Abortion Doulas: Inside The Movement

Some clinics call them "hand-holders."

"I have issues with that term," says Lauren Mitchell, co-founder of The Doula Project. Mitchell has just come from a day at the hospital — where she supports women through high-risk terminations, second-trimester procedures, and long, strenuous, induced-labor stillbirths. After hearing the details of her day-to-day, I have some issues with the "hand-holders" title, too. Holding someone's hand can go a long way — but Mitchell goes a hell of a lot further.

The current preferred title for her profession is Full-Spectrum Doula. Lauren and others in this field (largely made up of volunteers) are a part of a growing faction in reproductive care. Two decades ago, a birth doula would have been hard to come by in the United States. But, due to cultural shifts (C-section backlash, the Giselification of home-birth, and that sonic baby-boom that was The Business of Being Born), it seems like everyone who's anyone knows a doula these days.

Not everyone, though, knows what "doula" means. The word comes from Greek and refers to "the woman who serves." Medical anthropologist Dana Raphael first applied the word in 1976 to describe an experienced woman who assisted another with breastfeeding after giving birth. According to the NIH, doulas slowly became more popular beginning in the 1980s in direct response to the increasing rate of Cesarean sections. Many women who hoped to avoid the procedure enlisted a female friend or childbirth instructor to support them through labor and delivery. While the midwife and/or doctor are there for both mother and child, a doula's role is entirely focused on supporting the woman through one of the most inexplicable experiences of her life.

When I first heard the term "abortion doula," I balked. "What is an abortion doula?" asked everyone I mentioned it to. It can seem an unorthodox term at first. But, give it an instant, and it makes complete sense. For what is more inscrutable than an experience like this?

Abortion is different for every woman. It can be a relief, a trauma, a dissociated blank — there is no way to define or anticipate any individual response. Yet, it is fair to assume that support, or even just the option of support, should be a given. "It’s intuitive," says Lauren. "We’re not the first people and we won’t be the last to be in this role, but what we’re trying to do is formalize it — so, it's not just if the nurse is nice and has a free minute. We're trying to make it a regular, established role in clinics."

As in a birth scenario, an abortion doula provides informational, emotional, and physical support throughout the procedure, and sometimes immediately before and after. That may mean explaining the sounds and sensations happening, answering questions, keeping the patient engaged (or distracted, depending on her needs) — and, yes, holding a hand when needed. Sometimes, a doula stands in for the mother or friend that the patient doesn't have, serving to calm the young or traumatized woman with loving kindness and wisdom. Other times, all the patient wants is for the doula to sit beside her, "just in case." Either way, she's there and she's ready. One doula tells me, "It's my job to love people in five-to-10-minute increments."

Lauren founded The Doula Project (then called The Abortion Doula Project) in 2007 at the age of 22, along with other working birth doulas Mary Mahoney and Miriam Perez. Originally based in New York City, the organization trains volunteers — most of whom come from a background of birth work and/or activism — and then partners them with local clinics. Sarah McCarry, volunteer and Media Coordinator for the organization, explains that while the project was initially focused on straightforward abortion work, many women came to the clinics to deal with miscarriages or lethal fetal anomalies. "We were also facing terminations for wanted babies," McCarry notes. In response, the project's focus began to broaden.

During her two monthly shifts, Sarah doulas eight to 10 patients. All the clinics The Doula Project partners with offer a doula as a standard part of the service, and the patient can always opt out (which has happened only once since Sarah began volunteering in 2012). "I doula mostly first-trimester procedures," she explains, "which are really fast. People have no idea; there’s just so much rhetoric around it that I think people don’t realize it’s an unbelievably simple and short procedure. Most of the time the patient is in the clinic [she's] just waiting [to get] into the room."

Sarah's role during those few minutes in the room is amorphous — and entirely guided by her client. "Some people just want to make small talk, or want someone to distract them...ask them about their kids or the weather." Others need firm, clear instructions just to remember to breathe. Some will challenge the doula: "Do you think I'm going to hell?" they'll ask. The term "holding space" is one heard a lot in regards to abortion doula work, and it reflects their efforts to connect with a stranger: gauging, respecting, and meeting her needs for the five to 10 minutes it takes to terminate a pregnancy.

"I'm sure it's incredibly rewarding, but I imagine emotionally exhausting as well?" I prod. But, Sarah shakes her head at just how wrong I am. "I don’t find it exhausting at all. Our role is not to solve anyone’s problems while we’re there; it’s just to be supportive. For me, that takes a lot of the burden off the experience. And, I find it really restorative and awesome."

That's what it's like on Sarah's end of the spectrum. First-trimester, in-clinic terminations are the most common in the U.S. In those scenarios, the patient is awake but sedated, she recovers at home, and complications are rare. But, every procedure is different for every patient — and for every doula.

Lauren works at a hospital clinic. Though prospective patients can easily find The Doula Project's locations, I agreed not to publicize them in this story ("to protect our doctors in case of protestors," Lauren says). Here, the procedures are rarely as simple as a the five-to-10 minute aspiration abortions done in doctors' offices or at Planned Parenthood. Lauren routinely deals with high-risk or complicated terminations, as well as with the births that don't end with mother and baby both alive and well.

She and her co-founders all became birth doulas "right around that time when The Business of Being Born came out. I was at a birthing center for a little while, you know: birth in a bathtub, everything’s great." After starting the project, "I land[ed] in this very high-risk institution — and that [was] my foray into the world of abortion."

Lauren and her fellow doulas were also not met with universal acceptance, even from their own community. Slate's 2010 piece on The Doula Project quoted one opposing doula saying, "As much as I believe in a mother's right to choose how she will give birth, I also strongly believe in the baby's right to live... It was very hard for me to comprehend how doulas and midwives could be pro-abortion."

Lauren is neither terribly surprised nor bothered by the minor backlash she's received. "It's nothing I take seriously," she says, pointing out that she sees the value and impact of her own work every day. In the early days, her fellow pro-choice activists asked themselves whether they should actually consider themselves doulas. Their verdict was yes: "We viewed being a doula as providing three major core tenets of support: emotional, informational, and physical...and that is precisely what we do," Lauren says.

For Lauren and other doulas working in the hospital, birth is often a part of the equation — but not the birth most woman imagine. "If it's in the second trimester, or if it's an induction termination for someone who's chosen to induce labor early for a lethal fetal anomaly — that is a birth," Lauren explains, "and we’re there [for it]. We work with patients when they have made adoption plans and are delivering babies whom they are not planning to parent. We're there to help them by bearing witness to and navigating that loss."

Even when the procedure is easier, a doula's work is never routine. I ask Lauren how she might answer a patient like Sarah's — someone asking if she's going to hell. Not all doulas are religious, but Lauren describes herself as someone who is. "One [potential response] that a provider actually told me, which I think is brilliant, is to ask, 'Do you believe in a forgiving God?' That way, you help the patient answer the question [herself]. Still, when you’re a doula, your conversation can and will be broken off at any given moment. So, we train the doulas to make sure they have something to give the patient — and then we sort of work backwards. For example, if a patient asked, 'Do you think I’m going to go to hell?' and I’m in the doula role and I don’t know when the nurse is going to whisk [her] away, I’ll make it my business to say 'No, I don’t think you’re going to go to hell' first and foremost. Then, you go from there."

Lauren acknowledges that years of doing this work has taught her the crucial importance of her own self-care as well. The boundaries between work and life are all the more important (and difficult to maintain) when professional empathy is your job.

"When this is your reality — all day, every day — you do become very filled with story. And, if you’re not careful, you find that it calcifies in you. It builds a skeleton inside of you. There can be some loss of identity...because they’re not your stories."

Neither abortion nor doula work are as stigmatized and misunderstood as they once were. This month saw the release of Obvious Child, an honest-to-God rom-com centered on a young woman in the weeks leading up to her abortion on Valentine's Day. NARAL was a huge supporter of the film and hosted screenings and panels discussing the changing role of abortion in our cultural conversation. "When facing any life-changing moment, we rely on encouragement or comfort of others — abortion care is no different," says Samantha Gordon, NARAL's Director of Public Relations. "No one knows what a woman is going through when she faces an unintended pregnancy, and far too often women go through these moments alone. The organic growth of the abortion-doula movement reveals a widespread need in our society, and one incredible effort to stand up and address it."

For now, Lauren's decided to leave New York, step down from her leadership role at The Doula Project, and continue her education in medical humanities. She already has an MS in Narrative Medicine, a field that emphasizes the value of a patient's personal and psychological history when treating an illness. There's a widespread idea that much of medicine focuses on the problem rather than the patient; Narrative Medicine provides a subtle backlash against this concept, insisting that greater empathy and personal connection is crucial to effectively treating the patient as a whole. It's a complex and growing field — a natural fit for Lauren. Plus, there are Doula Projects all over the country now (including a Prison Doula Project), so she will continue to volunteer in her new city.

"I’m going to keep being a doula, and I’m going to keep being a full-spectrum doula. That’s just there. That’s in me."