This article is the first in a series on reproductive justice issues developed in partnership between RH RealityCheck and the Pro-Choice Education Project.
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.