In the clinic, it goes like this: Call the patients by their first name only, or it’s a security risk. When they come to the door, introduce yourself. Show them into the room, explain how to put the gown on, draw the curtain, and wait. When you go back inside, the procedure will begin.
The person on the table says, “I have five kids. I just can’t have another.”
The person on the table says, “My mom said this would hurt so much, but this isn’t even as bad as my tattoo.”
The person on the table says, “Can I see my baby?”
The person on the table says, “Thank God.”
Officially, an abortion doula provides nonjudgmental emotional, informational, and physical support to people receiving abortions for unintended, wanted, or miscarried pregnancies. We refer patients to help lines, wipe away tears, and chat about their kids, their commutes, and, sometimes, what constitutes a living being. I’ve been an abortion doula for two years, supporting patients at abortion clinics in Connecticut and New York.
In the past ten years, abortion doula collectives have proliferated across the country. One group that tracks abortion and full-spectrum doula groups currently active in the United States counts 35, located in every geographical region and in many major cities. They sprout out of birth doula groups, sexual violence centers, and reproductive health clinics. The collectives skew toward youth and are largely composed of volunteers; there is little or no money in being an abortion doula. Still, the doulas come.
Abortion is one of the most discussed medical procedures in the United States today but remains strangled in stigmas, silences, and outright lies. Doulas work not only to support people experiencing the medical procedure itself, but also to let some light, air, and sound into the stale conversation about abortion. We do this partially by demystifying abortion in the wider world. When people find out that I’m a doula and have been present for more abortions than the average person sees in their lifetime, I am often asked to describe what a surgical abortion looks like (probably not how you’d expect), how long it takes (five to 10 minutes), and who gets abortions (mostly people who already have children). But the real work of the doula takes place in the clinic, in the time, however brief, that we spend with patients.
Go back inside.
The doctor comes in and introduces herself. She is plump and kind, brown hair pinned up in a braid above her clean white coat. She asks if there are any unanswered questions. She asks if we are ready.
When you train to become an abortion doula, you learn first about the Procedure. You learn to call it The Procedure instead of the Abortion, because words have power, and that one can make people uncomfortable, even the ones who call themselves pro-choice, even while they are on the table.
You learn the science of it, the history, the laws. You learn the most common questions about how it will feel, about pain, about the pressure of guilt and grief or the denial of it, just as corrosive. You learn ways to relax the lower body and encourage deep breathing.
You learn about the steps of the Procedure. This is how the doctor will deliver a painkiller and dilate the cervix. This is how she will apply suction, with a handheld tool called a vacuum aspirator, to remove the products of conception from the uterus, and release those products into a metal bowl. What comes out is a spill of tissue. That’s what it looks like in the first trimester: a small, flesh colored sac smaller than my thumb, like some deep-sea jellyfish.
During the Procedure, it’s common for people to get cold. It’s a cool room, and they’re not wearing much clothing, and stress plays a factor, as does anesthesia. I offer my hand to hold; my body runs hot, always has. “It’s not just for comfort,” I say with a smile, when I think it will help. “I have warm hands. And you can squeeze as hard as you want.”
She touches my palm. “Oh, it’s hot!”
“Yep. Take as much heat as you need.”
She smiles at that, usually, and takes my hand.
Later, she might squeeze it, even if she wasn’t planning to.
Pregnant people have all kinds of reactions to working with a doula, just like they have all kinds of reactions to abortion. For some, the decision to have an abortion is a wrenching one. For many others, it’s not emotionally fraught—but when I explain to a patient that I’m a non-medical support person and that I’ll be with them throughout the procedure, I’ve never been turned away. Everyone uses our moments alone differently. I hear about the Netflix shows they’re binging and their parents’ deaths. One woman, her mascara smudged slightly, tells me she’s just left an abusive relationship. Another apologizes profusely that she hasn’t waxed.
Some compare their experiences at various clinics. “When I had my first abortion, it was totally different,” an older woman confided. “They were very professional, but it was a little bit—cold. There was nobody to talk to like this.”
Some don’t want to talk at all. Once a patient pulled a pair of Bose BlueTooth headphones out of her bag and said, “I get anxious, so I’m just going to listen to my own music, is that okay?”
I said of course it was, and once she was set up on the table, her eyes closed and her music turned up loud, I sat quietly, keeping an eye out and scrolling through my e-mail, until the doctor came. That woman didn’t ask for a hand to squeeze during the cramps; she didn’t ask any questions or list anxieties. Afterward, though, as she was leaving the recovery room, she stopped me, her headphones still looped around her neck. “Thank you,” she said. “It really helped that you were there.”
In popular imagination and media, abortions have often been represented as isolated and furtive. On TV, there are scenes where the abortion—in the rare cases one is pictured—consists entirely of patient and doctor. In real life, a surgical abortion has the following lineup: doctor, nurse, lab tech, often a resident, sometimes an anesthesiologist, and sometimes a doula, all gathered around the patient, who is in the center of the room, breathing now on my count. It takes a village.
The woman on the table says, “I want kids later, I do, but I just can’t right now, and I heard that getting this will hurt my chances.”
In 26 states, clinics are required by law to tell patients that abortion has a potential effect on future fertility. In four of these states, the information provided is medically inaccurate, by which I mean it is a lie. People are told that getting an abortion will mean their chances of getting pregnant later are significantly reduced. The truth is that scientists have found that an abortion performed by a trained medical professional is not associated with future infertility. Abortion is also a very safe procedure: The chance of major complications is only 0.23 percent—lower than the chance of major complications in pregnancy and birth.
In five states, clinics are required to lie and say that abortion is linked to breast cancer.
In six states, abortion clinic counselors are mandated by law to tell women that life begins at fertilization, which is a religious idea, not a scientific one.
I’ve had the privilege of doulaing in two states that provide medically accurate information, and by the time patients get to me, they’ve already made the decision to have an abortion, but still some ask for reassurance that they won’t get breast cancer or become infertile. Lies about abortion are our accepted frame of reference.
This is how to approach the clinic: Don’t engage with the protesters outside. Some of them don’t do anything but murmur Hail Marys over and over, but others are different. Wear your street clothes through the door and then change into your scrubs, for hygiene purposes but also so that the protesters will think you’re there to receive services. If they think you’re there to receive services, they say, Don’t kill your baby. If they think you’re providing the Procedure they slam on the glass doors and say, I’ll kill you, you fucking slut.
What they don’t teach you in training: how it will smell, wet and metallic. It is nearly the dark, rubbery smell of period blood, a smell that everyone with a uterus knows. This is that smell, but more so.
The woman on the table says, “Do you think God will forgive me?”
I don’t believe in any God who wouldn’t understand the choice you’ve made. Whether it’s because you have other mouths to feed or you don’t feel ready or this pregnancy is dangerous or you were raped or you’re not financially independent or you don’t want to be a parent right now or you don’t want to be a parent ever. I don’t believe in any God who wouldn’t understand that you have done nothing that needs forgiving.
The bones of my hand grate under her grip.
She is 39, 15, 25, 32, she is my age exactly. She is white, black, Latina, Asian. She wears a fuzzy sweatshirt, she wears a hijab, she wears black ballet flats, she wears a wedding ring. She is getting a ride home from her boyfriend, her best friend, her husband, her mother, she is here alone.
No. While she’s here, she is not entirely alone.
I change out of my scrubs and walked from the clinic to the parking lot. “Miss!” a man shouts, and I turn without thinking, without remembering where I am, and there he is, holding a sign with a picture of what is supposed to be a dead baby. It doesn’t look anything like what I’ve seen today.
“Don’t kill your baby,” he says. “It’s a sin. God won’t forgive you.”
In training, they teach you never to engage with the protesters because of the threat of violence to the clinic. I turn away and hear him whisper, “Devil slut.”
I keep walking, gathering silence about me like a cloak, or armor. I get into the car, turn the engine on, and sit for a minute, watching my rearview. The man has turned back to the clinic. He hoists his sign again, higher, like he’s already forgotten me.