Mi Compañera

Erin Steuter, head of the sociology department at Mount Allison University in New Brunswick, had a doula with her first birth at 27, a doula for her second birth at 30 and she wishes she had had a doula for the abortion she had when she was 18. The role of the doula in childbirth in the United States has become that of a hand holder, back massager, quiet supporter and advocate in a wide variety of birth settings. The doula, a person with non-medical training in labor support, focuses on the emotional and psychological elements of the birth. The doula's role is unique in that she or he is the only person involved in the birth process solely focused on the emotional and psychological status of the mother. Doula care is expanding across the United States as more people become familiar with the concept and more women seek out their services for labor and delivery. As this expansion continues as a part of the wider movement to change the standards of maternity care in the United States (by lowering intervention rates, increasing midwifery care and educating women about birthing options), there are doulas trying to apply their skills to another arena of women's reproductive lifecycle: abortion care.

For some women, the need for emotional support during pregnancy termination is high. Erin explained, "Even though I was very clear in my heart and mind that the abortion was exactly the right thing to do for me at that point in my life, it was nonetheless a very frightening experience. The medical staff at the hospital were not kind to me and there was no discussion about what was happening to my body, it was just a procedure that they were doing to me as coldly and clinically as possible." As the number of providers decreases (it has dropped 37% since 1982) and the number of women having abortions continues to go up, clinics and abortion providers are overextended and under-resourced. Not only are many providers not well equipped to provide adequate support, but the procedure itself can also be a painful one, during which many women are fully or at least partially conscious. Raquel Valentin, Practice Manager for the Family Planning Division at Beth Israel Hospital explained, "Many first trimester abortions are being done with local and moderate sedation. This means that the women are still awake and emotional." The decision to use moderate sedation is based on both the women's choices and the higher risks associated with full anesthesia but can result in an experience that can be both frightening and, at times, painful.

In at least one abortion provider setting, a group of women is looking to provide additional support to women during pregnancy termination. The Birth Sisters, an existing doula program at Boston Medical Center (BMC), is in the process of adding abortion to their already comprehensive list of support services offered. The program, fully funded by the hospital, provides women with support from the early stages of their pregnancy through the postpartum period, often from doulas who can provide culturally competent services to the burgeoning Latino immigrant population served by the Medical Center.

Within the Birth Sisters program, the doulas have developed specialties, which are accompanied by further training in a particular area. Some of the Birth Sisters have specialties in domestic violence, others in breastfeeding. In an effort to meet the needs of women having abortions, the program is looking to expand the program to include compañeras, doulas who would provide this abortion support. The idea is currently in the research stages, and the members of the program have developed a needs assessment that will provide data on what kind of support women who are terminating their pregnancies at BMC need. They plan on having the compañeras meet with the women before the abortion, accompany them during the procedure and then meet with them at periodic increments afterwards as well (two weeks, two months, four months, etc). This mimics the role of a birth doula, who frequently meets with women before and after the birth, and goes beyond the support that most abortion providers currently offer. Dr. Nilda Moreno, an OB/GYN and member of the Birth Sisters program, explained, "We don't only want to provide emotional support but also contraceptive support. We want them to have all the information to prevent unintended pregnancies." Dr. Moreno also explained that the training will be similar to what counselors at Planned Parenthood receive, but with a special focus on emotional support. In addition, they also plan on providing support to women having medication abortions, who usually go home and pass the pregnancy on their own.

The idea of providing a support person to women during pregnancy termination is not a new one. Planned Parenthoods, other abortion clinics and feminist health centers have a history of trying to provide support to women having abortions, in the form of options counseling and also with accompaniment during the procedure. Other abortion settings provide similar support in the form of specially trained counselors, or patient advocates. When these programs are already providing models for supporting women during abortion procedures, why doulas?

Erin explained why she would have wanted a doula at her abortion: "I feel that a doula would have helped me understand what was happening to my newly pregnant body, the process of the abortion, and the after care for my body." Doulas employ a variety of techniques with women in labor, some that help prepare her mentally for the labor, others that mediate pain, and others that focus on relaxation. Many of these techniques could have useful applications in the support of women during pregnancy terminations, as Erin describes. Explaining how the abortion procedure works is similar to visualization used by doulas during labor, when the doula helps the woman to visualize the baby moving down into the birth canal with the strength of each contraction. These visualizations can help the woman better cope with the pain of labor by enhancing her understanding of the purpose and cause of the pain she is feeling. In addition, pain mediation techniques, like massage, acupressure and breathing could all be helpful for some women during these abortion procedures.

Central to the concept of doula care for abortions is the follow up component. This is where most clinics and providers are unable to provide the longer-term support that a doula could. "I would also have welcomed their support in confirming that my body would, in the future, be ready and able to make a baby and that I would be a good mother when the time was right," Erin says. An important component of birth doula work, this follow-up allows the doula to check in with the woman throughout the months following her abortion, when additional concerns and issues may arise.

Susan Yanow, supporter of the Birth Sisters project and former director of the Abortion Access Project, explained that she sees abortion care as just another service that doulas can provide, in addition to the other areas where they already provide support. "I don't want to carve out abortion in any way that minimizes or maximizes it," she explained. Instead of implying that women who have abortions need a lot of support, this is simply another opportunity to help women within the broader context of doula care. To her it's important that women do not feel that abortion is being stigmatized and that women are not being sent the message that they need support during their abortion. "For some women," Susan reminded me, "all they feel after their abortion is relief."

"The reasons a woman decides to have an abortion are complicated, and her feelings are really complicated. We need to take care of all of it." Susan explained that what she doesn't want to do is send the message that all women need support; and she worries that it will simply add to the stigma that women already feel around abortion. Some women have social networks, family members and friend who will be there for her; some don't need any special attention at all. But for the women who do need it, Susan agrees that it should be available to them. At the Birth Sisters program, a large majority of the women they serve are immigrants from Latin America, many of who are terminating pregnancies that they acquired while crossing the US-Mexico border. These pregnancies can be a result of rapes that are not an uncommon occurrence for immigrants who come into the United States without documents.

For many in the midwifery and doula community, the idea of a doula offering her services to a woman terminating a pregnancy is controversial. Abortion is a topic that is rarely breached at midwifery and doula meetings and conferences, and in many ways has become the elephant in the room of the birthing rights movement. The reasons for this are varied, from a strong religious contingent within doula and midwifery communities to women who feel strongly that they are working on behalf of mothers and babies. A thread in reaction to an article I wrote for Campus Progress about being a radical doula on the site Alldoulas.com provoked an interesting discussion about this issue. One poster explained, "I am an advocate for moms and babies. Aborting babies is totally opposite from that in my view. As much as I believe in a mothers right to choose how she will give birth, I also strongly believe in the baby's right to live. 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."

One woman and advocate who is working to force abortion advocates and birth activists to dialogue with one another is Lynn Paltrow. Executive Director of the National Advocates for Pregnant Women (NAPW), Lynn has been advocating on behalf of pregnant women for most of her career. Last Spring, Lynn and NAPW hosted the Summit for Health and Humanity of Pregnant and Birthing Women in Atlanta, Georgia. What transpired was a gathering of abortion advocates, reproductive rights activists, midwives, doulas and birthing rights academics. Not everyone in the room was in support of abortion. Not everyone in the room understood the benefits of natural childbirth. Lynn explained in her article on TomPaine.com, "Participants moved beyond the divisive abortion debate to find common ground in the experiences of pregnancy and the increasing limitations to care and support that all pregnant and birthing women face." The Birth Sister's Compañera project, along with two other similar abortion doula projects (one in New York City and another in Washington State) arose from conversations that began at the summit.

In the last few years, we have seen the abortion climate in the United States become increasingly hostile. The current administration, including its newly appointed Supreme Court, seems adamant about limiting women's access to abortion procedures. Medical students aren't being trained to do the procedure, yet the need for abortion services remains steady. Some women make the decision to have an abortion within a supportive and loving environment, and they are able to cope well with the emotions that can come along with terminating a pregnancy. But other women make the decision alone, or without the support of a partner or families. It's these women who will benefit the most from having a doula at her side-someone who has no investment in her pregnancy, and simply wants to hold her hand, distract her, make her laugh or explain the procedure to her. But it's also about more than just helping a woman survive that one procedure, it's also about trying to mediate the impact it has on the rest of her reproductive life. "I had a hard first labor," Erin recounted. "I wonder if I had trouble connecting to my birthing body as a result of the abortion experience. Once I worked with a doula for the birth of my two very much wanted and planned children, I could imagine what it would have been like to have a doula at the abortion."

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  • http://www.nonviolentchoice.info invalid-0

    You wrote that Lynn Paltrow is “working to force abortion advocates and birth activists to dialogue with one another.”

    It’s one thing to arrange or facilitate or encourage or urge dialogue…But to *force* it? Is not force inimical to genuine dialogue?

    If the process in question is something that needs to be forced, then I have to wonder: Is it really about dialogue and cooperative action on common ground, or is it an attempt to commandeer the birth activism movement into uniformly advocating an abortion-rights agenda?

    Just asking…

  • invalid-0

    “…pass the pregnancy”? That’s an interesting way to put it, I would have said give birth to the foetus in order to terminate it.

  • http://vivalafeminista.blogspot.com/ invalid-0

    Thanks for this fabulous piece! I wish I had a doula for my birth and I can see how needed one would be during an abortion. And thanks for highlighting that PPFA already does this – to an extent – in their clinics. When I volunteered in a clinic, I met the most caring & loving people who truly worked to help women. I have a colleague who did her thesis (circa mid-70s) on Latinas & abortions. She is still moved that for many of the women, she is the only person they ever told. They went thru their abortions ALONE! Not just physically, but mentally too.

    Viva Companeras!

  • amanda-marcotte

    Not to speak for Miriam, but I don't think she picked the word "force" to mean literal coercion, but more to really drive home how important it is for activists in these various areas to dialogue with each other. Birth activists who are lured by fetus-centric anti-choice language into taking an anti-choice view on abortion would benefit from seeing how abortion bans hurt them, because they reinforce the notion that women's reproductive capacity is a wholly owned subsidiary of the state. Which is to say that a state that bans abortion will feel free to pass laws controlling how you give birth as well. And abortion rights advocates will benefit from seeing how their issue is linked to a lot of others.


    We're all in this together, basically. Like Loretta Ross said at the NAPW conference, I'm not pro-choice, I'm not pro-life, I'm pro-you. Birth activists and birth control activists are both about restoring the control over the female body to female people who live in those bodies, who are the rightful owners of it. Seeing the connections doesn't mean you have to change the focus of your activism. It's about deepening your understanding of what you do.

  • scott-swenson

    Two comments were deleted from this article because of the uncivil tone. For more than a generation anti-choice activists have poisoned civil dialog. Two other comments, that clearly have a different perspective on this piece and suggest opposition were not deleted. They genuinely engage the dialog and we encourage replies.

    It is very tough to have a civil dialog on these sensitive topics. It is much more so when a very few vitriolic voices contribute nothing but venom, engage no discussion, offer no new perspective.

    Where there is misinformation we should counter it and much of this site is filled with evidenced-based information and reality-based experience. We understand that people disagree and we encourage civil discourse. Unlike the sites the promote only the anti-choice agenda that don’t allow comments at all, we will continue to allow open commenting that is of a civil nature and that seeks to engage the debate, but we will delete without further explanation comments that threaten, demean, or decrease the civility of discussion.

    Be the change you seek,

    Scott Swenson, Editor

  • invalid-0

    I am pro-life/anti-abortion and I agree that we need to talk to each other. Both sides make the claim that the other wishes to harm women. Yet I firmly believe that both sides are sincere in their drive to help women lead more positive lives. We just disagree over the “how”.

    I think one of the things that hurts civil dialog is the labels we use for each other. I don’t regard myself as “anti-choice” because I see a fetus or embryo as a person with an inherent right to continue existing. I don’t see terminating that fetus/embryo as a choice, in the same way I don’t see the death penalty as a possible legitimate choice.

    I’m happy to be called anti-abortion, but I see myself as more pro-life. This however implies that you are “pro-death” which I don’t see as true. Perhaps I am truly pro-personhood-from-conception, but that is rather unwieldy. Until we can come up with labels for each other that respect the other’s sincerity it’s hard to really communicate with each other.

  • invalid-0

    Make that pro-personhood-from-fertilization having just read the hyperlink from my comment defining conception as occurring at implantation.

  • miriam-perez

    Thanks Amanda, I agree with your analysis of my use of the word choice. Lynn Paltrow just has the amazing talent of being able to bring people together, who have fundamental disagreements, but even just the act of hearing each another out can have profound impacts. I definitely did not want to imply that people are doing something they do not want to do.

    Miriam Perez


  • scott-swenson

    While we obviously disagree on the fundamental issue, I think we would all agree that the labels don't help. We wrestle with the "label" issue all the time because most of us work night and day because we are so much in favor of lives that can be lived to their fullest potential, and recognize that for many women around the world being seen as nothing more than property or womb, makes that difficult. The fertilization, conception, personhood construct appears to be just more nuance attempting to control women's reproductive lives. There is no doubt that making a decision to terminate a pregnancy is not one taken lightly by anyone and it is the suggestion that it is by opponents of women's rights to choose that option, that makes this more difficult. Those of us on the progressive side have had our share of bombast as well, but I do think it is fair to characterize it as reactionary — meaning reacting to those who would turn the clock back. Look at the Guttmacher study released with the authority of The Lancet behind it showing that liberalizing abortion laws actually moves us all in the direction of life; the Population Action International study about Women at Risk; the overwhelming evidence for comprehensive, evidenced-based sexuality education, and the success rates of contraception. Looking at the totality of reproductive health and the arrow points toward common sense policies that respect differences and work toward common ground and compassion, recognizing none of these are easy decisions.

    All decisions, especially of such sensitive nature, are better made in a truly civil society. While we clearly disagree on policy Tess, thanks for engaging the differences with civility.

    Be the change you seek,

    Scott Swenson, Editor

  • invalid-0

    I’m a woman and a mother of four. I honestly hold my views because I believe that personhood begins at fertilization. I can see no other point at which someone enters existence. Implantation is an arbitrary measure, since a unique genetic entity already exists. I don’t think that women who have abortions do it lightly but I do think that they end a life.

    I have trained as a Billings Ovulation Method teacher and I use this method of family planning myself, I am passionate about BOM because it teaches women about our bodies and because it provides so much information about our reproductive health. I think all menstruating girls/women should have in depth education about their sexuality and fertility.

    There is no way in which I wish to hold control over women. I strongly advocate left wing health policies, such as financial support for single parents, free health care and education. (I’m a New Zealander, so we have this and we are fighting to retain it).

    The countries which have the lowest rate of maternal death/harm are the ones that have invested in accessible high quality health care. So, for example, abortion isn’t going to directly rectify the fistula of a woman who wanted to have a baby. It won’t stop a woman dying of sepsis.

    I agree that contraception directly leads to a control of fertility. I personally do not agree with contraception (I am Catholic) however I have no problem with other people choosing differently. Having used hormonal contraception in the past, I have found that BOM is the best choice for my body and my relationship. But that is a personal choice. Other women aren’t in a stable marriage and BOM requires the effort and consent of both sexual partners.

    Why not have fully state funded contraception and maternal health, in depth education about fertility and sexuality and only resort to abortion as an indirect surgical consequence of saving a woman’s life? Eg. ectopic pregnancy.

  • scott-swenson

    Excellent and thoughtful reply. Good luck retaining that health care in New Zealand, as you know we’re light years behind in the US understanding the importance of a true right to health care. The most striking part of your reply is that you acknowledge your faith and the choices you make that are best for your body, and you even acknowledge that others (different faith or body chemistry) might make different decisions for themselves. You even acknowledge the importance of abortion as a medical procedure in certain, very limited, circumstances. We would all move much further faster if the acknowledgment you offer to others rights to make their own choices, were the starting point for all discussions about reproductive health. Perhaps you could take over the social conservative movement?

    Be the change you seek,

    Scott Swenson, Editor

  • invalid-0

    LOL. I would take it over if I could, however my super-powers seem to be a bit depleted right now!

    I’m all for personal choices. I believe that individual moral freedom is vital and an inherent human right. I just want to reiterate that our individual choices can not legitimate harm to other persons and I morally and philosophically can not exclude embryos and fetuses as persons.

  • invalid-0

    There’s no fetus present in a medication abortion. They’re only indicated through the first eight weeks of pregnancy, when it’s an embryo. A medication abortion is basically just the induction of a heavier than normal menstrual period. There’s certainly no “birth,” nor an identifiable “baby.” The closest thing to a baby you’re going to get is greyish clumpy stuff–the products of conception in a late-ish medication abortion.

  • invalid-0

    What an informative article! I wish abortion was more widely discussed, in such an open and frank way.

    Also I agree that we all need to stop sensationalizing pregnancy termination– It’s only a medical procedure. Invasive, yes–but not moreso than say, open-heart surgery.

    Seriously, what’s the big deal? I don’t get the need for all this politicizing.

  • http://www.nonviolentchoice.info invalid-0

    OK, Amanda, I think I grasp what you’re saying here, about the interconnectedness of the issues from a prochoice vantage point…But please correct me if I’m wrong, and if you find anything I say here offensive, I apologize profusely in advance…

    To me, though, it sounds as if you are approaching this with an assumption that anyone who believes in and advocates for women’s rights over their own bodies, through whatever venue, is somehow “naturally” about a prochoice-on-abortion position–all she needs is to be “shown the light” and voila, she’s there, and fortified for good against the fetus-fetishizing blandishments of the “antichoice.”

    Well, whether or not you would agree with it, the argument can also be made that a concern for people’s rights over their bodies is a “natural fit” with certain prolife-on-abortion positions. (The argument could even be made–without reducing women to uteri,and without resort to religious dogma–that such a position is even more fully”pro-you.”) And indeed this is an argument that many prolife-on-abortion, prochoice-on-all-else people like myself, and like many birthing activists, already make, whether or not you personally find it persuasive.

    But all that aside for now….I think the deeper point I was trying to make was this: it’s not only prochoice-on-abortion folks who care about sexual and reproductive rights. And we don’t have to agree completely with “your side” about abortion in order to identify and cooperate and most importantly act upon on areas of common ground.

    While of course both “sides” have the right to try to persuade whomever they so wish….it’s unrealistic to expect or hope that all people involved in, for example, birthing rights activism will all with a little persuasion go over to one “side” or the other on abortion. And, I think, such an expectation of also overlooks the sheer complexity of the issue, and the integrity of each person’s process in trying to make some kind of peace with it.

    From what I’ve witnessed, these are the conclusions that generally emerge from a process of organic as opposed to forced dialogue….

    However, in the meantime, there’s so much else we agree rather than disagree about, there’s so much work to be done…so…how can both “sides” go about it, without being pressured or forced to give up the integrity of their own positions on abortion?

  • invalid-0

    In the interest of broadening and moving dialogue without labels, I want to respond to Marysia’s comment above, because I think it brings out a lot of really powerful questions that can no longer go ignored.

    First, I want to thank Miriam for her article. I am a birth doula and worked for at a Planned Parenthood clinic for years. Miriam speaks to the stress placed on clinics to serve so many more clients as abortion providers become fewer and fewer. The limitations placed on nurses, counselors and administrators, I suspect, are very similar as those placed on labor nurses and other maternity hospital staff – a large reason for the “doula renaissance” that we are lucky to be a part of now – those folks are not given the time and resources to do their original intensive jobs because there is so much for so few to do. Until abortion providers have the resources they need in terms of funds and staff, women do feel very rushed and alone much of their day at an abortion clinic. A doula (though I would never use that word – I like companera!- since “doula” implies motherhood and many women who have abortions would be upset or offended at that implication -though some also do very much feel that they are saying goodbye to their baby, and that should be validated) would be such a wonderful presence. Ideally, I suppose, though, clinic staff would, in general, be more mindful of and trained in well-woman care that includes emotional, psycholigical and spiritual support . . . which brings me to . . .

    How can “well-woman care” be a central unifying theme that is shared by birthing rights advocates and healthy and safe abortion advocates? I think, first of all, that there are more of us than you’d think who are rooted in BOTH issues as a singular movement for Reproductive Justice. That is, the right to have a baby in the way that YOU want (prenatal support and resources and woman-directed gentle birth), the right to NOT have a baby in the way that YOU want ( contraception, abortion, abstinence), and the right to parent the children we have (parental leave, healthcare, environmental justice, not taking our kids away from us, resources and support in raising families, looking at the rights of incarcerated parents or how our government incarcerates children!!!). This is an INCLUSIVE movement! It is compassionate, non-judgmental and focused on valudating your experience. I feel that if we can break out of the dichotomy of the “Pro-Choice” and “Pro-Life” movements and look at our common ground, we would be heartened by how much we could achieve together.

    This does require a willingness to be open to learning from what is depicted as “the opposition” and also a willingness to honestly see what needs to be improved about a movement that you identify with. For example, I love my doula practice and the women I work with have taught me so much. At the same time, I am posting anonymously because funders have made it clear that they do not agree with abortion and will not allow dialogue about abortion support. Likewise, I left Planned Parenthood because I felt the pace was so fast that I could not provide the quality support that I knew I would want with the demands of a full clinic day. Ironically, I now have a pace in doula care to devote time to carefully exploring issues, and many clients bring up a past abortion during a pre-natal visit and, in some cases, they do feel that experience has or is impacting their feelings about this pregnancy and birth.

    Like it or not, birth and abortion are intrinsically tied. Women cannot split themselves in two for convenience. A birthing mom, according to US statistics, is very likely to have had an abortion at some point in her life. She may never share that with her family, friends, or even her current partner, but she may share that with her doula. As her doula, you can dismiss it as something outside of your comfort zone, or you can demonstrate compassion and suspend judgment and allow her to frame that experience for herself.

    I like to think as a sisterhood of doulas that we are gentle enough and kind enough and purposeful enough to focus on our common ground and guiding principles of serving that woman at that time. I say, I’d like to learn from other women and not presume that what I know to be true for myself applies to everyone. And for those women who have either had difficult abortions or were traumatized by anti-abortion messages, I personally would do anything I could to let her guide her communication to me about her abortion(s) in a way that would facilitate HEALING and not further trauma.

    What do you think?

  • invalid-0

    I had my abortion 2 years ago, at age 25. Since I had never had anesthesia and no one in my friends or family knew that I was pregnant, I chose to be awake during the procedure. During the procedure, I was crying and in a great deal of discomfort. The nurse did not look at me at all and the doctor only ever told me to hold still. When I told them that I was in pain and scared, they told me that I had chosen to be awake during the procedure and should deal with the pain. There was no sympathy from any of the staff at the clinic. I felt like a criminal during a medical procedure which most of these staff members would probably claim to support.

    While I do not regret my decision, I wish that I could have had a slightly less scary and more humane experience. There is no reason that a woman needs to be further humiliated during what is already a very intimate and personal experience. I just heard about abortion doulas from a friend a few days ago and I wish that someone could have been with me during the procedure.

    A woman who is unexpectedly pregnant will already feel a tremendous amount of embarrassment and shame. For a doctor and nurse to compound these feelings, is unprofessional but unfortunately very common. I look forward to the day when pregnant women can be comforted and made to feel like human beings even as they make a decision that others don’t agree with.