This reading group guide for The Doula includes an introduction, discussion questions, ideas for enhancing your book club, and a Q&A with author Bridget Boland. The suggested questions are intended to help your reading group find new and interesting angles and topics for your discussion. We hope that these ideas will enrich your conversation and increase your enjoyment of the book.


Introduction

Caroline Connors felt lost in her life until she found her calling as a doula, a birth coach trained to support women through childbirth. When her best friend Mary Grace experiences complications during labor, Caro steps in and saves the baby’s life, but when Mary Grace dies in childbirth her husband blames Caro. Charged with a medical malpractice suit, Caro must endure a trial that threatens her professional future, questions her identity as a doula and a friend, and forces her to confront a dark past that she’s been hiding from for years.  

Topics & Questions for Discussion 

1. Caro looks up to women like Ruby, Marilyn Hanover, Pixie, Mary Grace and Annabelle as role models. What qualities do these women share that Caro admires? Who are the role models in your life?
 
2. Discuss the role of mother figures in Caro’s life. How does not having a mother who is present for her influence Caro’s character? How does she substitute others for this role?
 
3. Caro describes the tragic summer at the lake as the end of her childhood. In what ways did the circumstances prematurely usher her into adulthood?
 
4. How does Caro try to protect both Momma and Mary Grace? Why do you think she chose to take on their secrets? Have you ever been placed in a similar position?
 
5. Did Caro overstep her bounds during Mary Grace’s labor? Discuss why or why not.
 
6. Caro describes a fine line between birth and death. At what points in the narrative is this line especially blurred?
 
7. Discuss the themes of medical ethics, spirituality and personal morality throughout The Doula. How does each theme impact Caro? Are there any other themes that stood out to you?
 
8. In what way is the lake a source of both refuge and fear for Caro? For the entire Connors family?
 
9. Do you believe Michael is the best match for Caro? What kind of future do you think they could have together?
 
10. Caro describes an almost sixth-sense feeling in situations like Paulie’s death and Mary Grace’s delivery. Were there any instances where she should have paid closer attention to her instincts? How much weight do you put on your own personal instincts? Has there ever been a time where you wished you had followed your gut? Discuss.
 
11. The Doula discusses the many childbirth options available today. Do you feel it was biased toward or against any particular delivery method? In your opinion, should births be treated more as a natural life process or a medical emergency?
 
12. Do you know anyone that has used either a doula or a midwife? After reading this novel, would you consider having a doula present if you or a spouse/partner were in labor?
 
13. Caro sees her family as flawed, while outsiders view the Connorses as an ideal family. How are both true?

Enhance Your Book Club

1. Discuss the different types of birth options available to women today—from an at-home water birth to an elective C-section—and the merits and risks of each. For reference and additional information, read Ina May Gaskin’s Guide to Childbirth, and visit the official website for Doulas of North America at www.dona.org to learn about the history and roles of doulas.
 
2. Watch The Business of Being Born, a documentary by actress Ricki Lake and filmmaker Abby Epstein, about the maternity care system in America. Compare the opinions in the film with what you read in The Doula.
 
3. Take a yoga or meditation class with your book club. Note any similarities in the breathing techniques with the methods Caro describes as using with her clients. Do you feel more relaxed? To find yoga classes near you, visit www.yogiseeker.com or www.forrestyoga.com.   
 

A Conversation with Bridget Boland 

You make clear distinctions between hospital births and “alternative” births throughout The Doula. What are your views on the variety of modern childbirth options?  

Modern advances in medicine minimize complications and maternal and fetal death rates. But I am concerned about the almost exclusive attention we currently place on the physical act of birthing. Climbing rates of inductions, epidural use, and C-sections alarm me. Yes, birth oftentimes involves pain, and in some cases interventions are warranted, but when we numb an experience as significant as giving birth we mask not only the discomfort but also the incredible sense of accomplishment that accompanies it.

After the myriad births I served at as a doula—in hospitals, birth centers and homes—I chose to birth my son at home with the support of a midwife and a doula. It remains the most empowering experience of my life. But home is not the location in which every woman feels most comfortable delivering. The philosophy I adopt with my clients is that there is no one “right” way to have a baby. I encourage them to view the process as more than a medical event; it’s an emotional, mental, spiritual journey, one that requires preparation and attention in each of those realms.

We can make any birth a ceremonial, holistic experience, even a C-section in a hospital operating room. Locale is only one component to mindful birthing. My vision is that we as a society offer women and their families support and resources to create a true rite of passage around giving birth. For more on this topic, visit www.bridgetboland.com.

How did your personal experience of switching careers from a medical malpractice attorney to a yoga teacher, shamanic energetic healer, and doula influence your writing? Was the trial of Mary Grace’s death inspired by any real-life events? How much did you draw upon personal experience?  

I’ve always loved mysteries, and I’m fascinated by the greatest mystery of all: Who are we? I’m a “seeker” at heart, and I like the metaphor of life as a journey. I’m constantly evaluating my experiences for what I can learn from them and tracking my own personal evolution. Many of the clients I see in my shamanic energy medicine practice are also looking to awaken to their life’s purpose and create it. Writing is another way to explore what it means to be human. I drew upon what I gleaned from my own long and winding path to help me understand and portray Caro’s journey.

Mary Grace’s death and the trial wasn’t so much inspired by real-life events as by me asking the question, “What if . . . ?” The first thing I did after I became a doula was look for malpractice insurance, since the lawyer in me was concerned about the possibility of being sued. I couldn’t find coverage of any kind back then, and wondered what would happen if I did find myself in the position of practicing medicine without a license. So perhaps the book started as a kind of defense mechanism, a place to work out my fear about what I would do if faced with that choice in real life.

In terms of the rest of the book, it’s a mix of autobiographical material and pure fiction. I won’t spoil the fun of speculation by revealing which is which.

Furthermore, what inspired you to make this dramatic professional move from an attorney to a doula?  

I like to think it was destiny! I had always been very interested in medicine and helping people. My mother is a nurse, her brothers are funeral directors, and I was premed (very briefly) in college. When I chose law as a profession, I picked medical malpractice as my specialty. But for me, the legal realm was too far removed from the lives of the people involved. I felt as if I was doing damage control after the fact rather than aiding people in a time of need. My father is also an attorney. Ironically, his passion for the law reflected back to me that I didn’t feel the same way. So I set out to discover just what it was I did feel passionately about.

Writing was one thing, health and wellness another. So I took an MFA in creative writing, and also attended a yoga teacher–training course with Ana Forrest. I had no idea how I’d make a living after I completed these educational bits, which understandably caused some worry for the folks back home.

Then a cool thing happened. During the yoga teacher–training, we were asked to write down what we wanted to create in our lives. I wrote goals around teaching yoga, finding a boyfriend and writing. Then “midwife” appeared on my page. I stopped short, trying to make sense of where that had come from. Then my brain devised the “logical” explanation that writing characters was a kind of midwifery, and I went on about completing the list.

Six months later, a student in my yoga class became pregnant. She asked if I had ever heard of a doula, and told me she’d like me to be hers. I immediately recalled that list I’d made in training and said yes. Then I had to take the doula certification so I could know what to do when her birth time arrived. That string of events taught me an invaluable lesson about trusting my instincts and following them even when I wasn’t sure where they would lead.

What kind of research did you do in preparation for the many technical aspects of labor and delivery discussed in The Doula? Were you surprised by anything you learned?  

Both my legal background and my doula training provided a lot of knowledge about what happens in labor and delivery. I also consulted with an obstetrician, midwives and several doulas, relying on their expertise to enrich my own. I pored over every book and DVD on childbirthing I could get my hands on. I especially appreciated Ina May Gaskin’s Spiritual Midwifery and the documentary film The Business of Being Born.

One thing that really surprised me came from Catherine Taylor’s book, Giving Birth. In it she lays out the similarities and differences between hospital, birth center and home births. At the time, I was pregnant and thinking that I would do a natural birth with a midwife in a hospital setting. This felt like the best of both worlds; I’d have a nurturing care provider sensitive to the holistic nature of birthing with all the resources of modern medicine available in case we needed it.

I was surprised to learn that because hospital-based midwives must adhere to the same policies as the OBs on staff, such as limits on the length of time women are allowed to labor without intervention, their care options are often constrained to those that follow the dictates of the hospital. The likelihood of interventions such as induction drugs, breaking the bag of waters and C-section is often as high with a hospital midwife delivery as with an OB. And many midwives work in practices similar to doctors’ groups, which means the midwife who sees a client for many months of prenatal visits and develops a relationship with her is not necessarily the one who will attend the client at delivery.

As you explain in the book, “doula” is a Greek word meaning “servant.” What first drew you to learn this practice and then write a novel about it?  

I first heard the term “doula” from my yoga student when she asked me to serve at her birth. I was honored she asked, but then had to rush out and register for DONA’s (Doulas of North America) training since I had never even heard of a doula before, let alone knew what one did. I left that first birth experience convinced there was nothing we do as humans that is more important than bringing new life into the world. It’s such an act of courage, hope and love.

Since that first birth, I’ve served women who delivered naturally in hospitals, those who chose epidural or other medications for pain relief, some who had uneventful and beautiful home births, and others who planned for a home or birth center birth but wound up in a hospital, having every possible intervention, including a C-section. What I became aware of was that, regardless of how the birth actually occurred, what seemed to matter most in terms of how the mother felt about the experience afterward was whether or not she perceived the outcome was the result of her own educated choices versus being told what to do by a care provider. I began to see the need for education about all the possibilities childbirth holds, particularly the emotional support doulas provide, and I wanted to offer that in a compelling manner instead of in a textbook.

Finally, I like to think Caro herself had a hand in insisting this book be born. Prior to The Doula, I wrote exclusively memoirs. I’d convinced myself I didn’t have the imagination to tackle fiction. Then one morning, I woke up to a tentative voice whispering in my head. It said, “Other women have babies. I watch.” That grabbed my attention. I wanted to know who the voice belonged to. I went to my laptop and the opening of the book emerged from that first whispered confidence.

Why do you think the field of doulas is growing so rapidly—from 750 to 5,842 between 1994 and 2005? Why tackle the subject now?  

Happily, I think this is the result of a new level of consciousness about the profound nature of childbirth. Trends occur in birthing; home births were the norm until fairly recently. In most cases things went well. But when they didn’t, the results could be catastrophic. With the advent of hospital birthing came reliance upon the medical expertise of health-care providers. For a while “twilight sleep” was a popular way to deliver. An era of women birthed essentially unconsciously. Now, as more women realize that birth is not so much a nuisance to be endured as a powerful rite of passage, they’re looking for care providers who are trained in accompanying them on that journey. Doulas are uniquely qualified to offer emotional and spiritual support so physicians, midwives and nurses can focus on the physical care of mom and baby.

As a doula, have you ever had to “cross the line” into the medical realm during a birth? What was the outcome?  

Thankfully, I’ve never been faced with the prospect of what Caro had to deal with, although at one birth my client’s water broke and the nurse and I had just enough time to move her from the birth ball onto the bed before she delivered. The delivery happened in less than two minutes. The OB didn’t make it in time but the nurse took the role of “catching” while I tended to Mom—and Dad, who was too stunned to do anything!

I have, however, been faced with scenarios where I’ve felt it necessary to respectfully remind caregivers about the benefits of certain comfort measures like perineal massage, which can keep a woman from tearing badly during delivery. Many Western physicians simply aren’t trained in these techniques and their benefits. I often walk a fine line between advocating for my clients’ best interests and deferring to the medical practitioners’ preferred methods of practice. The negotiating skills I learned in my legal career come very much in handy in these cases.

On your website, www.bridgetboland.com, you describe yourself as a “pilgrim at heart.” How was Caro’s pilgrimage to Milwaukee a turning point for her?  

Stephen Cope and Carol Pearson write about the universal archetype of the Wanderer: the heroine hears a mystic call, journeys forth and undergoes great testing in order to reach a goal. The Wanderer intentionally sets out to confront the unknown, taking a journey that marks the beginning of life at a new level. The Wanderer sets off, always alone, on the “road of trials,” which is the initiation into heroism. The Wanderer is visited by an intense but unsettlingly vague sense of homesickness. She is not sure where home is, but she knows that she will recognize it when she sees it, and she knows that she must pursue it at all costs.

This is the archetype I wanted to explore through Caro. Her move to Milwaukee marks a new way of engaging with the world. For Caro, the move itself constitutes a heroic act. It’s the moment when Caro finally chooses to participate in her own rescue.

As a first-time novelist, what writers inspired you? What did you find most challenging about the process?  

I love to read, so the list of writers who inspire me could be pages long. But some of my all-time favorites include Barbara Kingsolver (The Poisonwood Bible), Audrey Niffenegger (The Time Traveler’s Wife), Marisa de los Santos (Belong to Me), Isabel Allende (The House of the Spirits), Diana Gabaldon (the Outlander series), Wally Lamb (She’s Come Undone), and Abraham Verghese (Cutting for Stone).

The most challenging thing about the process was feeling so new to it. Grappling with the sheer length and amount of material a novel requires felt awkward, like feeling my way in a dark tunnel scene by scene toward the final resolution. For me, finding the plot is challenging. I typically start out with characters who bring me an idea or issue to explore. Then the plot makes itself known as I discover the particulars of how the characters encounter and interact with the themes.

What’s next for Caro? Do you see a future for her and Michael? Are you working on any new projects?  

My hope for Caro is that she continues to discover herself and live courageously. When I think of her after this book ends, I actually see her traipsing around some foreign country, volunteering in orphanages and further expanding her boundaries. Sometimes I get the impression that Oliver joins her on some of her travels as a strictly platonic soul mate. Both Michael and Oliver were instrumental in helping Caro discover herself. Now that she’s reconciled her past, she’ll have to decide what kind of life she wants to craft for her future.

I always have new projects in the works. I’m currently writing a “domestic” novel about a marriage struggling to survive in the wake of every parent’s worst nightmare: the death of their child. The tragedy is deepened when the father is convicted of murdering the little girl. I’m curious to explore how the human spirit endures such incomprehensible loss.

What is your favorite yoga pose?  

It’s so hard to choose, since every one has its own benefits and gifts. I love backbends like Urdhva Dhanurasana (wheel, or upward-facing bow), because they invigorate the central nervous system. And inversions like the handstand are amazing for offering a new perspective on things, since they literally turn the world as we know it upside down.