City Hospital ran a small abortion service that focused on complicated cases, either medically or financially speaking. Pregnant people were referred there if they had a high-risk pregnancy that a freestanding clinic could not manage or if they were unable to pay full price for their abortions or qualify for Medicaid. At the point when we were introduced to the clinic they were expanding their service and looking for greater support systems for their clients.
The clinical coordinators, who served as the primary abortion counselors, were typically responsible for attending procedures with clients at City Hospital; Dr. B wanted to make sure someone was always there. But as their workload increased, the clinic realized they needed someone else to fill that gap. Dr. B remembers, “Before [the doulas] it was fine, but [the counselors] were just really busy because there’s such a high demand for services. [The doulas] took a huge burden off of them.”
The day we entered City Hospital for our first meeting, we were beyond nervous. Mary had a terrible headache. Lauren, who had woken up at three in the morning for no good reason, mulled over her second cup of coffee and prayed she wouldn’t pass out at random. We were both wearing khakis and button-downs for probably the first time in our lives. We looked like 1990s Gap clerks. It was our first big chance to be abortion doulas: we couldn’t blow it.
Little did we know, Dr. B had already green-lighted the project on the recommendation of Dahlia and Sarah. As long as Melissa, the clinic coordinator agreed, we were in. This would be our first lesson in the power the abortion counselor has in the clinic, the way in which they hold the service together.
We met Melissa, Sarah, and Dahlia in an exam room, one that would become the site of hundreds of meetings with our clients. Both parties tittered with excitement, the energy crackled, electric. It was like the beginning of a great first date. We all knew immediately we had found “the one.”
Within ten minutes Melissa was handing us the clinic schedule for the following week. We blinked. After a year of trying, our work finally began.
Dr. B says today that the clinic was “really the ideal situation” for introducing doulas. She reflects:
Dr. M, the previous clinic director, had started a clinic [through the hospital] that was kind of a freestanding unit, and we didn’t have anesthesia. So we just had ourselves, who were trained to offer conscious sedation, but nobody was completely asleep. The nurse was also super busy getting all the details medically done so having an extra support person for the patient was just really phenomenal. It made things better for all of us. You were so incredibly dedicated. There were [patients] who were coming from far away, some with absolutely no support people, so having that support was amazing.
Those early years of existence would test us beyond what we could imagine, in the most wonderful ways as well as the most challenging. “I remember how excited and nervous you all were,” Thorne-Thomsen says today. “You already realized you were gonna hit some bumps. You were breaking orthodoxies, and I think you knew that. And so there was an excitement, but also, like, ‘How are people gonna receive this? How is this gonna go down?’”
Pushback
In a 2010 Slate article entitled “What’s An Abortion Doula?” writer Marisa Meltzer opined that abortion doulas “seemed unnecessary” and that they “don’t do anything during an abortion that a friend or clinic worker couldn’t do.” The piece went on to question whether women were “so fragile that they need to hire a complete stranger to hold their hand at the doctor’s.”
When we created the Abortion Doula Project, we understood that the “abortion doula” was a provocative idea. We knew that we would face pushback, that the world might not “get it” right away. “Any new or different idea takes some time to get used to,” we comforted ourselves.
There were those who didn’t see the distinction between us and a clinic escort or recovery volunteer, between a counselor or someone who “just stands there and holds a hand.” There were the more traditional pro-choice groups and activists who would express concern about our acknowledgment of the emotion that accompanies an abortion. We had been fed narratives through our activist work that many people felt “empowered” by their abortions. But our very presence in the procedure room undermined that message by hinting that abortion might be physically painful or people might have complicated feelings about it. Mostly what we saw from people having abortions was a nuanced mix of mourning and relief. We would rarely hear that our clients regretted their procedures, nor would we hear them speak of it in empowering terms. But when we talked about all of this, it often wasn’t received by the pro-choice community the way we expected it to be.
Supporting a client before, during, and after an abortion, being a nonjudgmental presence and having no agenda other than that, was a departure from the standard pro-choice framework. We were coming from advocacy and policy backgrounds, connected to the people creating the abortion rights messages in the United States. We knew that acknowledging complicated feelings about abortion was going to be a delicate task and that being real about what an abortion actually looked like would be even more delicate. Asserting that someone might need support during an abortion? Forget it. Those were acknowledgments that many felt could be dangerous to the policies and laws in place that protect our right to choose.
Frequently, there was concern that we could be feeding the antichoice movement with our perspectives. Baker reflects on this sentiment, “Before Exhale started, the most prominent people who were talking about post-abortion feelings were pro-life.” There had been a few pro-choice projects here and there that had considered this perspective—such as the books Peace after Abortion (1996) and The Healing Choice (1997), the November Gang, and Anne Baker’s work at the Hope Clinic in St. Louis—but these were “few and far between and did not have wide pro-choice support.”
The common pro-choice refrain was “most women feel relief “—and nothing else—and pro-choice advocates rejected the idea of a “postabortion syndrome” (characterized by stress, anxiety, and depression) that had been coined by pro-life organizations. It was assumed that anyone who talked about abortion feelings, especially difficult ones like sadness or grief, had been bamboozled by pro-life extremists. In truth, a political strategy had been developed to make abortion an unthinkable option for women. Part of making it unthinkable was to say that it was something women might regret, and to save women from the pain of regret, they should not have the choice.
Today, we have organizations like the I Had an Abortion Project, the Abortion Conversation Project, and Sea Change. We have films like I Had an Abortion and Silent Choices. We have innovations such as the 1 in 3 Campaign, The Abortion Diary Podcast, and Angie Jackson live-tweeting her procedure. We have abortion speak-outs happening all over the country. Because of this, it may seem obvious that acknowledging the complexities of abortion is the direction the movement should head in—in fact, it is already headed there. Ten years ago, creating direct service work within this nuance was more complicated. Thorne-Thomsen reflects, “In some ways, the movement either moves glacially or at the speed of light, sometimes both, so it feels like nothing’s changing, nothing’s changing, and then overnight everything has changed at once. And I think storytelling, narrative, and putting out a broader idea of what an abortion experience is looks dramatically different since the Doula Project started.”
Each time an article diminishing us was published, we were surprised. Wouldn’t acknowledging the human element in abortion reduce the stigma of the procedure? Wasn’t our mutual goal to make it less shameful and secretive?