization practices regarding childbirth reinforce “social politics of non-relationship, of being not-accountable for each other” rather than the autonomy they promise (625). What do doulas make of this turn toward the self, rather than relational sociality? How do they reconcile this with the very communal and intimate nature of entering into a caregiving relationship with a childbearing person?

AF: Well, non-relationship is a corollary (or an extreme) of autonomy. It’s not an either-or, a bait and switch where people are promised autonomy and end up with alienation. Rather, there’s this fundamental ambivalence about whether and to what extent autonomy is good. I think this is related to the way doulas exist as both “a niche commodity for bespoke care and an activist platform for birth reform” (606). Most doulas I encountered would extoll the benefits of both autonomy and relational sociality, with differing awareness of a potential contradiction; but the way they fostered each would depend largely on the socio-economic situation of themselves and their client. Ironically perhaps, the greater autonomy a childbearing person already had (via wealth, profession, age, white privilege, etc.), the more emphasis seemed placed on cultivating desires and designing self-knowledge. For people who were more structurally dependent, the aid that doulas offered could be far more practical, including how to access welfare resources, negotiate housing, and fight for rights within hospitals, alongside encouraging self-confidence. Some explicitly activist doula groups would promote awareness of structural racism and exploitation in their materials and meetings, though I do not know how this translated into their work with childbearing people.

In my experience volunteering with a home for vulnerable childbearing women, the “value” of the doula’s work was a site of contention between the middle-class doulas and struggling clients, since it was not mediated by a financial transaction. Yet in all cases, as you point out, the actual practice between doula and childbearing person is inevitably intimate and focused on caregiving. This is true whether the doula is paid or unpaid, though that difference is quite important in other ways. There is a model of autonomy-within-relationship in this kind of intimate care, which I’ve written about in a forthcoming paper as “attuned consent.” Perhaps in its best light, doulas learning and practicing attuned consent is a way to actually sidestep this ambivalence about autonomy and its extremes. Yet this doesn’t fully resolve the contradictions between doulas offering individualized and individualizing modes of childbearing care (especially when framed as an economic transaction) and doula knowledge traditions that value relational sociality, largely inherited from community midwifery.

KG: Reading your article, I was repeatedly struck by the anxiety, disconnection, and senses of personal failure that some of your interlocutors must have felt due to this neoliberal focus on self-optimization and the structural pressure often put on the childbearing parent. How is failure defined, experienced, or rehabilitated, particularly in a setting so focused on creating “individualized, exclusive, technical solutions for a problem that might otherwise be solved by collectively restructuring working conditions, gender relations, and state responsibility” (622)?

AF: Indeed, the specter of failure looms large. I found, though, that it was frequently acknowledged. For example, at a film screening about the microbiome and birth, the doulas and midwives present discussed this being a film for providers and not parents because more guilt is the last thing moms need. Failure, guilt, and shame were all linked, because it is such an intimate failure, at something presumed so “natural” and indeed cultivated as such. As I discuss in the essay, childbearing anxieties are increasingly focused on failure at individual self-actualization rather than failure at being a woman in a gendered matrix of responsibilities predicated on the nuclear family. Nevertheless, there is still a component of anxiety about womanhood traditionally defined, including for trans and queer people who feel ambivalence or animosity towards such womanhood. The idea that there is “no right answer” to parenting and birth can emerge in reaction to this pervasive sense of risk of failure, while paradoxically entrenching the alienated, individualized responsibility that colors the experiences of failure it seeks to salve. People giving birth are pressured not only to achieve the thing, but also to decide what it is! Such openness might feel liberating were it not for the broader cultural context that lauds optimization, promoting the idea that there is in fact a “best” thing out there. I can imagine this aspirational, optimized, self looming in one’s peripheral vision as one goes about transitioning into parenthood with the tools at hand.