Understanding the role of a doula

Doulas, or female attendants that are present during a woman’s childbirth to assist and coach her through delivery, are becoming increasingly common within maternal health programs. Though popularly associated with labor and delivery, many doulas offer services that support the full spectrum of birth outcomes. One particular role within full spectrum work is the abortion doula.

As part of the shift towards full spectrum support, doulas are increasingly helping women navigate abortions, miscarriages, and stillbirths. The idea behind this role expansion is that all pregnancy outcomes and choices should be supported equally, and no single outcome (like birth) should be privileged over others.

The expanding role of abortion doulas

Formalized abortion doula collectives have only been in existence for about 10 years, starting in New York City with a group called The Doula Project. However, the concept of women providing support to other women through abortion procedures has a long history in many countries, not just the United States.

Given the newness of the phenomenon, statistics on abortion doulas are scarce. Stories from the reproductive rights field suggest that abortion doulas are active around the world, in both formal organizations and informal groups. For example, in Mexico, several “accompaniment” collectives have supported more than 5,000 women through medical abortions, often just by being physically present when women take their pills.

HowToUse spoke with a U.S.-based abortion doula, Jen Smith, of New Hampshire, to learn more about what it means to be an abortion doula and how doulas can help women safely and successfully make reproductive health choices. A slightly edited transcript of the interview is below.

Hi Jen, thank you so much for taking the time to speak with us about your work as an abortion doula. Could you start by talking a little bit about what brought you into this work?

It was really the fact that I had personal experience with having an abortion and wanting to help other people who were going through same experience. When you have a medical abortion, you take the first pill in the doctor’s office and then the other pill at home. You’re supposed to have someone you trust with you when you take that second pill, and while I was fortunate to have a person like that, many people don’t.

I kept thinking about other people who don’t want to tell anyone they’re getting an abortion and have to go through it alone. That just isn’t right. I wanted to be that person for people—someone who is not part of their family or social network, but who can just be there to make them feel comfortable.

I see my role as honoring their experience, and importantly, I am also there to watch out for any medical complications that could arise from the procedure. I’ve been practicing as an abortion doula for about three years now, and it really is so rewarding. It’s not always easy, but at the end of the day I feel that I am making women safer, and providing a service that they otherwise might not have access to.

Did you take a class or training to become an abortion doula?

I took a training to become a doula for full-term births, and we talked a little about abortion doulas during that training. I don’t know of any trainings specifically for abortion doulas in my area, but I’ve had personal experiences with abortions and am very familiar with the process. I know a lot of people personally in my life who have been through it as well. My life experience allows me to be there for other women.

What exactly does an abortion doula do? How does the process work?

Some abortion doulas work through abortion clinics, but I don’t do that—I work directly with the patients. They come to me mostly by word of mouth; people pass my name along. I tell them upfront that everything is confidential, because it’s important that they trust me to keep their privacy.

Once a client contacts me, I like to meet face-to-face before the procedure to get a feel for who they are as well as their needs. Sometimes that’s not possible due to time constraints, but I try to establish a relationship beforehand.

My clients’ needs vary considerably. Some people need a lot of talking, coaching, and reassuring, while others just need me to be there and be the witness to their experience. Some people are grateful you’re there just to walk them into the clinic, past the protestors. I’m used to the protestors by now, but for women walking into an abortion procedure past people telling them they’re murderers, that experience is horrible. I’m glad to be walking beside them during those awful few moments.

Sometimes they want you there when they receive the first pill (during medical abortions). Lots of times I’m in the waiting room of the clinic, because in New Hampshire they don’t allow your support person to come into the surgical room. I also drive them home if they want. Sometimes clients want emotional support when they take the second dose of pills. So everyone has different needs, and it’s my job to fill whatever need they have.

You must see all kinds of emotions from your clients. What’s it like to deal with such a range of different feelings?

That’s totally true, I’ve seen all types of reactions, feelings, and emotions. But I would say that most often, women feel simply relieved after the procedure. Sometimes women take a little longer to get to that feeling of relief, but in my three years of practice I’ve never once heard someone say they regret it and wish they could take it back.

Sometimes women feel a little sad too, and many just want to get back to “normal” life. They feel confident in their decision, though, because often times it just wasn’t the right moment in their lives to have a baby. They know it’s the right choice as hard as it might be. Sometimes they have questions about what will happen to them physically after the procedure, and that’s when it’s helpful for me to share my knowledge to help ease their fears.

What do you want people to know about abortion doulas?

I would want people to know you don’t have to be alone if you don’t want to be and that there are people you can reach out to for support. It can be important to have someone there for you, especially if you need help processing what you’re going through.

Abortion doulas can also be really helpful to watch out for anything that could go wrong physically, even though that very rarely happens. But it can be useful just to have someone be there to reassure you that everything you’re experiencing – both physically and emotionally – is normal and OK. Abortion doulas can hold space and honor what the patient is going through. We want to be there for women.

How do you see the work of abortion doulas fitting in with the broader reproductive rights movement?

I see the work of an abortion doula as a direct action in support of furthering the goal of increasing women’s autonomy, rights, and decision-making power over their own bodies. It’s the most direct action you can possibly take, because deciding when to be pregnant and birth a child is so fundamental to women’s independence.

I’m encouraged to see more women than ever speaking up about things that have been happening to women forever. We’re coming into our own in a lot of ways, and I think people are starting to realize women are smart enough to make our own decisions.

We know our bodies, ourselves, and what’s right for our lives, and we should tune into that more and trust our bodies and minds. I hope society catches up to that soon, and I see my work as helping to further that idea and empower women to make their own choices.