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Activism and Patient Vulnerability 

FOLKLORICA 2022, Vol. XXVI 

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Activism and Patient Vulnerability: Resistance to Medical Authority and 
Regulation in Russia 

Tatiana L. Kuksa 
Center for Medical Anthropology, Institute of Ethnology and Anthropology 

HSE University, Moscow, Russia 

Abstract 

The paper analyzes the opposition and adaptation of Russian patients, 
independent perinatal specialists, and professional human rights activists to 
normative regulation of obstetric care, medical authorities, and the practices of 
the Russian maternity hospital. During my ethnographic research, I have collected 
personal stories about the clashes of women in labor and their assistants (primarily 
doulas) with the medical system, stories of collective and individual appeals to 
authorities, and protest flash mobs. The article presents the history of the 
transformation of the Russian system of obstetrics and the development of 
grassroots movements by midwives and doulas. It outlines the features of human 
rights and perinatal protest discourses and identifies the tactics of legal and 
vernacular resistance and non-resistance to medical authorities encountered 
during fieldwork. 

Introduction (1) 

In the course of ethnographic research starting in 2017, I have collected 
contemporary birth narratives describing the decisions and interactions of women 
and their families with medical professionals and midwives, doulas, and other 
external perinatal specialists. In narratives from the Soviet and post-Soviet eras, 
there was practically no mention of independent choice and freedom of action in 
medical institutions and official discourses, or indeed of the involvement of 
family members or independent participants in medical care during childbirth 
[Belousova 2003, 2012; Olson and Adon’eva 2013; Rivkin-Fish 2005; Rouhier-
Willoughby 2003, 2008: 66, 91]. However, in contemporary narratives, Russian 
women convey their agency in some detail and negotiate with the obstetric system 
for various options [Gramatchikova 2020; Kuksa 2020b, 2021a, 2021b; Kuksa 
and Shnyrova 2021; Temkina and Rivkin-Fish 2020]. Thus, my fieldwork shows 
that women now plan and shape the birth process much more than they did in first 
two decades after the fall of the USSR. 

This more active patient position of Russian women is connected primarily 
with grassroots activities and training by independent perinatal specialists 
(midwives and doulas). As a rule, they have had several children, hold college and 
graduate degrees (often both), and had a different experience in childbirth, either 
at home or in the hospital, than the average woman. These midwives and doulas 
construct the boundaries of patient agency and teach tactics to overcome bodily 
and mental vulnerability. They also interact with doctors during labor and delivery 



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and provide variety of non-medical support for women at all stages of the birth 
process [Kuksa 2021a, 2021b]. 

My analysis of both discourse and narratives from independent specialists 
reveals how and why women have become more active in pregnancy and 
childbirth as well as demonstrates the role of grassroots activists in legal and 
vernacular protest to medical authorities. As Kleinman [1978] wrote, each group 
of “agents of care” (from popular, folk, and professional arenas of the health care 
system) has its own “explanatory models” of health/sickness with its specific 
idioms—abstract or concrete, technical or non-technical, impersonal, or highly 
personal—that they need to convey to each other. He has argued that there are 
conflicts “between professional medical (especially biomedical) explanatory 
models that construe sickness as disease and lay (popular culture) explanatory 
models that construe sickness as illness” [1978: 88]. Given the multiplicity of 
“agents of care” and actors during delivery and their divergent interests and 
expectations, I explore representations of birth (including popular, folk, and 
professional explanatory models) and the interpretations of experiences from 
different perspectives, including of the patient and her family, physicians, the law, 
and perinatal specialists. According to Bakhtin’s theory of speech genres [1986: 
159], we must approach the analysis of speech utterances as a dialogical and 
interactive process that considers speaker and addressee goals and genres that they 
may choose and use in certain contexts. In this paper I will apply Bakhtin’s and 
Kleinman’s conceptual approaches to reveal the multiplicity, polyphony and 
heteroglossia of discourses by participants in childbirth. Participants’ models and 
discourses rely on speech genres with variable meanings and functions that are 
affected by legality, legitimacy, degree of stigma and contexts (or frames) 
[Bakhtin 1986]. 

The grassroots activism and legal or vernacular tactics of resistance to 
medical authority described in this article are only formally similar to American 
feminist and anthropological critiques of biomedical and technocratic childbirth 
in favor of individual “control over childbirths” [Davis-Floyd and Sargent 1997; 
Rapp 1999; Sargent and Gulbas 2011]. In this framework, we would be forced to 
classify tactics to counteract medical authorities as part of a contemporary 
feminist agenda and as a struggle for political and neoliberal rights and social 
control over reproduction. Any evaluation of grassroots activism and legal and 
vernacular protest in Russia must take into account the following essential factors, 
which the feminist approach ignores: 1) the variable meanings and functions of 
bureaucratic and vernacular texts (depending on genre, addressees and 
communicative contexts (or frames) [Bakhtin 1986; Kuksa 2020b]; 2) differences 
between collective and individual forms of legal prose; 3) obstetric policies at 
different regulative levels and in local contexts [Kuksa 2021b]; 4) illegal and 
stigmatized homebirth practices, which are difficult for ethnographers to observe 
[Kuksa 2018, 2021a]; 5) recent medicalization, financing, and technologization 
of Russian obstetric care; and 6) the majority of obstetricians and gynecologists, 
from the Soviet era to the present, are women, unlike in the United States [Kuksa 
2018; Rivkin-Fish 2005; Rouhier-Willoughby 2003, 2008; Sargent and Gulbas 



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2011]. My approach highlights how informants reclaim agency in vulnerable 
situations and their oppositional and adaptive tactics when interacting with the 
obstetric system. A primary avenue is hiring independent midwives and doulas, 
and this paper will focus on how they have been able to resist and even transform 
the birth process, at least for some women. 

This research is based primarily on a corpus of semi-structured in-depth 
interviews collected from doulas, midwives, physicians, and parents living in 
Moscow and Saint Petersburg (since 2017) or in cities located in the Central, 
Northwestern, Volga, the Urals, Siberian, and Far Eastern Federal Districts (since 
2020). For this article, I have also relied on data from an online survey of 
Muscovite and regional perinatal specialists conducted during the COVID-19 
lockdown in spring and summer of 2020 on the attitude toward medical 
interventions by women in labor. I have explored federal statutes regulating 
childbirth as well as materials from medical, midwife and doula conferences, 
lectures, and training sessions, which I attended as a participant or online listener. 

I focus on documented digital and verbal opposition to the practices of 
Russian obstetric institutions. In particular, I study midwife, doula, and parental 
discourses and resistance tactics used by human rights activists, independent 
perinatal specialists, and laypeople. In this article, I present the most characteristic 
methods for legal and vernacular resistance to medical authorities as well as 
opting-out (e.g., home birth) encountered in my research. I analyze the 
dependence these types of resistance on the agency of parents and perinatal 
professionals in the contemporary maternity hospital. 

The practice of written refusal of a woman in labor to routine medical 
interventions is a relatively non-confrontational and common form of the 
mobilization of law. It is guaranteed within a legally stipulated framework of 
informed consent to medical intervention. Private conflicts at the grassroots level 
are resolved through individual complaints, appeals and, less commonly, lawsuits 
initiated by patients to compensate for harm done to them, investigate medical 
misconduct, and hold medical professionals accountable for their actions. The use 
of petitions signed by citizens (usually unknown to one another) to protect women 
generally also mobilizes the law through a collective appeal to state authorities or 
as part of a class action lawsuit [Kuksa 2011; 2020a]. All three variants of routine 
law enforcement and legal conflict fall within the framework of the concepts of 
“everyday legality” [Ewick and Silbey 1998, 2003] and “law mobilization,” a 
term coined by Black [1973, 2010] to express that the law exists not on paper, but 
only when citizens use it to protect their rights. These legal tactics display overt 
women’s resistance to medical authorities in the maternity hospital. 

While legal tactics are used by some, the more common approach to counter 
medical authorities is vernacular resistance. Vernacular articulation of the 
problems of patient rights and agency and the physical and mental vulnerability 
of pregnant women, women in labor, and mothers is seen in online protest flash 
mobs and accusatory discourses. In my view, they serve the same function— 
resistance to and protest of the system—as urban folklore about medicine. Urban 
lore about doctors, hospitals and diseases exists in a variety of genres, including 



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rumors, gossip, fakelore, and conspiracy legends, and expresses dissent with 
institutional medicine and treatment (for more on this topic, see Kitta 2019). I 
examine “victim” narratives and accusatory texts distributed by perinatal 
specialists and women who have experienced psychological and bodily trauma in 
a maternity hospital from three perspectives. First, these texts function as a 
“socially sanctioned outlet” for protest [Dundes 2003] and a modern ritualized 
form of behavior [Rouhier-Willoughby 2003, 2008; Kitta 2019]. They also help 
narrate and contextualize psychophysical experience [Kleinman 1978; 
Khristoforova 2020; Kuksa 2020b]. Finally, they allow for “symbolic resistance” 
(what Scott calls the “weapon of the weak” [Scott 1985]) by traumatized women 
and independent perinatal specialists not embedded in the medical and 
bureaucratic hierarchy. 

A distinctive feature of grassroots perinatal movements in Russia are forms 
of female opting-out that express dissent, but that are invisible to bureaucratic 
institutions—by analogy with Yurchak’s concept of “outsideness/out-of-reach” 
[Yurchak 2014: 267-270, 563-571]. Yurchak applies this concept to the Soviet 
citizen, who discursively and performatively shifted authoritative ideological 
discourses towards their own interpretations. They include illegal practices of 
home and solo childbirth among Russian educated women, which are stigmatized 
in the institutional space and were especially popular in 1990s and 2000s 
[Belousova 2003, 2012; Kuksa 2018, 2021a, 2021b, Kuksa and Shnyrova 2021; 
Rouhier-Willoughby 2008]. I also have recorded a surge in home births since the 
spring of 2020, especially outside of Moscow. They resulted from the introduction 
of anti-COVID restrictions that reduce the agency of women in local hospitals, 
e.g., prohibition of partner- or doula-accompanied births and separation of mother 
and child (discussed in more detail below). 

Transformation of the Russian System of Obstetrics  

Russian women can exercise their agency and opt for a delivery in 
accordance with their expectations as a result of the transformation and financing 
of obstetric infrastructure over the past two decades. Some key historical events 
resulted in a shift in the system toward a focus on women’s needs and the 
development of grassroots movements dedicated to parenting and the training of 
midwives and doulas. 

As a result of federal funding for the Delivery Certificates program in 2006, 
regardless of the mother’s place of residence (as recorded in the propiska [official 
place of residence indicated in the person’s passport and state accounting 
system]), a pregnant woman received the right to access any Russian maternity 
hospital within the framework of compulsory medical insurance (hereafter CMI). 
CMI was introduced in 1991 to ensure the constitutional right to free medical care 
and protection of the health of the citizenry. Patients thus present an insurance 
card and receive a Delivery Certificate (in electronic form as of July 2021) from 
a medical institution, which guarantees coverage for medical services (e.g., 
prenatal clinic, maternity hospital, or children’s clinic) from the Social Insurance 



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Fund or its regional branches. However, actual choice among obstetric 
organizations, according to the testimonies of interviewees, was primarily 
implemented only in large cities, where there are enough hospitals to create real 
competition for CMI and private deliveries. 

At the initiative of the Moscow-based obstetrician-gynecologist Mark 
Kurtser, founder of the only network of private maternity hospitals in Russia (2), 
since 2006, midwives at the Moscow Center for Traditional Midwifery and 
Family Medicine (hereafter CTM (3)), could legally accompany women in labor 
only in one pilot program at the 6th Maternity Hospital (now closed). These trained 
professionals from CTM taught natural childbirth and promoted the popular 
approach of “soft childbirth.” Tamara Sadovaia, the founder of CTM and 
“traditional” midwife, defined this term as follows: 

«Мягкие роды» — это организация условий для проведения 
естественных родов с максимальным использованием внутренних 
резервов женщины и минимальным медицинским вмешательством. 

[“Soft childbirth” is the organization of conditions for natural childbirth 
with the maximum use of the woman's internal reserves and minimal 
medical intervention] [Tamara Sadovaia, 14 April 2018]. 

Today CTM works officially with some Moscow maternity hospitals and doctors 
with a unique program for personal obstetric services, which include non-invasive 
anesthesia and other “soft” treatment practices designed to benefit women and 
children, as Sadovaia discusses: 

Мы абсолютно легитимно работаем. В нашей инструкции нет 
никаких нарушений отечественных стандартов практики 
[протоколов]. Может, это для кого-то звучит парадоксально. То, что 
мы называем торопить роды, то, что мы называем агрессией и 
насилием в родах — это не отображено в стандартах [протоколах], 
это просто стереотипы и дурные привычки нашего постсоветского 
акушерства, с которым мы стараемся как-то работать и их 
искоренять. Наша практика, которая говорит о том, что женщина 
имеет свое время, она может рожать долго и она может рожать в 
любых позах не только в первом, но и во втором периоде, что мы 
можем использовать воду. 

[We are absolutely legal. There are no violations of domestic standards 
of practice [protocols] in our instructions. Maybe it sounds paradoxical to 
someone, what we call birth, what we call aggression and violence in 
childbirth—this is not reflected in the standards [protocols]. These are 
just stereotypes and bad habits of our post-Soviet obstetrics, with which 
we are trying to somehow work and eradicate them. Our practice, which 
says that a woman has her time, she can give birth for a long time, and 



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she can give birth in any position, not only in the first, but also in the 
second period, that we can use water.] [Tamara Sadovaia, 19 March 
2018] 

The 2011 federal law “On the basics of protecting the health of citizens in 
the Russian Federation” № 323 (hereafter 323-FZ) guarantees the option for 
partner-accompanied childbirth (with a husband or another family member) 
without a fee (using CMI). However, it is subject to the availability of a ward in 
a maternity hospital, and the partner must submit medical test results, the extent 
of which may vary in practice (due to the lack of an exhaustive list of required 
tests in the law and at the discretion of the hospital) [Kuksa 2018, 2021a, 2021b]. 
A freelance obstetrician-gynecologist at the Moscow Department of Health in 
2019 reported on the positive impact of spousal participation in childbirth and said 
that a third of Muscovites have partners in the delivery room [Olenev 2019]. For 
the last ten years, two dozen Moscow maternity hospitals (with the exception of 
three specialized ones) have offered the option of partner-accompanied births, at 
least with the father of the child. 

The situation with non-familial support is somewhat different. At first, 
doulas worked exclusively outside of medical institutions. After 2011 
independent personal, non-medical support of childbirth was arranged through 
private (paid) contracts in some maternity hospitals [Kuksa and Shnyrova 2021]. 
Later, birth partners without a medical education were allowed (since 2015 in 
some Moscow maternity hospitals) without confirmation of a kinship relationship 
(effectively as quasi-relatives). Occasionally they have been admitted as unpaid 
volunteers since 2018. Doula services, especially in the case of informal 
admission as quasi-relatives to deliveries with CMI are much cheaper for clients 
than paying for two separate contracts with a maternity hospital and a medical 
center of midwifery. This fact allows doulas to compete for clients who do not 
have the financial means to hire an individual midwife for the delivery, as a 
Moscow doula describes below: 

Сейчас независимым акушеркам, не работающим в центрах типа 
ЦТА или Акушерство клаб (у центров есть лицензия на 
медицинскую деятельность и официальные договоры с роддомами), 
нет нужды мимикрировать, они оформляются на кусочки ставки во 
все интересующие их роддома и таким образом имеют право 
работать как акушерки в роддоме. Прямо роды принимать. 
Роддомам это выгодно, чтобы купить контракт с такой акушеркой, 
необходимо купить контракт с самим роддомом. Мимо роддома 
нельзя. То есть 100–150 [тысяч рублей] роддому плюс 50–60 [тысяч 
рублей] за акушерку. Это вам не с доулой по ОМС пойти 

[Now independent midwives who do not work in centers such as CTM or 
The Obstetrics Club (the centers have a license for medical activities and 
official contracts with maternity hospitals), there is no need to double up 



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[contracts], they are employed part time in all maternity hospitals of 
interest to them, and thus have the right to work as midwives in a 
maternity hospital. To attend a delivery directly. This is profitable for 
maternity hospitals, to contract with this kind of midwife, you need to 
contract with the maternity hospital itself. You can't avoid the hospital. 
That is, 100-150 [thousand rubles] to the maternity hospital plus 50-60 
[thousand rubles] for a midwife. This is much more expensive than with 
a doula using CMI] [Doula 2, 15 January 2020]. 

The popularity of independent midwives from the initial grassroots wave of 
perinatal specialists and family birth partners has contributed to the admission of 
new participants, namely those with no family ties or medical education, into 
labor and delivery. Non-medical and emotional support for a woman has become 
attractive for mothers with many children who are on maternity leave, for 
psychologists, and for other perinatal specialists, who may benefit from additional 
earnings [Kuksa 2021a]. It has promoted demand for private doula educational 
programs (like the Institute of Perinatal Support (4)). The availability of remote 
learning also has led to the spread of this occupation outside of Moscow and to a 
second wave of the grassroots perinatal movement throughout Russia. Activists 
united in the Association of Professional Doulas (hereinafter APD (5)) are trying 
to legalize the profession and the admission of trained doulas to maternity 
facilities [Kuksa 2021a]. 

The interviews collected for this study also indicate that individual choice 
of relevant management of childbirth (e.g., vaginal birth without intervention or 
after a caesarean, a “soft” caesarean, delayed cord clamping) and a variety of 
psychophysical practices (e.g., non-medicalized pain relief, freedom of 
movement, skin-to-skin contact with newborn during the first “golden hour” after 
birth) are in demand among pregnant women. Therefore, they require personal 
assistance by midwives or doulas from attending doctors, at least in paid contracts. 
However, generally women with childbearing experience and of financial means 
articulate this kind of agency [Kuksa and Shnyrova 2021]. According to my 
interlocutors, the farther from the larger cities, the more conservative the staff are 
in maternity hospitals. As a result, fewer opportunities exist for independent 
choice by women in these areas. Thus, regional and local features of the obstetrics 
system also play a role in a woman’s options and degree of agency. 

Therefore, diversity, competition, and interaction of providers and 
“explanatory models” of childbirth have contributed to the gradual transition from 
solo and home childbirth to “natural” and “soft” childbirth with a midwife in 
maternity hospitals (at least in Moscow, where independent midwives are legal) 
[Kuksa 2018, 2021a]. In addition, we see the rising popularity of spousal 
childbirth partners and professional doula support [Kuksa 2021a; Kuksa and 
Shnyrova 2021]. As a result, changes in obstetric infrastructure and policies have 
led to the “humanization” of Moscow maternity hospitals and competition among 
all the parties potentially involved in the process. Hospitals try to attract private 
clients of midwives and/or doulas, or patients with Delivery Certificates 



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requesting state-sponsored deliveries with partners or quasi-relatives (doulas). 
These social and legal changes have resulted in the introduction of more humane 
and patient-centered obstetric care (mainly in the private sector), the emergence 
of separate maternity wards and family wards in regional maternity hospitals, the 
development of medical “tourism” to Moscow for state-sponsored or private (for-
pay) deliveries with non-familial or familial support. Despite slow 
implementation of updated protocols of obstetric care by medical personnel, the 
grassroots movements by perinatal activists have transformed maternity hospitals 
to meet women's needs. They have likewise encouraged the active involvement 
of women in the training of delivery and legal protection of her interests in the 
maternity hospital, as we will see below. 

Protecting Patients: Official and Unofficial Approaches at the Individual Level 

The first wave of independent midwives, who established the Russian home 
birth movement, call themselves “materi-spetsnaz” [mothers-special forces]. This 
term accentuates the difficulty of survival under post-Soviet conditions of 
information isolation and lack of material goods. They, like elite troops, overcame 
these difficulties through active training and self-help, as a Moscow doula 
explains:  

Старая школа, 1990-2000-е годы, тогда был такой рассвет 
домашнего акушерства. Какой их основной посыл был? Женщина 
должна очень хорошо подготовиться физически к родам, взять на 
себя всю ответственность за роды и подготовиться. То есть 
обливание, баня, там закаливание, физические нагрузки. Вот 
физические. И тогда она хорошо выносит, хорошо родит. Взять на 
себя такую внутреннюю ответственность за этот процесс. И тогда 
было достаточно много самостоятельных родов, когда женщины 
всю ответственность брали и рожали без акушерки. Потом сами 
становились акушерками — вне медицинского подхода. Потом они 
заканчивали всякие медицинские, но потом. Сначала начали 
практиковать просто от посыла «мы взяли на себя эту 
ответственность». «Взять ответственность» — это первый посыл 

[Old school, 1990-2000s, then was the dawn of home midwifery. What 
was their main message? A woman should be very well prepared 
physically for childbirth, take full responsibility for childbirth and 
prepare. That is, washing with cold water, the bathhouse, hardening, 
physical activity. Those are the physical ones. And then she endures well, 
gives birth well. To take on such internal responsibility for this process. 
And then there were quite a lot of independent deliveries, when women 
took all the responsibility and gave birth without a midwife. Then they 
themselves became midwives—outside of the medical approach. Then 
they finished all sorts of medical [courses], but later on. At first, they 



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started practicing simply from the message “We took this responsibility 
upon ourselves.” “Taking responsibility” is the first message] [Svetlana 
Shnyrova, 17 February 2018]. 

As we see, the explanatory model of the first perinatal wave endorses 
psychophysical and informational preparation for the process and recommends 
that women take responsibility for decisions about financing and care. However, 
they regretfully note the tendency of Russian women to perceive themselves as 
passive subjects, rather than independent actors, as a Moscow midwife told me: 

Очень маленький процент женщин готовится к родам. […] Когда 
предлагаешь поработать в родах с ощущениями (поменять 
положение, подвигаться), отказываются, предпочитая анальгезию. 
Персоналу роддома на потоке невозможно работать иначе, чем 
стандартный протокол, так как только такой протокол обеспечивает 
безопасность мамы и ребенка в отсутствии возможности 
реализовать индивидуальный подход из-за нехватки персонала. Для 
женщины, идущей на роды осознанно, как субъект процесса, 
реализовать свой план родов возможно только либо по контракту с 
индивидуальными специалистами, либо активно отстаивая свою 
позицию, что в родах не всегда реализуемо, так как процесс родов 
достаточно яркий и требует несколько другого состояния, чем 
активное отстаивание своих прав 

[A very small percentage of women prepare for childbirth. […] When 
you offer to work a delivery based on bodily sensation (change of 
position, moving), they refuse, preferring analgesia. It is impossible for 
the staff of the maternity hospital to work differently than from the 
standard protocol, since only this protocol ensures the safety of mother 
and child in the absence of an option to implement an individual 
approach due to the lack of staff. For a woman who goes into childbirth 
deliberately, as the subject of the process, to realize her birth plan is 
possible only either through a contract with individual specialists or by 
actively defending her position, which is not always feasible during 
delivery, since the birth process is quite vivid and requires slightly 
different conditions than active defense of one’s rights] [Midwife 1, 7 
April 2020]. 

Doulas are ascribed illegal status at maternity hospitals, except when hired 
through private contracts or serving as official volunteers. Referring to the 
boundaries of competence and the concept of respect for patient choice, they 
support any decisions the woman makes, including requesting or refusing forms 
of (non)-medical care. This right lies at the core of the explanatory model of the 
second perinatal wave. Therefore, for ideological, practical, and ethical reasons, 
they rarely complain about the passivity of their clients. As a rule, doulas, like 



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midwives, blame the “conveyor” system in labor and delivery, e.g., the use of 
standard protocols to the detriment of a patient-centered approach, excessive 
medicalization to speed up labor, high burnout in the medical environment, and 
outdated practices that are convenient for doctors and bureaucrats, as we see in 
this excerpt from an interview with a Moscow doula: 

И всё до потужного периода более-менее естественно выглядело 
(они как бы встали на путь гуманизации). Но, когда женщина 
раскрылась в полное раскрытие, её, как обычно, посадили на кресло, 
собралась вся бригада, и её стали жёстко растуживать. […] А 
детский врач подошла и начала командным голосом: «Так, ребёнку 
очень плохо, он сейчас страдает, ты должна постараться, давай, 
делай вдох и тужься изо всех сил». Ну как обычно вот эта вот 
история, выпучив глаза, да? Акушерка ей показывает так пальцем: 
«Ну что ты ещё, дай ей спокойно войти как бы в процесс», а та 
показывает на часы: «Время, мне идти пора, давайте уже родим, и я 
пойду». То есть здесь включаются не интересы женщины, а 
интересы персонала — собрались около родильного стола: «ну 
давайте уже побыстрее её родим». И тогда всё в ход идёт 
эпизиотомия, потому что она ускоряет — расширили просто проход. 
А то, что у женщины потом будет на самом деле шов, там будет у 
неё достаточно глубокий рубец, там будут затянуты ткани. И это 
будет долго заживать — это целый месяц восстановительного 
периода. Потому что это шов, он болит, он как бы там стягивается, 
его надо обрабатывать, его нужно там, за ним ухаживать всяко. 
Сидеть нельзя. Ну, куча всяких неудобств 

[And everything before the active period looked more or less natural 
(they seemed to have embarked on the path of humanization). But when 
the woman was fully dilated, she was, as usual, put on a chair, the whole 
team gathered, and they began to heave her around roughly. […] And the 
pediatrician came up and began with a commanding voice: “So, the child 
is very bad, he is suffering now, you have to try, come on, take a breath 
and push with all your might.” Well, it’s the usual story, with bulging 
eyes, yes? The midwife points her finger at her, like this: “Well, what 
more do you want, let her calmly enter in the process,” and the 
pediatrician points to the clock: “It’s time, time for me to go, let’s give 
birth, and I’ll go.” That is, it is not the interests of the woman, but the 
interests of the staff—they gathered around the delivery table: “Well, 
let’s deliver her as soon as possible.” And then the episiotomy comes 
into play because it speeds it up—they just widened the passage. And the 
fact that the woman will then actually have a suture, there will be a fairly 
deep scar there, the tissues will be tightened there. And it will take a long 
time to heal—this is a whole month of recovery. Because this is a suture, 
it hurts, it kind of shrinks there, it needs to be treated, it needs to be cared 



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for in every way. You can’t sit. Well, a lot of inconveniences] [Svetlana 
Shnyrova, 17 February 2018]. 

This doula emphasizes the medical personnel’s responsibility, not the woman’s, 
unlike the midwife above. They approach the situation from two different 
perspectives and explanatory models, given their roles in the process, it appears. 
Importantly, while preparing for childbirth, women can choose personal assistants 
suitable for them and plan the degree of medical intervention that is acceptable to 
them. Thus, despite their difference in status, roles, and explanatory models, 
personal midwives and doulas provide “empathic witnessing of the existential 
experience of suffering” [Kleinman 1988: 10]. 

Based on interviews and my observations in maternity hospitals, I have 
found that women striving for “natural” childbirth in hospitals (according to a 
popular explanatory model held by parents) refuse a number of medical 
interventions. For example, they sign an informed consent waiver for oxytocin 
stimulation (typically prescribed for an anhydrous period or for weak or irregular 
labor, according to delivery protocols, but in deliveries with CMI, it is 
administered in most cases to speed up the process), anesthesia or pain relievers, 
amniotomy, episiotomy, and infant vaccinations. As a Moscow doula told me 
[Doula 4, 1 April 2020], “идеальная практика невмешательства в роды — без 
навязывания сценариев протокола — редко, но случается” [the ideal practice 
of non-interventive childbirth—without imposing protocol scripts—is rare, but it 
does happen]. In order to minimize the risks of excessive intervention, some 
resilient Russian women calculate arrival time at the hospital to avoid the routine 
use of invasive procedures and drugs, but to ensure adequate medical care during 
the active phase of labor. They may also prepare an oral or written plan and, less 
often, properly executed refusal of these treatments, if they are trained in legal 
genres [Bakhtin 1986; Hull 2012]. The practice of written informed consent forms 
or the refusal of routine medicalization (for certain forms of medical intervention) 
was established by federal law 323-FZ and is one of the most common ways to 
mobilize the law in the everyday context of contemporary obstetrics system 
[Black 1973, 2010; Ewick and Silbey 1998, 2003]. However, as the preceding and 
next interviews both show, it is difficult for women to ensure the implementation 
of their plans due to the nature of the communicative situation and the specifics 
of medical speech practices (see also Belousova 2003; 2012 and Kuksa 2020b for 
further discussion). 

Но вы знаете, врачебная какая штука есть. Что, если женщина 
начинает отказываться, они начинают объяснять так, что женщине 
становится страшно. Ну, то есть «если ты не подпишешь, ты, 
конечно, можешь не подписывать, но, если ты не подпишешь, все 
умрут». Типа такого, да? Ну, так везде, мне кажется. … мне кажется, 
врачи некоторые говорить так учат врачей, в общем, немножко 
запугать, потому что они всё-таки отвечают, там, за жизнь, да? И им 



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тоже наверно немножко тревожно, если женщина от чего-то 
отказывается, что они считают абсолютно необходимым 

[But do you know this medical thing. That if a woman starts to refuse, 
they begin to explain in such a way that the woman becomes scared. 
Well, that is, “if you don’t sign, you certainly cannot sign, but if you 
don’t sign, everyone will die.” Like that, right? Well, it’s everywhere, it 
seems to me…it seems to me that some doctors teach doctors to speak 
like that, in general, to intimidate a little, because they are still 
responsible for life, right? And they, too, are probably a little anxious if a 
woman refuses something that they consider absolutely necessary] 
[Doula 8, 10 April 2020]. 

As Kleinman has argued, the meanings of illness (and, I would add, its treatment) 
are “polysemic and multivocal” [Kleinman 1988: 8], which we can see in patient 
and family stories. Even though some women reject certain medical interventions, 
my interviews reveal that other women have different expectations and ideas 
about childbirth. They do not refuse early or prolonged hospitalization, medical 
intervention, or analgesia. Women describe worries about having an experienced 
anesthesiologist on staff (or on the delivery team) and the availability, sufficient 
quantity, and quality of analgesics during labor with CMI. Therefore, these 
interlocutors arranged for an early arrival at the hospital to have time for 
procedures prescribed by standard protocols or entered into informal relationships 
with the anesthesiologist and other personnel in order to provide quality care 
[Kuksa 2020b]. 

It should be noted that, in some metropolitan and most regional maternity 
hospitals, doctors generally oppose the right to refusal by patients within the 
framework of deliveries with CMI. 

И у нас точно нет в Петербурге такого, что при подписании этих 
бумаг (информированных согласий) как-то это обсуждалось на 
потоке, скажем так, да. То есть, как правило, пожелание, какой-то 
план родов, может обсуждаться клиенткой, если это контрактные 
роды с выбранным врачом. Или если это домашние роды с 
акушеркой 

[And we certainly do not have this in Saint Petersburg that, when these 
papers (informed consent) were signed, it was somehow discussed on the 
fly, let’s say. That is, as a rule, a wish, some kind of delivery plan, can be 
discussed by the client if it is a contract delivery with a chosen doctor. Or 
if it’s a home birth with a midwife] [Doula 10, 16 May 2021]. 

If the refusal of interventions as provided by 323-FZ produce conflict, or the 
parties encounter violations in medical care and interactions, there are cases of 
formalized confrontation and medical and patient litigation, when midwives, 



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doulas, or birth partners can strengthen the position and agency of a woman. 
Medical staff also fear prosecutorial and judicial investigations as a result of 
adverse consequences after childbirth (especially if it did not conform to the 
established protocol). As a consequence of this concern, according to my 
interviewees, the practice of defensive medical litigation has spread recently in 
Russia. Attending doctors at maternity hospitals use expedited court procedures 
to file claims against “unreliable” patients, as a Petersburg doula explained, 

Однажды на женщину, которую я готовила к родам, 10 роддом 
Санкт-Петербурга подал иск в суд с формулировкой «угроза жизни 
и здоровью ребёнка» в 2017 году. Причина — женщина ушла до 
выписки и написала отказ от госпитализации. Благодаря хорошему 
юристу суд был выигран. Я оказывала помощь в поиске адвоката 

[Once the 10th Maternity Hospital of Saint Petersburg filed a lawsuit 
against a woman whom I was preparing for childbirth with the wording 
“a threat to the life and health of the child” in 2017. The reason—the 
woman left before she was discharged and wrote a refusal to be 
hospitalized. Thanks to a good lawyer, the case was won. I helped find a 
lawyer] [Doula 6, 4 April 2020]. 

At the same time, the stories tell of courageous women who, in the face of 
intimidation and disregard for their wishes, take advantage of their right to change 
doctors, break contractual agreements, or submit pre-trial complaints to higher 
authorities while in labor or after childbirth, as we see in the quotation below: 

Это как раз было там, где врач отказался меня пускать на роды, он 
стал потом давить на женщину, что роды надо возбуждать. В итоге 
она разорвала контракт, потому что, когда она отказывалась, он 
давил на нее психологически, пугал 

[This was exactly where the doctor refused to let me into the delivery, he 
then began to put pressure on the woman to stimulate labor. As a result, 
she broke the contract because, when she refused, he put pressure on her 
psychologically, frightened her] [Doula 3, 1 April 2020]. 

Written records produced by women about ignoring their wishes in situations of 
legally guaranteed patient choice force physicians to respond quickly and resolve 
conflicts in situ to avoid a formal legal appeal. Therefore, the stories sometimes 
tell of cases when electronic appeals and pre-trial complaints have the desired 
effect on the staff, as in this citation: 

Была направлена жалоба с сайта Минздрава Саратовской области в 
2017 году: женщине угрожали — не выписать ее из роддома без 
внутреннего осмотра дежурным гинекологом. Через полчаса 



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пришла заместитель главного врача, мило улыбалась, спросила в 
чем суть претензии — не нашла повода не выписывать. И они ушли 
домой 

[A complaint was sent from the website of the Ministry of Health of the 
Saratov Region in 2017: they threatened not to discharge a woman from 
the hospital without an internal examination by the on-call gynecologist. 
Half an hour later, the deputy chief physician arrived, smiled sweetly, 
asked what the essence of the claim was — she found no reason not to 
discharge. And they went home] [Doula 5, 2 April 2020]. 

Sometimes doulas take part in individual complaints and claims to protect the 
injured woman, as we see below, or testify in defense of the client if a claim is 
filed by a medical organization. However, the illegal status of non-medical 
assistants in the maternity hospital and informal participation as quasi-relatives 
does not allow them to be in targeted opposition to the system without potentially 
negative consequences for their career, except in rare cases. One doula told me 
“Медики плохо относятся к доулам, на одну жалобы даже подавали в 
прокуратуру” [Medical providers have a bad attitude towards doulas, one 
complaint was even filed with the prosecutor’s office] [Doula 9, 20 September 
2021]. Another outlined a similar situation based on her experience. 

Я написала жалобу на врача в 2013 году, который непотребно себя 
вел с моей клиенткой, писала в Департамент. Это спустили 
главному врачу. В итоге этот заведующий отделением мне потом 
отомстил — в следующий раз он отказался меня пускать в 18 
роддом Москвы (сейчас закрыт) 

[In 2013, I wrote a complaint against a doctor who had behaved 
improperly with my client, I wrote to the Department. This was kicked 
down to the head physician. As a result, this department head later took 
revenge on me—the next time he refused to let me into the 18th maternity 
hospital in Moscow (now closed)] [Doula 3, 1 April 2020]. 

The controversies they describe, which had reached the stage of filing official 
complaints and lawsuits, are a variant of civil and criminal law mobilization 
[Black 1973, 2010; Kuksa 2011]. They are initiated to compensate for harm, 
investigate the improper provision of medical services (medical misconduct or 
legal infractions), and to hold medical professionals accountable. 

Despite these descriptions of clashes between participants in obstetric care, 
litigation mechanisms to resolve conflict are rarely used by patients or doctors in 
Russia. Nevertheless, criminal prosecution of doctors has an enormous 
perlocutionary effect and is actively discussed in conversations and in thematic 
perinatal social media groups. They emphasize women’s powerlessness and 
vulnerability, obstetric aggression and medical neglect and harm, and the 



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inhumanity of the system. At the same time, the medical community in the media 
space condemns patient litigation (calling it “patient extremism”) and laments the 
lack of protection for doctors in the face of legal prosecution and by the Prosecutor 
General's Office in particular [Kuksa 2020a]. The activism on the part of perinatal 
specialists led to a range of network and vernacular strategies to protect women, 
particularly since individual legal remedies are so rarely an option, because of 
ignorance of legal genres. Such cases, as we see below, demonstrate how 
midwifes and doulas have mobilized women to take a more active role in 
childbirth. 

Protecting Patients: Vernacular Resistance Strategies 

In 2016, two regional representatives of the doula community with degrees 
in psychology launched the flash mob #violence_in_childbirth. They have 
collected more than 1000 digital anonymized stories of Russian women, written 
mainly in the genre of abuse narratives on a single social network [Goriacheva 
and Ushankova 2016]. The organizers of the network action believe that “тема 
акушерской агрессии табуируется обществом, ведь главное в родах — это 
живая мама, живой ребенок. А роды — ну да, больно, страшно, грязно, 
следует потерпеть, а потом попытаться все забыть” [the topic of obstetric 
aggression is taboo in society, after all, the main thing in childbirth is ‘a living 
mother, a living child,’ and childbirth—well, yes, it hurts, is scary, dirty, you 
should be patient, and then try to forget everything] [Goriacheva and Ushankova 
2016]. Separate hashtags were proposed to classify the types of violence in 
childbirth, namely psychological abuse (insults, blackmail, gaslighting) and 
physical violence (face slaps, forcing out a child, cutting the perineum and other 
interventions without the woman’s consent). Using these classifiers and the 
stereotypical narrative model for describing childbirth [see Kuksa 2018 for a 
discussion], women negatively described their experience of being in a modern 
maternity hospital, obstetric aggression, medical neglect and harm, and 
psychological and physical abuse during childbirth. The following quotation 
displays typical invectives and accusations from medical personnel, as described 
by an anonymous woman on the digital flash mob: 

…каждый раз мне говорили, что так я угроблю ребёнка. Сил от 
этого не прибавлялось, прибавлялся дикий страх и истерика от 
собственного бессилия. Через 2 часа такого “тужения”, у меня 
начались настоящие потуги и меня заставили лезть на стол высокий 
(это с обездвиженной одной ногой), хорошо муж был и затащил 
меня туда. И тут мне сказали, что ребёнок застрял в родовых путях 
и в этом виновата я. Ко мне в палату в ближайшие 1,5 часа человек 
15 врачей заходило, все взволнованные бегали. Моего ужаса не 
передать. Сил тужиться не было совсем, все ругали меня и пугали 
ещё больше. В итоге сделали мне эпизио, но и оно не помогло и 



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тогда 3 человека локтями начали давить ребёнка. Достали дочь всю 
фиолетовую, с обвитием 

[…every time they told me that I would ruin the child this way. Strength 
did not increase from this, added wild fear and hysteria from my own 
impotence. After two hours of such “pulling,” real contractions began, 
and they forced me to climb onto a high table (this is with one leg 
immobilized), it was good that my husband was there and dragged me up 
there. And then they told me that the child was stuck in the birth canal, 
and I was to blame. In the next 1.5 hours, about 15 doctors came to my 
ward, everyone ran excitedly. My horror is indescribable. I didn’t have 
the strength to push at all, everyone scolded me and frightened me even 
more. As a result, they did an episio[tomy] to me, but it didn’t help either 
and then three people began to crush the child with their elbows. We got 
our daughter all purple, with entanglement [from the umbilical cord] 
[Anonymous, 20 October 2020]. 

On the one hand, the narratives presented are anonymous and not directly 
addressed to actants that are assigned the role of rapists and abusers. According 
to Bakhtin, every statement has an addressee, “the reciprocal understanding of 
which the author seeks and anticipates” [Bakhtin 1986: 322-323]. The actual 
readers of the network flash mob (addressees of the message) are an indefinite 
circle of people involved in a single emotional experience, most likely the 
initiators and authors of stories, as well as journalists and researchers. 
Functionally, network narratives about medical abuse reproduce the pragmatics 
of the widespread ritual practices of “closing labor” [Kuksa 2020b], which are 
actively used by individual perinatal specialists for a woman’s postpartum 
recovery. The continued revitalization of traditional rituals in modern urban 
culture testifies to the continuity with the “post-Soviet maternity ritual complex” 
[Rouhier-Willoughby 2008]. On the other hand, despite changes in infrastructure 
and a new context for labor and delivery, some of the motifs in childbirth 
narratives testify to the partial continuity of invective speech genres [Belousova 
2003] used by physicians along with the “conveyor” practices of obstetrics. 

The confessional narratives of the flash mob (as well as the modern rituals 
of closing childbirth) allow women to voice their traumas, suffer, and let go of 
unjustified expectations and resentments. They strengthen and transform negative 
emotions through narration, gain support from similar stories, and express 
solidarity with other victims. Such texts rather quickly “infect” the network 
communicative spaces and become explanatory folk models [Garro and Mattingly 
2000; Kleinman 1978, 1988]. Vernacular discourse and narratives thus describe 
psychophysical experience and contextualize the interaction between women in 
labor and medical personnel [Bakhtin 1986; Garro and Mattingly 2000; 
Khristoforova 2020; Kitta 2019; Kleinman 1978, 1988; Mattingly 1998], 
becoming an acceptable and formulaic “socially sanctioned outlet” [Dundes 
2003], with which one can try to express an uncomfortable traumatic experience 



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of childbirth and designate a guilty or responsible actor. As Rouhier-Willoughby 
has argued, an essential feature of the (post-) Soviet ritual complex is 
simultaneous resistance and acceptance [Rouhier-Willoughby 2008: 112]. 

If the model of a network flash mob implies personal articulation of 
traumatic experiences and collisions with suffering, emotional solidarity with the 
victims of “obstetric aggression” and “psychological” and “physical” violence 
presupposes the use of appropriate psychoanalytic terminology and a stereotypical 
narrative model that mandates a suffering victim and an abuser. In comparison 
with formulaic folk models of narratives, online petitions require participants 
(petitioners and signatories) to have a different, bureaucratic conversation and 
require people to arm themselves with human rights terminology, so that the 
format and content of the appeal is accessible and understandable to the addressee, 
as we will see below. 

Protecting Patients: Collective Network Strategies 

Russian perinatal specialists and human rights activists commonly organize 
online (or, less commonly, hard-copy) petitions to protect the rights and free CMI 
of pregnant women and their families. Online activism mobilizes the law through 
collective appeal to public authorities within the framework of pre-trial feedback 
or class action legal proceedings [Kuksa 2011, 2020a]. Two cases from my 
fieldwork, one from 2017 and another from 2019, will illustrate this process. 

On 29 March 2017, perinatal rights activists Olga Arutiunian and Nadezhda 
Anan’eva from Krasnoiarsk and Ekaterina Mariposa from Moscow, with the 
assistance of the lawyer Arina Pokrovskaia, launched a network campaign to 
protect pregnant women, regardless of their place of residence, material resources 
and marital status, and ensure their right to free childbirth accompanied by a 
partner of their choice [Arutiunian et al 2017]. The authors of the petition hoped 
to amend Article 51 of 323-FZ to expand support for patients in state-sponsored 
wards during labor and delivery. Theу argued that the current interpretation of the 
law by medical organizations was too narrow. Hospital personnel sometimes 
demand documented proof from relatives and allow only a husband, mother, or 
an adult daughter into the delivery room. Therefore, from the point of view of the 
authors of the petition, they discriminate against those that do not meet these 
criteria, e.g., widows, unmarried women, and military wives, to name a few (for 
a complete list, see (6)). 

The authors of the petition also wanted to eliminate the requirement for 
medical testing for certain diseases (by analogy with visits to an intensive care 
unit). They also demanded birth-partner access to the operating room, as is 
customary elsewhere in the world. They also pushed for removal of the right of 
physicians to set restrictions on partner deliveries “at their own discretion,” 
because the wording (“taking into account the state of the woman in labor”) is 
vague and can justify barring birth partners for no actual medical reason. 

The petition was posted on the Change.org portal under the title: “Supported 
childbirth should be available to all Russian women.” A year later, on 12 March 



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2018, Pokrovskaia announced that she had sent a collective appeal by registered 
mail to the authorities of the Russian Federation. The departments promised her 
to take into account the proposed “legislative initiative.” Over the last five years, 
the petition has garnered 13,861 signatures (as of 10 June 2022). Despite 
significant numbers of supporters, not a single legislative initiative about these 
proposed changes has been introduced. 

Two years later, in 2019, the founder, director, and lead educator at the 
Doula Link Institute of Perinatal Support (the largest educational doula project in 
Russia) Ekaterina Jitomirskaia-Sсhechtman also began an online appeal directed 
at regulators. She is also a renowned doula, a former midwife, and a member of 
APD. On 26 February 2019, Jitomirskaia-Sсhechtman initiated a campaign on 
Facebook to send appeals to the Russian Ministry of Health and regional health 
departments in protest of restrictions on doulas’ volunteer initiatives and 
professional support for mothers [Jitomirskaia-Sсhechtman 2019]. A template 
with blanks for a woman to complete was developed for this purpose. Their 
testimonies confirm discriminatory situations when using CMI: if denied the 
opportunity to call a spouse or mother, other birth partners were refused 
admittance. Doulas also pointed to the closure of volunteer projects based at 
maternity hospitals, which has led to the elimination of free professional support 
from doulas during delivery. 

In informal conversations, officials explained to the doulas that there was no 
significant demand for professional support from patients. However, in response 
to numerous individual appeals from women that responded to Jitomirskaia-
Sсhechtman’s initiative, regulators provided the standard response that the law 
does not guarantee the right to a “non-family” partner during delivery when using 
CMI. As one Moscow doula reported, despite patient and doula support for an 
amendment to the law, they would not succeed without blat [pull, connections] 
[Doula 1, 29 August 2021]. To date, the Ministry of Health of Russia continues 
to ignore requests by the Institute of Perinatal Support and APD, despite the 
implementation of a state program to support volunteerism and unpaid assistance 
by civic activists in medical institutions since 2018-2019. 

Therefore, unlike the vernacular narrative model discussed above, these 
statements are produced by legally competent senders trained in this genre and 
directed toward regulators of the Russian obstetric care system. Network 
statements functionally reproduce the legal pragmatics of individual and 
collective appeals to public authorities with a request, proposal, complaint, or 
claim within the framework of the methods of pre-trial feedback or legal 
proceedings [Kuksa 2011, 2020a]. 

Protecting Patients: Collective Strategies in the COVID-19 Pandemic 

The COVID-19 pandemic only exacerbated the situation for perinatal 
specialists and patients. Spring 2020 regulatory restrictions to prevent the spread 
of COVID-19, digital surveillance, and sanctions (in the form of fines for 
violations) have temporarily suspended daily physical communication and non-



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medical assistance in medical institutions (at least in the Moscow region and 
Tatarstan). At the same time, interdependence has increased, while patient choice 
and the usual pre-COVID volume of medical care for patients have been reduced 
[Kuksa 2020a, 2021a, 2021b]. Pregnant women and women in labor found 
themselves in a forced medicalized “COVID-19 reality” while in an extremely 
vulnerable state, feeling insecure, fearful, and even guilty about making decisions 
about care. 

My informants have intensified their protests since March 2020. Moscow 
doulas and human rights activists released strident statements in the media, on 
social networks, at conferences, and in interviews about the illegality of the 
prohibition on partner births and the forced separation of mothers and babies in 
Moscow and regional maternity hospitals [Kuksa 2021b]. 

Restrictive decisions by the Moscow Rospotrebnadzor [the Russian Federal 
Service for Surveillance on Consumer Rights Protection and Human Well-Being] 
and the Moscow Department of Health on 12 and 13 March 2020 that “prohibit 
the admission of visitors to hospitals” led to an absolute ban of family-oriented 
births in the wake of the general lockdown [Kuksa 2021b]. Appealing either to 
the “quarantine” regimen or to the “ban on the admission of visitors to hospitals,” 
by the end of March 2020 (and through August of that year), all Moscow 
maternity hospitals, except for one private hospital, had suspended birth partners 
of any kind from both CMI and paid deliveries. A Moscow doula describes her 
reaction to these restrictions as follows: 

Но вот именно попытки запрета партнерских родов я переживала 
тяжелее, чем то, что сейчас. Потому что ощущалось, что все, что мы 
выстроили (мы это обсуждали в доульском сообществе), все, что мы 
строили столько лет — эти доверительные отношения с роддомами, 
которые немножко откатились назад после ситуации [уголовного 
дела на перинатального специалиста]. И вот сейчас все стало вроде 
исправляться. И началось опять волонтерство потихоньку. И опять 
все схлопнулось! И опять черте что, извините 

[But I have experienced more difficult attempts to ban partner childbirth 
than there are now. Because it felt like everything that we built (we 
discussed this in the doula community), everything that we built for so 
many years—these trusting relationships with maternity hospitals, which 
had rolled back a little after the situation [of the criminal case against a 
perinatal specialist]. And now everything seems to be getting better. And 
once again, volunteering had begun slowly. And again, everything 
collapsed! And again, all to hell, sorry] [Doula 2, 31 March 2020]. 

By default, as with partner births, support by doulas was prohibited. As a rule, 
due to their illegal status, doulas were viewed not as perinatal professionals, but 
as quasi-relatives of any woman in labor relying on CMI, as this doula went on to 
explain: 



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До этой недели, которую Путин объявил типа выходной/нерабочей 
насильственно, пускали в 70-й роддом. Потом с обеда субботы, 
последней субботы, доул перестали пускать. И пап стараются не 
пускать в 70-й роддом. Под прикрытием того, что: «Да, главный 
санитарный врач, конечно, не может запретить партнерские роды, 
но Путин сказал: «Все обязаны сидеть дома». Значит, папы должны 
сидеть дома и доулы должны сидеть дома». Понятно, доулы 
бороться не могут, папы бороться могут. А до этого было очень 
дружественно к доулам и можно было по ОМС пройти доуле с 
папой вместе в 70-м, да 

[Until this week, which Putin declared forcibly as a day off/non-
workday, we were allowed to enter the 70th Maternity Hospital. Then 
from Saturday afternoon, last Saturday, doulas were no longer allowed. 
And they try not to let dads into the 70th Maternity Hospital either. Using 
the excuse that “Yes, the Chief Sanitary Doctor [the head of 
Rospotrebnadzor], of course, cannot prohibit partner childbirth, but Putin 
said: “Everyone is obliged to stay at home.” So, dads should stay at home 
and doulas should stay at home. It is clear that doulas cannot fight, dads 
can fight. And before that it was very friendly to doulas and it was 
possible for a dad and a doula together to get into the 70th using CMI, 
yes] [Doula 2, 31 March 2020]. 

Moscow doulas pointed out the injustice and discrimination against women, who 
were prohibited from having birth partners during state-sponsored childbirth, 
while the private perinatal hospital MD Group provided for partners at a cost few 
could afford despite the pandemic regulations to reduce the spread of coronavirus 
infection. Since pregnant women were denied the presence of their spouses, even 
in deliveries when paying themselves, women urgently sought out new doctors 
and maternity hospitals where birth partners were allowed or drew up private 
contracts with midwives who worked in maternity hospitals that welcome a “soft 
birth” approach in “commercial” departments. 

In interviews and on social media, professional doulas with a legal education 
complained frequently about the limits of the anti-epidemic regulation and the fact 
that the edict issued by Rospotrebnadzor should not abridge the rights of pregnant 
women guaranteed by 323-FZ [Kuksa 2020a]. For example, the same Moscow 
doula mentioned it in her interview as well: 

Да, в этом постановлении нет ни слова о партнерских родах — там 
только о посещении стационаров. Посещение стационаров законом 
не гарантировано. А партнерские роды — с отцом, по крайней мере, 
с членом семьи, — законом гарантированно. И под это дело мы 
тушкой и чучелком — папы с моим заявлением, которое я для них 
разработала, — пролезали в роддома до последних дней. Я сама 
проходила — вот последний раз я была 27 марта в роддоме — в 70-



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м, в Новогиреево. Сейчас Москву зарубили на эту тему полностью. 
Сказали: «Все, все мы боимся — не будем пускать никого, может 
только самых настойчивых пап». И партерские роды у нас остались 
только в Московской области. […] Я надеюсь со своей девочкой 
съездить, потому что у нее сломана спина и первые роды, ей не 
нужна эпидуральная анестезия, ей нужны естественные методики 
помощи. Мы очень уповаем на возможность все-таки родить 
«партнерски» 

[Yes, in this resolution there is not a word about partner childbirth—there 
is only about visiting hospitals. Hospital visits are not guaranteed by law. 
And partner childbirth—with the father at least, with a family member—
is guaranteed by law. And in this case, by hook or by crook, the dads 
with my application, which I developed for them, got into the maternity 
hospital until the last few days. I myself got through—the last time I was 
in the hospital on March 27—in the 70th, in Novogireevo. Now this topic 
has been completely shut down in Moscow. They said, “Everyone, we 
are all afraid—we will not let anyone in, maybe only the most persistent 
dads.” And delivery with partners remained possible only in the Moscow 
region. […] I hope to go with my girl [a client], because she has a broken 
back and it’s her first birth, she does not need an epidural, she needs 
natural methods of help. We hope very much for the opportunity to 
attend partner births] [Doula 2, 31 March 2020]. 

From the point of view of Russian human rights activists, if a “state of emergency” 
had not been introduced, it is only through legislative means that federal laws 
(namely Article 51 of 323-FZ) may be suspended [Kuksa 2020a]. Lawyers and 
professional doulas with a legal education, as one discusses below, also wrote to 
the administration of maternity hospitals, Rospotrebnadzor, and to prosecutors of 
Moscow and the Moscow region asking for an explanation of the legal grounds 
for limitations on the rights of patients as guaranteed by 323-FZ. 

Мы с Марией […] написали обращения в Роспотребнадзор и 
прокуратуру. Но пришла отбивка, что ответят в течение месяца. Это 
было 18-19 марта. Когда роддома стали захлопывать для партнеров 
массово. И некоторые мои женщины написали жалобы. Но 
некоторые и смирились 

[Maria [a lawyer] and I […] wrote appeals to Rospotrebnadzor and the 
prosecutor's office. But they wrote that they would answer within a 
month. That was March 18-19. When maternity hospitals began to close 
en masse for partners. And some of my women have written complaints. 
But some have resigned themselves] [Doula 2, 31 March 2020]. 



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A similar situation unfolded in other regions, but not as quickly as in Moscow. 
Perinatal specialists in those areas relied on human rights activists and their 
support initiatives, including with money transfers for legal costs. One regional 
doula told me that she hoped that “чтобы нашлась отважная роженица с 
мужем, которые бы отстояли свое конституционное право на партнерские 
роды в условиях ограничений в связи с коронавирусом” [a brave woman with 
a husband could be found who could defend their constitutional right to partner 
delivery despite COVID restrictions]” [Doula 5, 2 April 2020]. In rare cases, 
married couples outside of the Moscow region tried to defend the rights 
guaranteed by federal law 323-FZ in the courts, as a Pskov doula told me: 

И вот [одна] из последних побед — в наше ковидное время мы 
добились. Была такая пара, они работали с юристом. […]. Благодаря 
ей эта пара прошла в роды сейчас, вот буквально неделю назад 
прошел муж на роды. [А во время ковида и до сих пор нельзя 
[было]]? Нет, закрыто, закрыто. Ковид и все. Роспотребнадзор, 
главврач Роспотребнадзора запретил. Дальше был суд. И были 
выставлены требования — при каких условиях можно пройти. Они 
эти требования соблюли. И все — они родили вместе…вот неделя, 
10 дней назад 

[And here is [one] of the last victories that we have achieved in COVID 
time. There was this couple, they worked with a lawyer. […]. Thanks to 
her, this couple went to the delivery now, just a week ago, the husband 
went into delivery. [And during COVID and up to now [was] it was not 
allowed]? No, closed, closed. COVID and all. Rospotrebnadzor, the head 
physician of Rospotrebnadzor forbade it. Next was the trial. And the 
requirements were set—under what conditions you could get in. They 
met these requirements. And that's it—they were at the delivery 
together…a week, 10 days ago] [Doula 14, 18 September 2021]. 

After the subsequent official relaxation of restrictions (for a vote on a 
constitutional referendum) and changes in the March decree by the mayor of 
Moscow on 8 June 2020, partner birth did not return to Moscow maternity 
hospitals. On 11 June 2020, human rights activist and member of the APD Maria 
Molodtsova posted a proposal for the return of partner deliveries entitled 
“Supported childbirth should be available even in an epidemic” on the “Russian 
Public Initiative” website [Molodtsova 2020]. This Internet resource was created 
to accommodate public initiatives by citizens pursuant to presidential decree 
№183 (4 March 2013). Such initiatives mobilize the law through a collective 
appeal to public authorities. A proposal will be considered by federal authorities 
if signed by more than 100,000 citizens. Voting on Molodtsova’s initiative ended 
on 21 December 2021; only 528 votes supported the idea, 95 votes were against. 
The low number of supporters can be partially explained by the fact that partnered 



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23 

births in Moscow were once again allowed in August 2020, so that the proposal 
had become moot for in the Moscow region. 

Meanwhile, perinatal specialists from other regions complained that, unlike 
in Moscow, partner- and doula-accompanied births were still not possible in most 
cities. One doula said “cейчас только в платном можно. […] Да, а 
родовспоможение лет на десять в прошлом в сравнении с Москвой” [Now 
you can only [have a doula] in a for-pay [ward]. […] Yes, but, compared to 
Moscow, obstetric care is ten years in the past] [Doula 11, 15 September 2021]. 
Another expressed the same opinion: “Ну и вообще доступ в роддома 
ограниченный. Иногда мужей пускают, но доул, кроме мужей, не пускают. 
И то мужей пускают только в два роддома из семи, вот, и то по контракту 
только” [Well, in general, access to the maternity hospital is limited. Sometimes 
husbands are allowed, but doulas, other than husbands, are not allowed in. And 
then husbands are allowed only in two out of seven maternity hospitals, there, and 
then only under a contract] [Doula 12, 17 September 2021]. 

Since the beginning of COVID-19, perinatal activists have been mobilizing 
all available forms of civic and human rights activism—from volunteer projects 
and network protests calling people to fight for partner birth, support by a doula, 
and patient rights, to complaints to the prosecutor’s office and the organization of 
collective appeals and petitions to federal government bodies. 

Doulas note with regret that some Russian women show aggression towards 
rights activists, and the overwhelming majority display inaction and non-
resistance, even if they can improve the situation through bureaucratic means. A 
Moscow doula describes this situation: 

Просто люди же разные: не все хотят бороться. Меня в том же 
инстаграме в нескольких местах просто помоями облили. Мы 
делали общий прямой эфир […] про партнерские роды. […] И очень 
многие сказали, что «я враг, что я враг всех врачей, хочу, чтобы 
мужья заразили врачей. И вообще меня нужно распять, убить и так 
далее». Люди у нас, к сожалению, в отличие от Нью-Йорка, где 
мамы выбили себе партнерские роды, написав губернатору, и у них 
все это восстановили и возобновили. У нас, к сожалению, очень 
многие люди сами не хотят, хотят сильную руку и все вот это 
печальное, что меня вгоняет в около депрессивное состояние, скажу 
вам честно. Ну что ж? Будем держаться 

[It’s just that people are different: not everyone wants to fight. In the 
same Instagram in several places, they just trashed me. We made a 
general live broadcast [...] about partner childbirth. […] And many 
people said that I was the enemy, that I was the enemy of all doctors, that 
I want their husbands to infect doctors. In general, I needed to be 
crucified, killed and so on. Unfortunately, our people are unlike New 
York, where mothers knocked themselves out for partner childbirth by 
writing to the governor, and they have it all restored and resumed. 



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Unfortunately, many people here do not want to do for themselves, they 
want a strong hand, and all this is sad that it drives me into a depressive 
state, to be honest. Well, we’ll be hold on] [Doula 2, 31 March 2020]. 

In pandemic conversations, other pessimistic doulas describe the manifestation of 
“learned” helplessness and inertia in Russian women, especially in comparison 
with the victories of Western perinatal specialists, which, from afar, seem much 
more impressive than their own Russian successes. 

Сейчас у них ограничение — один человек. И женщины вынуждены 
думать, кто это будет - или муж, или доула, да, например. Это то, с 
чем я сталкиваюсь в разговорах с коллегами из Израиля. Некоторые 
больницы у них запретили вообще. Вообще запрет касается 
женщин, которые поступают в роды с признаками инфекции, да, 
респираторной. Но это как бы, мне кажется, это нормально и 
понятно, да, почему это происходит. Но тем не менее какие-то 
ограничения ввели сразу. В том же Нью-Йорке наши коллеги 
говорят, что… Ну, вы знаете эту историю, да? [Читала.] Что 
женщины просто отстояли. И поэтому им разрешили. У нас, к 
сожалению, женщина очень инертна. И добиться вот такой массовой 
инициативы, мне кажется, это очень сложно. Не думаю, что это 
вообще нереально, но это должно быть какое-то прямо движение, 
движение. У нас еще сидит такое, что, ну, сказали: «Нет». Значит, 
нет. Или вот еще: «Ну, все же рожали без поддержки, ну и я как-
нибудь рожу». То есть, женщины сами себя… 

[Now they have a limitation of one person. And women are forced to 
think who it will be—either the husband or the doula, for example. This 
is what I come across in conversations with colleagues from Israel. Some 
hospitals have been forbidden to them altogether. In general, the ban 
applies to women who enter childbirth with signs of infection, yes, 
respiratory. But it seems to me that this is normal and understandable, 
yes, why this is happening. But nevertheless, some restrictions were 
introduced immediately. In New York, our colleagues say that... Well, 
you know this story, right? [I read it.] The women defended it. And so, 
they were allowed. Unfortunately, our woman is very inert. And to 
achieve such a massive initiative, it seems to me, is very difficult. I don’t 
think it’s unreal at all, but it must be some kind of movement, movement. 
We still have such a thing like, well, they said: “No.” So, no. Or here’s 
another: “Well, everyone used to give birth without support, well, I'll 
give birth somehow”. That is, women do it to themselves…] [Doula 7, 5 
April 2020]. 

Some perinatal specialists nevertheless reacted with understanding to quarantine 
bans and isolation of women in labor from families, as in the quotation below, 



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since they are familiar with similar restrictive policies in other countries and, in 
principle, consider them reasonable and permissible. 

Сопровождения запрещены. Это карантинная мера. И они 
запрещены по всем роддомам Москвы. [...] [А запрещены и папам 
тоже, да?] Да. Всем. Партнерские роды вообще. Ну, это карантинная 
мера. Это форс-мажорные обстоятельства. Да, то есть мы должны 
понимать, что это не потому, что врачам захотелось перестать 
пускать партнеров на роды. Это именно для того, чтобы избежать 
распространение инфекции. Как бы, понятно, что к этому есть 
вопросы. Но тем не менее…как бы Главный санитарный врач 
выпустил такое распоряжение. Все роддома прикрыли до особого 
распоряжения. В принципе это нормальная мера. Это то же самое, 
как сезонный карантин по гриппу, да, когда каждый роддом сам 
принимает решение 

[Partner support is prohibited. This is a quarantine measure. And they are 
banned in all maternity hospitals in Moscow. [...] [And dads are also 
forbidden, right?] Yes. Everyone. Delivery with partners in general. 
Well, this is a quarantine measure. These are extreme circumstances. 
Yes, that is we must understand that this is not because the doctors 
wanted to stop letting partners into delivery. This is precisely to avoid the 
spread of infection. As it were, it is clear that there are questions about 
this. But nevertheless…the Chief Sanitary Doctor [the head of 
Rospotrebnadzor] issued this order. All maternity hospitals have been 
closed until further notice. In principle, this is a normal measure. This is 
the same as seasonal flu quarantine, yes, when each maternity hospital 
makes its own decision] [Doula 7, 5 April 2020]. 

Since the very first days of the pandemic, the freedom of choice for the location 
and the team for the delivery, which provided for competition between maternity 
hospitals and doctors, has been restricted in larger cities. Both individuals 
providing and receiving medical aid have lost their pre-COVID agency and have 
been turned into objects of medicalization and budgeting (of the Ministry of 
Health of Russia) and are subject of public health and epidemiological controls 
(of Rospotrebnadzor). This situation has led, once again, to a rise in opt-out 
strategies for some women. 

Opting-out during the COVID-19 Pandemic 

During the pandemic, some Russian women made choice for home birth 
with the support of a midwife and doula out of fear. They worried about the risk 
of infection during childbirth, increased medical interventions, and separation 
from the newborn in a maternity hospital. Pregnant women, women in labor, and 
their relatives, who, pre-COVID, have legally guaranteed statuses of patients, 



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26 

partners, legal representatives, or visitors, became “coronavirus threat sources” 
while on the premises of healthcare facilities, for doctors and for their own babies. 
The suspension of partners and doulas, and restrictions on the baby remaining 
with the mother, according to informants, contributed to a significant increase in 
illegal home births in the regions. 

Вроде как партнерские роды из-за ковида стали невозможны — у 
нас жесткий карантин был в роддомах. […] Женщины все чаще 
решают рожать дома, как вижу так — издалека. Но это очень в 
диковинку. И родные потом очень плохо это воспринимают. 
Индивидуальных акушерок с медицинским образованием нет. Я 
знаю трех доул, одну домашнюю акушерку. Только если договор с 
врачом заключать, но это совсем не гарантия мягких родов 

[It seems like partner-accompanied births became impossible because of 
COVID—we had a strict quarantine in maternity hospitals. [...] Women 
increasingly were deciding to give birth at home, as I see it—from afar. 
But this is very unusual. And then the relatives perceive it very badly. 
There are no individual midwives with a medical education. I know three 
doulas, one homebirth midwife. Only if you conclude an agreement with 
a doctor, but this is not at all a guarantee of a soft birth] [Doula 9, 20 
September 2021]. 

[А большой процент женщин, которые на это [домашние роды] 
идут? И в связи с чем? Вам это известно?] Да, большой процент и он 
увеличивается с каждым разом. Потому что, во-первых, в условиях 
пандемии сейчас, когда закрепилась практика разлучения мамы и 
ребенка до анализа ПЦР на коронавирус, стали очень бояться вот 
этого момента и больше стало домашних родов. […] Потому что 
женщины стали бояться роддомов, перестали перекладывать 
ответственность на врача, стали сами изучать физиологию 
беременности и родов. […] И негатива, конечно, много по этому 
поводу. […] [Да, это я знаю, стигматизация до сих пор очень 
сильная. […] 20–30% по вашему региону?] [...] Больше, конечно, от 
домашних акушерок эту статистику мы слышим. У них очень 
много. Они вообще не сидят без свободного времени. У них прямо 
вообще все под завязку. [А вы не знаете, они имеют официальное 
образование или сами учились?] Да, конечно, это женщины, как 
правило, с большим опытом работы в государственных роддомах, и 
в частных, и всяких. Они в итоге просто уходят в домашнее 
акушерство 

[And the large percentage of women who go for this [home birth]? And 
in connection with what? Do you know?] Yes, a large percentage and it 
increases every time. Because, firstly, now it’s pandemic conditions, 



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27 

when the practice of separating a mother and child before the PCR test 
for coronavirus had become established, they have become very afraid of 
this moment and there are more home births. [...] Because women began 
to be afraid of maternity hospitals, they stopped shifting responsibility to 
the doctor, they began to study the physiology of pregnancy and 
childbirth themselves. [...]And, of course, there is a lot of negativity 
about this. […] [Yes, I know that, the stigmatization is still very strong. 
[…] However, 20-30%?] [...] More, of course, we hear these statistics 
from homebirth midwives. They have a lot. They are constantly busy. 
[Do you know if they have a formal education or did they study by 
themselves?] Yes, of course, these are women, as a rule, with extensive 
experience working in state maternity hospitals, and in private ones, and 
all kinds. They end up just going into home obstetrics] [Doula 13, 17 
September 2021]. 

Unlike in Moscow, in other regions, epidemic-control restrictions banned partner 
and doula accompaniment for an extended period of time. Opportunities to choose 
the location and team for childbirth were reduced—thus, patient and parental 
rights were limited. Under authoritarian restrictions of patient agency, women 
have turned to home births and perinatal specialists have shifted to interactions 
with women into a space uncontrolled by and invisible to the state as in the first 
two post-Soviet decades. Therefore, these self-same authorities have ironically 
undermined, to some extent, the objectives of preventing the spread of COVID-
19 by excessively reducing family and patient agency in maternity hospitals. This 
decision by women in regions usually seen as more conservative or traditional is 
strong evidence for the influence of perinatal activists on the Russian obstetrics 
system as a whole. 

Conclusion 

We have seen that protest and resistance to the medical system during labor 
and delivery may take many forms and has been significantly influenced by the 
grassroots efforts of independent perinatal specialists. They have changed the 
view of childbirth significantly, leading to vernacular models that call for 
“humane and soft” approaches to the process. While medical personnel may hold 
to established medical protocols, patients and perinatal specialists have, at least in 
some cases, means to resist them. Individual legal strategies of resistance are used 
exclusively by women who are prepared for childbirth, with experience in 
childbirth and/or a familiarity with requisite linguistic skills to negotiate the legal 
system. In addition, professionals with legal and/or doula skills rely on collective 
legal strategies addressed to regulators. The only resistance strategy that involves 
two-way interaction is discussions the woman’s plan and expectations for labor 
and delivery with the staff within the context of informed consent forms. Opting-
out to avoid the system is chosen by women who had a negative experience during 



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28 

their first delivery or in situations where the usual or expected patient agency and 
freedoms have been prohibited. 

If a woman is inexperienced in these areas or unaccustomed to confrontation 
to express their agency, they choose retroactive strategies to protest the medical 
system. For example, they may share their narratives in digital flash mobs. Most 
often, flash mob abuse narratives describe situations of obstetric care using CMI 
and employ the vernacular genre of victim narratives. Alternatively, they may 
cope with their trauma during postpartum rituals to “close the birth,” which have 
become widespread over the last ten years. In either case, we find active perinatal 
specialists who participate in protests and develop women’s interactive skills with 
medical staff or help to cope with birth trauma. 

Signature collection on electronic and hard-copy petitions links patient, 
medical and bureaucratic discourses and frames. Whether based on a template or 
not, digital or on paper, individual or collective letters to the authorities allow 
activists to articulate problems and indicate solutions acceptable to women and 
perinatal specialists. They can be perceived by senders as a kind of digital 
resistance calling for human rights. In general, mobilization by perinatal human 
rights activists of various methods of direct and symbolic protest communication 
with powerful actors gives women a greater voice. It has allowed for the 
successful presentation of patient rights in the maternity hospital. They have laid 
the legal and scientific groundwork to challenge established medical protocols by 
teaching and promoting new ideas and values that have led to this new vernacular 
model of childbirth in Russia. 

NOTES 

1 I am very grateful for the careful proofreading, thoughtful editing, and 
invaluable assistance of Jeanmarie Rouhier-Willoughby, the recommendations of 
anonymous reviewers as well as the information provided by my interlocutors. 

2 A contract delivery in private Moscow maternity hospitals of Mark 
Kurtser with an experienced obstetrician-gynecologist, according to independent 
midwives, costs more than 800,000 rubles. For more information on MD Medical 
Group, see https://mamadeti.ru/about/rukovodstvo/. 

3 For more information on the Moscow Center for Traditional Midwifery 
and Family Medicine, see https://center-akusherstva.ru/o-nas/. 

4 The Institute of Perinatal Support (https://doula.link/) has produced 24 
cohorts, for a total of over 800 professional doulas in their six-year existence. 

5 For more information on the Association of Professional Doulas, see 
https://doularussia.ru/about. 

6 Women who: used IVF with donor sperm; live far from family; without 
close relatives, orphans; minors, residents of orphanages; whose husbands work 
on a rotational basis, are on long-term business trips, or are in detention; whose 
husbands or other family members do not want to attend the birth for personal or 



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health reasons; do not want the presence of their close relatives but want the 
support of another person. 

BIBLIOGRAPHY 

Arutiunian, Olga, Nadezhda Anan’eva, Ekaterina Mariposa, and Arina 
Pokrovskaia. 2017. Арутюнян, Ольга, Надежда Ананьева, Екатерина 
Марипоса, и Арина Покровская. “Роды с поддержкой должны быть 
доступны всем женщинам” [Supported childbirth should be available to 
all Russian women]. Change.org. Cited https://www.change.org/p/роды-с-
поддержкой-должны-быть-доступны-всем-российским-женщинам. 
(consulted 10 June 2022). 

Bakhtin, Mikhail. 1986. Бахтин, Михаил. “Проблема речевых жанров” [The 
problem of speech genres]. Эстетика словесного творчества [Aesthetics 
of Verbal Creativity]. Москва: 250-296. 

Belousova, Ekaterina. 2003. Белоусова, Екатерина. “Родильный обряд” [The 
Childbirth Rite]. Современный городской фольклор [Contemporary Urban 
Folklore]. Москва: 339-369. 

Belousova, Ekaterina. 2012. Waterbirth and Russian–American exchange: From 
the Iron Curtain to Facebook. Doctoral Dissertation. Houston: Rice 
University. 

Black, Donald. 1973. “The Mobilization of Law,” Journal of Legal Studies 2: 
125-149. 

Black, Donald. 2010. The Behavior of Law. Bingley: Emerald. 
Davis-Floyd, Robbie and Elizabeth Davis. 1996. “Intuition as Authoritative 

Knowledge in Midwifery and Homebirth,” Medical Anthropology Quarterly 
10(2): 237-269. 

Davis-Floyd, Robbie. and Carolyn Sargent. (eds.) 1997. Childbirth and 
Authoritative Knowledge: Cross-cultural Perspectives. Berkeley: 
University of California Press. 

Dundes, Alan. 2003. Фольклор: семиотика и/или психоанализ. [Folklore: 
Semiotics and/or Psychoanalysis, Alexandra Arkhipova, ed. and transl.]. 
Москва: Восточная литература. 

Ewick, Patricia and Susan Silbey. 1998. The Common Place of Law: Stories from 
Everyday Life. Chicago: University of Chicago Press. 

Ewick, Patricia and Susan Silbey. 2003. “Narrating Social Structure: Stories of 
Resistance to Legal Authority,” American Journal of Sociology 108(6): 
1328-1372. 

Gramatchikova, Natalia. 2020. “‘How I gave birth’ (and why I am writing about 
it): women’s narratives of first childbirth experiences from internet 
publications, “Electronic Journal of Folklore 80: 97-124. 

Garro, Linda and Cheryl Mattingly. 2000. “Narrative as Construct and 
Construction. Narrative Turns.” Narrative and the Cultural Construction of 
Illness and Healing. University of California Press. 



Activism and Patient Vulnerability 

FOLKLORICA 2022, Vol. XXVI 

30 

Goriacheva, Iulia and Maria Ushankova 2016. Горячева, Юлия и Мария 
Ушанкова. “Остановим насилие в родах” [Stop violence in childbirth]. 
ВКонтакте. Cited by: https://m.vk.com/humanize_birth. (consulted 20 
February 2022) Facebook. Cited by: 
https://www.facebook.com/humanizebirthrussia/. 

Hull, Matthew. 2012. “Documents and Bureaucracy,” Annual Review of 
Anthropology 41: 251–267. 

Jitomirskaia-Sсhechtman, Ekaterina. 2019. Житомирская-Шехтман, 
Екатерина. “Кто не рожал с доулой, ибо отказали” [Who did not give 
birth with a doula, because they refused]. Facebook. (consulted 20 February 
2022) Cited by: 
https://www.facebook.com/groups/rodyidouly/permalink/19454552455636
53/. 

Khristoforova, Olga. 2020. Христофорова, Ольга. “Гнетке — сонный 
паралич? Необычное между фольклористическими и медицинскими 
классификациями” [Is gnetke sleep paralysis? The unexpected between 
folkloristic and medical classifications], Shagi 6(4): 101-125. 

Kitta, Andrea. 2019. The Kiss of Death: Contagion, Contamination, and Folklore. 
Utah State University Press. 

Kleinman, Arthur. 1978. “Concepts and a Model for the Comparison of Medical 
Systems as Cultural Systems,” Social Science and Medicine 12 (1): 85–93. 

Kleinman, Arthur. 1988. The Illness Narratives: Suffering, Healing, and the 
Human Condition. New York: Basic Books. 

Kuksa, Tatiana. 2011. Кукса, Татьяна. “Роль и место процедур досудебного 
обжалования в контроле за сферой государственного управления, или 
перспективные направления административной и судебной реформ” 
[The role and place of pre-trial appeal procedures in the control of public 
administration, or promising areas of administrative and judicial reform], 
Public Administration Issues 1: 81-96. 

Kuksa, Tatiana. 2018. Кукса Татьяна. Рассказы о родах и родовспоможении 
в современной городской культуре [Stories about childbirth and obstetric 
care in contemporary urban culture]. Москва: Магистерская работа, 
РГГУ. 

Kuksa, Tatiana. 2020a. Кукса, Татьяна. “Биополитические решения и 
правозащитный активизм в период распространения COVID-2019 в 
России: ограничения субъектности и новые границы 
взаимозависимости” [Biopolitical Decisions and Human Rights Activism 
During the Spread of COVID--19 in Russia: Subjectivity Limitations and 
New Limits of Interdependency], Medical Anthropology and Bioethics 
1(19): 67-99. 

Kuksa, Tatiana. 2020b. Кукса, Татьяна. “«Страшилки» для рожениц: 
конструирование и преодоление страха в родах” [“Horror Stories” for 
Women in Childbirth: Construction and Over-coming of Fear in Childbirth], 
Urban Folklore & Anthropology 3(1-2): 166-187. 



Activism and Patient Vulnerability 

FOLKLORICA 2022, Vol. XXVI 

31 

Kuksa, Tatiana. 2021a. Кукса Татьяна. “Доульское сопровождение родов: 
генезис, дискурсы и практики эмоциональной и физической 
немедицинской заботы” [Doula Support During Childbirth: Genesis, 
Discourses and Practices of Emotional and Physical Non-Medical Care], 
Monitoring of Public Opinion: Economic and Social Changes 3(163): 226-
249. 

Kuksa, Tatiana and Svetlana Shnyrova. 2021. Кукса Татьяна и Светлана 
Шнырова. “Взгляд доулы на призвание и профессию: пребывать с 
женщиной в точке боли” [A Doula’s Perspective on Her Vocation and 
Profession: Being with the Woman at the Point of Pain], Medical 
Anthropology and Bioethics 1(21). 

Kuksa, Tatiana. 2021b. Кукса, Татьяна. “Партнерские роды и 
индивидуальные сопровождения в условиях COVID-19: властные 
решения, практики и дискурсы” [Partner-Accompanied and Individual 
Care Providers in the Setting of COVID-19 Pandemic: Power Decisions, 
Practices and Discourses], Этнографическое Обозрение 6: 294-313. DOI: 
10.31857/S086954150017611-2. 

Mattingly, Cheryl. 1998. Healing dramas and clinical plots: The narrative 
structure of experience. Cambridge: Cambridge University Press. 

Molodtsova, Maria. 2020. Молодцова, Мариа. Роды с поддержкой должны 
быть доступны даже в условиях эпидемии [Supported childbirth should 
be available even in an epidemic]. Russian Public Initiative. Cited by: 
https://www.roi.ru/74771/. (consulted 20 February 2022). 

Olenev, Anton. 2019. Оленев, Антон. “Депздрав рассказал о росте 
популярности партнерских родов в Москве” [Depzdrav spoke about the 
growing popularity of partner births in Moscow]. News of the Moscow City 
News Agency. Cited by: https://www.mskagency.ru/materials/2946293. 
(consulted 20 February 2022). 

Olson, Laura and Svetlana Adon’eva. 2013. The Worlds of Russian Village 
Women: Tradition, Transgression, Compromise. Madison: University of 
Wisconsin. 

Rapp, Rayna. 1999. Testing Women, Testing the Fetus: The Social Impact of 
Amniocentesis in America. Routledge. 

Rivkin-Fish, Michele. 2005. Women’s Health in Post-Soviet Russia: The Politics 
of Intervention. Bloomington: Indiana University Press. 

Rouhier-Willoughby, Jeanmarie. 2003. “Russian Birth Customs: Ancient 
Traditions in Modern Guise,” Slavic and East European Journal 47(2): 227-
250. 

Rouhier-Willoughby, Jeanmarie. 2008. Village Values: Negotiating Identity, 
Gender, and Resistance in Urban Russian Life-Cycle Rituals. Bloomington: 
Slavica Publishers. 

Sargent, Carolyn and Lauren Gulbas. 2011. “Situating Birth in the Anthropology 
of Reproduction,” A Companion to Medical Anthropology (Eds. M. Singer, 
P. Erickson) 289-303. 



Activism and Patient Vulnerability 

FOLKLORICA 2022, Vol. XXVI 

32 

Scott, James. 1985. Weapons of the Weak: Everyday forms of Peasant Resistance. 
New Haven: Yale University Press. 

Temkina, Anna and Michele Rivkin-Fish. 2020. “Creating Health Care 
Consumers: The Negotiation of Un/official Payments, Power and Trust in 
Russian Maternity Care.” Social Theory & Health, 18(4): 340–357. 

Yurchak, Alexei. 2014. Юрчак, Алексей. Это было навсегда, пока не 
кончилось. Последнее советское поколение. [Everything was Forever, 
Until it Was No More: The Last Soviet Generation]. Москва: Новое 
Литературное Обозрение. 

INTERVIEWS 

Doula 1. Moscow, Russia. Interviewed over Messenger. 21 February 2019, 29 
August 2021. 

Doula 2. Moscow, Russia. Interviewed over Video Messenger. 15 January, 31 
March 2020. 

Doula 3. Moscow, Russia. Responded to questionnaire. 1 April 2020. 

Doula 4. Moscow, Russia. Responded to questionnaire. 1 April 2020. 

Doula 5. Volga region, Russia. Responded to questionnaire. 2 April 2020. 

Doula 6. Saint Petersburg, Russia. Responded to questionnaire and interview. 4 
April and 17 August 2020. 

Doula 7. Moscow region, Russia. Interviewed over Audio Messenger. 5 April 
2020. 

Doula 8. Far Eastern region, Russia. Interviewed over Audio Messenger. 10 
April 2020. 

Doula 9. Far Eastern region, Russia. Interviewed over Messenger. 8 May 2020 
and 20 September 2021. 

Doula 10. Saint Petersburg, Russia. Perinatal Conference. 16 May 2021. 

Doula 11. Siberian region, Russia. Interviewed over Messenger. 15 September 
2021. 

Doula 12. Volga region, Russia. Interviewed over Audio Messenger. 17 
September 2021. 

Doula 13. Ural region. Interviewed over Audio Messenger. 17 September 2021. 



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Doula 14. Northwestern region, Russia. Interviewed over Audio Messenger. 18 
September 2021. 

Midwife 1. Moscow, Russia. Interviewed over Video Messenger. 7 April 2020. 

Sadovaia Tamara, the founder of CTM and “traditional” midwife. Meeting with 
pregnant women. 19 March and 14 April 2018. 

Shnyrova Svetlana, Moscow doula. North Goa, India. Interviews. 12 and 17 
February 2018.