It would take me many more abortions, many more conversations, and hours of internal reflection to learn how profound the doula role is: how “just being there,” a silent observer, bearing witness to someone else’s experience and reflecting it back to them can be so much and enough. Critics and supporters alike would sometimes claim the abortion doula role to be sensational or unnecessary. They would miss the bigger point and strip the entire experience of its greater meaning.
“De nada,” I smile back, offering Maria the rest of the Spanish that I know.
Dr. B reenters and quietly tells Dr. W that the pregnancy has been removed completely. Maria can go to recovery now. Ann eases her into the recliner, discreetly tossing the blood-soaked plastic chuck underneath her into the wastebin.
We wave goodbye.
As a reproductive justice activist for more than a decade, I have often been asked how I got into this work, what inspired me, and why doula care? These have been tough questions to answer. For years I avoided sharing my abstinence-only background, my fear of sex, the time I publicly shamed a friend for having an abortion. I thought that if I didn’t fit into a perfect activist box I would be cast out of the movement.
When I started talking, though, I learned my story was more common than I thought—maybe the most common of all stories. Most women in the United States have to confront the fear we have of our own bodies and sexuality and how we project that onto others and internalize it within ourselves. When I was growing up, no one ever spoke to me in a real way about my body or my health—not even my staunchly pro-choice, hippie parents. When I ask my parents about this now, my dad shrugs wistfully, “But I thought you weren’t having sex.” My mom, who has always welcomed any and every topic under the sun, simply says, “I didn’t know how to talk about it.” They aren’t alone; most parents don’t know how to talk to their kids about sex. Conversation around abortion and birth in my community was not nuanced—there was no conversation at all. That inane and dangerous “Lifesavers” program was the only vehicle my classmates and I had to talk about or to be close to sex. We all just wanted to explore something innate and undiscovered in ourselves.
I’ve stopped being ashamed of my story. Mostly. It led me to doula work. Being a doula speaks directly to the part of myself that is complex and contradictory, and it doesn’t let me hide from it. It allows me to juxtapose two opposing ideas and say these are not bad or good—they just are. It opens up a space for things to be messy, unpackaged, raw, unflinchingly human. When I work with a client, I become an activist in a way I didn’t know was possible. There is no box I have to fit into.
After I witnessed that first abortion, I was on fire, more alive than I’d ever been. I felt as if I was part of some sort of historical moment. I wasn’t. Abortions happen every day—more than a million people have abortions every year in the United States alone. But witnessing the care and being part of the care that goes into the abortion experience was something I wasn’t aware of before. At least not in the way I saw at the hospital that day from the doctors and nurses, and even from myself. I wanted to tell the world about this care. I wanted to capture it in a bottle and pour it over everyone who would ever have an abortion.
This would prove to be difficult. Many cities would not see the value of abortion doula care. Many pregnant people would not have access to the kind of abortion care they wanted or needed. As we expanded our work, the privilege our clients held just by virtue of the fact that they were in New York City became clear. Here, abortion is accessible up to twenty-four weeks, Medicaid covers most procedures, and there are several options for care, from at-home medical abortion to freestanding clinic abortion to hospital-based abortion. Our clients don’t encounter the restrictions on abortion that people in other states face, such as mandated waiting periods, consent requirements, or unreasonable travel barriers. Our fellow doulas around the country would struggle against these restrictions and many would be denied the opportunity to ever get into a clinic.
And yet we would find, for our clients in New York City, the emotional experience of abortion often transcends many of these legal barriers. Years later Dr. B reflects on the early days of the Doula Project:
Mostly I remember being really grateful that you were there because patients had an enormous amount of anxiety. Even though in New York City you don’t always have to walk through a thick line of protesters, I think that most people who have abortions have ambivalent feelings about it. Sometimes it’s a very intense, very painful part of their lives. And having somebody to attend to emotional needs and just be there and hold their hands made a huge difference in the quality of [care]. I remember [the doulas] at the head of the bed while performing procedures and really providing a lot of comfort. And that was huge. I remember watching you guys getting so attached to these people, which . . . was really touching.
The deeply collective nature of the world we would help create within the clinic walls started to show itself to me that first week. Before we entered City Hospital we imagined ourselves as totally client focused. Birth doulas, at the time, frequently held contentious relationships with labor and delivery staff, and we were prepared for a similar experience in the clinics. Yet the impact we would have on the doctors and nurses who served our clients would become a cornerstone of our mission. Dr. B remembers, “You made a big difference for people. In addition to [the patients], as a young provider, as I was at the time, it’s really nice to have validation. The group of [doulas] was so kind to us as providers. You know, abortion providers don’t get that much love in the world, but we got so much love and respect from you. That was really lovely.”
The Doula Project would become the most rewarding work of my life, but it would never be without its hardship or stigma. It was not work I could share with my Christian community in southern Indiana. (To this day I can count on one hand the number of times I’ve said the word “abortion” outside the walls of my parents’ homes. Meredith and I continue to lock ourselves behind closed doors—talking in hushed tones about anything “vagina related.”) The fire I felt the first days and weeks and months would burn out, and I would come to carry a certain amount of pain and dread with me. My clients would change me, how I practice care and walk through the world. The abortions, the stillbirth inductions, the adoption plans, they would move into me, and I would hold on to tiny pieces of every person I cared for.
Fellow doula and energy healer Jini Tanenhaus would later tell me, “Your chakras are closed around your heart. That’s very common in this line of work. You’re heartbroken.” Caregiving leaves a mark. And who cares for the caregiver? Who do we let care for us? Though Lauren and I would often pride ourselves on being “hardcore,” unsentimental to the point of detachment, deep down we also needed someone to care for us. Like many caregivers, we—as well as the doulas in the stories that follow—would struggle to allow ourselves to be vulnerable in that way, to let others see us when we were scared or tender, even as we levied that brand of care to our clients and to the world.
Maria was the first—the first client in an organization that would go on to support more than thirty-five thousand people across the spectrum of pregnancy options over the next decade.
a Religious Freedom Restoration Act: an Indiana Senate bill signed into law in 2015 that, in a nutshell, asserts that individuals and companies may use their religion as a defense in denying services to others. The LGBTQ community has been particularly targeted by this law. Purvi Patel: a pregnant woman who was charged with feticide and child neglect and sentenced to twenty years in prison for allegedly inducing her own miscarriage.
How to Use Your Birth Doula Training . . . and How Not to Use It
A mini chapter about how traditional birth doula care doesn’t always translate to the world of full-spectrum doula care. This is a list of statements that many of us heard in our doula training that we initially tried to incorporate into our organizational model. Some of it applied, and some of it did not. This section is specifically geared toward people who want to become full-spectrum doulas.
“Doulas