Doulas are expanding their services to include abortion.

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April 27 2010 7:04 AM

What's an Abortion Doula?

They're strangers who will hold your hand while you go under the knife.

A recent Bust magazine article on the pregnancy assistants known as doulas contained this description of their duties: "Sometimes the doula will hold a woman's hand or rub her scalp to calm her; other times, she may crack corny jokes or trade dating stories." Except the article wasn't about a doula entertaining a woman in labor—it was about a doula helping a woman during her abortion.

Assisting a woman during her vacuum aspiration was not always part of a doula's job description. Most doulas serve pregnant women in the last few months before and during her delivery. (Doula comes from a Greek term meaning "woman of service" or "caregiver." Some translations say it comes from "female slave.") They've become more popular in the United States over the last few decades as interest in individualized birth plans has increased. They're not the same as midwives, who have medical training, or social workers, who have advanced degrees. Doulas are meant to be a reassuring presence during labor—an ally whose sole interest is in the happiness of the mom-to-be. They have evolved as jack-of-all trades, on call for hand-holding, massage, acupressure, breathing techniques, or pain management. Some postpartum doulas will even do housework and run errands. They can cost anywhere from $300 to a few thousand dollars.

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Abortion doula services were unheard of until three years ago, when pro-choice activists within the birth community decided that they should serve the full spectrum of pregnancy choices, whether it's birth, adoption, or abortion. Mary Mahoney and Lauren Mitchell created New York City's Doula Project, a volunteer-based service that provides free doula services to women in New York City. They work with pregnant women who can't afford doulas, expectant birth-mothers at a pro-choice adoption agency, and provide abortion doula services in Manhattan and Brooklyn. Though the public perception of doulas is that they are liberal crunchy types, the community has a strong pro-life contingent. These anti-abortion doulas are less-than-thrilled with the Doula Project. And they're not the only ones who are skeptical. Even as a pro-choice feminist, when I heard about abortion doulas my first thought was: Are women really so fragile that they need to hire a complete stranger to hold their hand at the doctor's?

Like a birth doula, the abortion doula uses deep breathing and visualization while talking the patient through the procedure. "We are there before, during and after the abortion," says Mahoney. "We hang out with them in the pre-op waiting room, accompany them to their procedure and stand with them during [it], and then spend time with them in the recovery room." Most abortions don't transpire like the one in the recent movie Greenberg, in which a character opted for general anesthesia during her procedure. A situation like that isn't common (not to mention riskier and more expensive), so women are most often awake and only mildly sedated. "You're there, you're providing comfort, telling them what to expect," says Pérez. Afterward, the abortion doula will come bearing warm blankets and hot-water bottles and can even discuss birth-control options. Doctors, they say, have an easier time working with patients who have someone tending to their emotional needs. At this point, the Doula Project has volunteer abortion-doulas who work in two different clinics in New York City, and women can opt out of providing the service if they wish. "We have served 1,000 women in the past 18 months and not one has opted out yet," Mahoney says.

The outspoken members of the Doula Project have received their share of backlash from within their community. When writer and doula Miriam Pérez wrote a story about being a pro-choice doula, it sparked a fierce debate on Alldoulas.com. "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," wrote one poster identified as Doula Lori. "When I was new in this doula work, I started out assuming that most in the childbirth field would naturally be pro-life. It was very hard for me to comprehend how doulas and midwives could be pro-abortion."

Though I don't share Doula Lori's views, abortion doulas seemed a little unnecessary to me. Doulas don't do anything during an abortion that a friend or clinic worker couldn't do. A woman named Kristen who was quoted in the Bust story also felt an initial skepticism when presented with an abortion doula: "I thought, 'I don't want to talk to this woman," she said. But Kristen came around. "[The doula, Lauren] calmed me down [during my abortion]. She held my hand through the most painful thing I've ever gone through. I was pretty close to freaking out, but with Lauren there, I felt like I was in safe hands."

Doulas can do one thing that a friend or boyfriend cannot: They're allowed to be present during surgery. The abortion doulas are trained volunteers with the clinic—they wear scrubs, undergo training, and are covered by the clinic's insurance. Even if they're not imperative, ultimately, they don't do any harm—and in many cases they're welcome, comforting additions to an abortion process that can be pretty terrifying. As Lauren Mitchell, the other Doula Project co-founder, points out, "Surgeries are scary even in the best of circumstances, and if you add to that the huge social and cultural taboos that surround reproductive healthcare, it would seem a logical extension to expand the doula model of care to work with people who have chosen abortion."

The success of the New York doula project has inspired women in other cities to mimic their efforts. There are groups in Asheville, N.C., Greensboro, N.C., and Seattle organizing abortion doulas, and the L.A. Doula Project will be opening in a clinic this spring. Pérez puts the whole thing into perspective for me with a story about her brother having emergency appendicitis. "I totally was his appendicitis doula," she laughs. "My job is [to ask], 'What can I do to make you feel better?' " What woman going through a fraught experience wouldn't want that?

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