This article is the first in a series on reproductive justice issues developed in partnership between RH RealityCheck and the Pro-Choice Education Project [16].
Three years ago I became a doula. Early in my training, I became part of a conversation that focused on providing doula support for all of a pregnant person’s choices, including abortion. Since that time, I have served more than 100 pregnant people as part of The Doula Project in New York City. The project was founded on the idea that pregnancy is a spectrum and that as female-bodied people we may experience any and all of the possibilities that spectrum contains in a lifetime. Within that, we should also have access to doula care for each of our pregnancies.
The Doula Project has served over 500 pregnant people since the fall of 2008, guided by the mission of providing free compassionate care and emotional, physical and informational support to people facing birth, abortion, fetal anomaly, or miscarriage. The foundation of our project is built on meeting pregnant people where they are, something I've taken with me from working four years in the reproductive justice movement. This connects to our belief that pregnant people should be trusted to make the choices that are best for them and that their experiences and the memories of those experiences should be honored.
Doulas hold a unique position in health care as non-medical lay people who are there solely for the pregnant person. The birth doula movement has certainly grown over the past few years, and innovative and radical projects have expanded care for pregnant people who might otherwise not receive it, such as young mothers and women in prison. During this time, The Doula Project has been building on a new model of doula care: one that supports pregnant people having abortions and choosing adoption.
Doulas in Abortion Care
Compassionate care and emotional support are not new to the practice of abortion. Counselors and patient advocates have been serving as 'doulas' for years, providing a hand to hold and an ear to listen during procedures. However, many clinics do not have the resources to provide this intensive one-on-one care. The Doula Project began its services with this in mind, as a way to support not only pregnant people seeking abortions, but the clinics providing them.
Many components contribute to the well-being of a pregnant person terminating a pregnancy and different medical staff supply different components of care. The doula's primary role is to serve as a continuous uninterrupted presence before, during and after each client's abortion, and to provide various emotional, informational, and physical comfort measures. This can include massage, hand holding, reassurance, providing clarity around procedures and birth control methods, or engaging them in conversation. Each of the support measures we offer and how pregnant people react to them vary from day to day and depending on the procedure taking place. I can highlight the diversity by giving an account of my most recent day in the clinic with four patients who were having 2nd trimester abortions.
Since patients are normally under general anesthesia during this procedure, doulas spend the majority of our time with them before they enter the operating room. The first woman I supported that morning was in her early 30s, Spanish-speaking, religious, and scared. I spent my time with her holding her hand, wiping her tears, and telling her it was going to be ok and that she would be safe, in my own broken Spanish. My next client was having strong cramps from measures that were taken to dilate her cervix, and so I gave her a lower back rub and massaged a pressure point on her hand. After her procedure, at her request, I went to the waiting room to tell her husband and sister that she was fine and would be discharged in a couple of hours. The next woman I met mostly wanted to be alone, so I checked in with her every few minutes to see if she needed anything and pulled the curtain closed around her bed. My final patient was a gregarious, talkative young mother. I brought a warm blanket and a hot water bottle for her cramps, and spent the next 30 minutes with her talking about her future job prospects, different kinds of birth control she might like, and just joking around.
From my experience, this is a pretty average day in the life of an abortion doula, with varying levels of intensity. Meaning, pregnant people need us for different things, sometimes to provide real physical comfort relief or answer a question about their procedure, sometimes to tell a good joke or listen to them talk about something that's going on in their lives, and sometimes just as a person who doesn't forget that they are there, who checks in on them. To be clear, some of our clients don't know what doulas are when they meet us. They can be hesitant to engage with us, especially in a public hospital like the one our project is located in where a patient is likely to talk to 15 different people in a matter of hours. However, we have not yet had a pregnant person opt out of our doula service. We attribute this to the ability of doulas to build trust quickly and meaningfully with clients and to engage with them on their terms.
After serving as an abortion doula, talking to other abortion doulas, providers, health professionals, and the pregnant people we serve, it is clear there are many benefits doulas bring to providers and to people having abortions. Providers have shared that with doula support, procedures can be less complicated and therefore quicker, due to the patient's relaxed state. In addition, they have mentioned that it can be easier to communicate with a patient and check in on their well-being during a procedure since the doula is so connected to the patient's needs. Pregnant people we have served have told us that we help them feel more physically comfortable, safer, and more informed and in control of their experiences.
Doulas in Adoption Care
I met Marci Lieber, a Community Outreach & Advocacy Coordinator at Spence-Chapin Children and Family Services, when The Doula Project was still known as the Abortion Doula Project, and we were mostly focused on providing doula care in an abortion context. Spence-Chapin is a pro-choice and pro-birth mother adoption agency in New York City, and within a few minutes, Marci began to share some of the horrific stories of their birth mothers’ experiences on Labor and Delivery floors: nurses and doctors not respecting the mothers’ wishes to have the baby taken out of the room following the birth, or just the opposite, nurses not letting the mothers hold or breastfeed their newborns since they were choosing not to parent, as well as doctors and nurses inflicting unnecessary medical interventions on them. Among these accounts, the hardest part of all was to hear that these mothers were completely alone during these experiences.
Most people face similar issues in giving birth, such as where they are going to deliver, how they will deliver, and with whom. For those choosing adoption, these issues can be even more complex and barriers in their lives can make them nearly impossible to resolve. For example, most of the mothers we've worked with don't shop for doctors, midwives, or hospitals. They go to the one closest to where they live, the one that takes Medicaid, and they aren't given any information outside of what their doctor tells them. Thus, they are pretty much at the mercy of wherever they happen to end up. I asked Marci, “Does Spence-Chapin have doulas?” Marci said they didn't but that she was committed to making it happen. Within 2 months, The Doula Project had formed a partnership with Spence-Chapin, and we were at our first birth with a young Tibetan woman choosing adoption.
Incidents that occurred during this woman's birth spoke to all of my worst-held fears going into the experience. Namely, that some doctors, midwives, and nurses don't trust a laboring woman who is choosing adoption. To begin on a positive note, this birth mother ultimately had a vaginal delivery of a strong and healthy boy. I had the opportunity to meet his adoptive parents and speak to them about the strength of their new child's birth mother and the grace with which she delivered. What I left out of this conversation was the heinous treatment she was subjected to within the hospital's doors. She experienced the cascade of interventions, which is not uncommon to many women's birth stories: pitocin (which theoretically helps speed up labor) leads to epidural leads to c-section. What was different for this particular woman was not only a complete language barrier but, perhaps even more significantly, a complete cultural barrier. She was terrified of having a c-section - it was the one thing she told me could absolutely not happen. Her understanding of a c-section was that it meant either she or the baby would die. When the doctor told her she must get one (with little explanation as to why) and she refused, she was branded a murderer. Hospital administration was called into her delivery room and they told her that they were going to force a court-ordered c-section on her. This was after hours of being denied a medical interpreter and 40+hours into her labor. The statement that most reflects the medical professionals' attitude toward her that night was by a nurse who said, "Just because you don't want the baby doesn't mean he should die."
I don't want to give the impression that mothers choosing adoption have the same doomed experiences as the one I've shared. Many mothers choosing adoption do, in fact, have the support of their family and friends and positive birth experiences. Our doulas work with those who need extra support and feel otherwise isolated in their pregnancies. And it is their experiences that I intend to raise awareness about. I also want to emphasize that mothers choosing adoption are not helpless victims of the medical system. The Tibetan woman ultimately had the vaginal delivery she wanted because she was a strong advocate for herself. Even though many of the mothers we work with claim to not know the first thing about childbirth, they do come to us with a birth plan, if only in their heads. Our job is to help them articulate what they feel is best for them, give them further information about the process, and serve as a silent but strong advocate for them in the delivery room.
Connecting to the Doula Model of Care
One of the first things we discuss with new volunteers is what a privilege it is to be in these rooms. To bear witness to such important moments in people's lives and to be the one person they might remember among the sea of faces is really gratifying. Doula Project Co-Founder and Co-Coordinator, Lauren Mitchell is often blown away by the power of a doula's quiet presence. "You can't speak for your client, even if what's going on is the opposite of what she wanted - you're not in control of the room. But you are in control of what you are giving your client, and that is an informed ally and a deeply empathetic presence. When you're a doula you have to acknowledge how to be 'human' even when you want to be more than that. What keeps me going is the feedback from the clients that the space that I've created for them is unique and extremely important."
We've continued relationships with several of our clients: some we go to the movies with, some are interested in joining the project or getting trained to be birth doulas, and some even speak on behalf of our organization. Ultimately, we believe that providing pregnant people with the resources, tools and the support they need can lead to empowering birth and abortion experiences that can affect the rest of their lives and even have a positive effect on their communities. One of the most common things I hear, other than “Thank you for being here.” is “You have such a cool job, I want to be a doula.” When people feel taken care of, when they know what it's like to be treated well, they want others to feel that way. It's a model of care that people feel deeply connected to and one which they have the personal resources to provide to someone else.
If you are interested in connecting with The Doula Project you can visit our website at www.doulaproject.org [17].