The Doulas

Radical Care for Pregnant People

Mary Mahoney, Lauren Mitchell

• Publisher: The Feminist Press at CUNY
• Year: 2016
• ISBN:
  9781558619494
• Topic: Social Sciences
• Subtopic: Feminism & Feminist Theory
• Index: Social Sciences

Weaving together how-to manual, activist memoir, and manifesto, The Doulas is an "honest, raw, and charged" treatise on full-spectrum doula care. ( Rewire )

As more feminist conversation migrates online, the activist providers of the Doula Project remain focused on life's physically intimate relationships: between caregivers and patients, parents and pregnancy, individuals and their own bodies. They are committed to supporting a pregnancy no matter the outcome—whether it results in birth, abortion, miscarriage, or adoption—and to facing the question of choice head-on.

In this eye-opening book, Doula Project founders Mary Mahoney and Lauren Mitchell present the history, philosophy, and practices of these caregivers, contextualizing the doula movement within the larger scope of pregnancy care and reproductive rights. They illustrate how, through their unique hands-on activism, full-spectrum doulas provide tangible support for those confronting life, death, and the sticky in-between.

Part 1

The Beginning

A Great Idea

The Abortion Doula Project was a great idea.

It was one of those brilliant shining stars that catches your eye from high above, the kind you want to reach up and grab with both hands, make a wish on. And this was it in all its profound simplicity: people having abortions should have continuous and nonjudgmental physical, emotional, and educational support just like people giving birth. For one year, between the summers of 2007 and 2008, we floated on our big, beautiful idea, lifting it up bright and glowing into a cloudless sky.

The idea was conceived at the NYC Birth Coalition meeting, a local attempt to bring abortion and birth activists together in one room—something that didn’t normally happen. That day, Lauren Mitchell, Mary Mahoney, and Miriam Zoila Pérez, the Doula Project’s founders, all stood up and said, “We want to be abortion doulas.”

Words of encouragement fluttered through the air, the group nodded and smiled at each other as the idea dawned. Maybe this will be the next “big thing,” their reactions seemed to say.

The three of us circled each other curiously. We had met briefly before at some point or another—the New York repro scene was relatively small. We decided to grab lunch after the meeting. We walked to Zuccotti Park to eat our deli fare and jumped into how we might start an abortion doula program here in the city.

We had each entered the reproductive justice fold in the early to mid-2000s and were trained under its holistic justice-based framework created by women of color in the 1990s, with Loretta Ross spearheading the conversation. Often, the feminist movement of the 1960s is associated with a reproductive rights framework—the right to choose when, how, and with whom someone has children. Reproductive justice takes that movement further, bringing together intersections of identity to form a definition of social justice hinged on lived experiences—especially lived experiences of women of color. It analyzes and exposes the intersections—including gender, race, sexual orientation, and access to resources—that affect how a person makes decisions and whether that person has meaningful choices around reproductive health. Reproductive justice looks not only at the right one has to an abortion but also one’s right to have a child and to parent that child.

Connecting the right to give birth and parent to the right to an abortion was a groundbreaking concept that would greatly influence the mission of the Doula Project (which would become our official name within a year).

Full-spectrum care, the cornerstone of our organization, was a direct descendant of the reproductive justice framework and bolstered the stance that abortion should not stand alone, that it is one part of a person’s entire reproductive life. The same individual may have an abortion, give birth, and then have a miscarriage. The point we feminists wanted to make was no longer only, “I’m having an abortion.” It was now, “I am pregnant. This is what I choose to do for this pregnancy. This is what I am able to do. Next time, I might choose something different. Can I get some care and support for this pregnancy’s path?”

Full-spectrum care acknowledged the experience of being pregnant—whether for four weeks or nine months—not just the outcome of the pregnancy. Somehow this idea seemed new. Aimée Thorne-Thomsen, former executive director of the Pro-Choice Public Education Project (PEP), early advisor to the Doula Project, and current vice president for Strategic Partnerships at Advocates for Youth, remembers:

It felt like there were more conversations about the end result of pregnancy. We would talk a lot about abortion or birth control, we would talk about things around pregnancy, but not pregnancy itself. And at the point you all were going to launch, it was like, huh, there’s a process here that we skip over in the field all the time: the actual pregnancy.

We were compelled to do this work because we wanted to see and feel the changes we were trying to create. The reproductive justice movement was home to us, and we were well aware of the debt we owed to the intellectual and political framework it created, which opened the door for us to dive into this project. We were standing on the shoulders of giants, women in the field who were changing both policy and the messages being presented in media. As a result they changed the lives of countless people, who started receiving better care and more acknowledgment of the state of their care.

We also looked back to the 1960s and early 1970s, the time before Roe v. Wade was decided, when women still had to obtain abortions illegally in most states. We discovered Jane, the underground abortion network in Chicago that helped more than eleven thousand women receive safe abortions between 1969 and 1973. Jane was known for its radical feminist politics and DIY spirit. Members of Jane put together pop-up abortion clinics in whatever nice apartments they could find, they did extensive counseling and phone support, they provided post-abortion care—and often were the abortion providers. What we were most struck by, though, was how much support and care was exchanged between the members of Jane and their clients who had little to no anesthesia to offset the pain. Thinking about how this support played out, Laura Kaplan, author of The Story of Jane and one of the coordinators of the Jane Collective, reflects, “How you behave toward another person and what you do for her affects her view of herself.”

Kaplan describes the Jane Collective as mixing abundant idealism and social responsibility. They were responding to a pressing need in the community, saying, “We saw all of these problems, and we felt like abortion access was something we could actually do something about.” They learned quickly what we would also learn quickly: that direct care means you do not put good against perfect. “We were very focused on the here and now,” she says. People would call needing abortions and needing them fast. Most of the time, they weren’t able to pay much, if anything at all, so Jane worked through the energy of volunteers, with a handful of paid staff who were doing the heavy lifting of coordination and procedures. An elaborate yet flexible process was set up to ensure that Jane would be able to operate efficiently and under the radar of the law. But doing this work on the fringes of legal and medical systems highlighted that no amount of planning and theorizing would be able to anticipate the messy reality of working with people during abortions.

We set out to translate the reproductive justice framework into a more direct-care-oriented approach, using pieces of what Jane did as a model. The reproductive justice movement promotes the idea that, in a lifetime, a person might experience the full spectrum of reproductive health decisions, that these decisions are linked to other intersecting factors in their life, and that any decision made should be respected and protected. So what did this actually look like on the ground for pregnant people? How was this lived out during their pregnancies?

Cofounder Miriam Zoila Pérez (who goes by Pérez), founded the blog Radical Doula and wrote The Radical Doula Guide: A Political Primer for Full-Spectrum Pregnancy and Birth Support. Pérez reflects:

Starting a program to support people during abortions just made so much sense to me. Of course doulas can and should use their skills during a different pregnancy outcome. Why wouldn’t we? I also appreciated the potential political impacts of even the phrase “abortion doula.” I knew that it would push at the silos between abortion and birth, and hopefully push the birth activist world to talk about abortion and miscarriage.

As we laid down the bones of our mission, a simple but strong skeleton formed, built largely on our own personal value systems and what we had uncovered fighting for reproductive equality over the years. We quickly agreed that the clients we most wanted to serve were the ones who may not have easy access to social support during pregnancy or who could not afford to go to the private clinics or fancy hospitals with the most resources. Because New York is a very culturally diverse city with enormous disparities in wealth and class status often based on the color of a person’s skin, primary language, or age, we knew we would primarily be serving women of color, immigrants, and young people.

We wanted our service to be free to all people who needed it, something we would become known for throughout the doula world. Doulas are often reserved for a more affluent crowd—their service isn’t cheap and is not typically covered by health insurance. We believed all pregnant people deserved this kind of support regardless of their financial status. In order to do this with little to no funding of our own, we, like the Jane Collective before us, decided we would create a volunteer network. Lauren and Pérez had already attended numerous volunteer births as doulas, and Mary had been an AmeriCorps VISTA. We all felt passionate about the power of volunteerism, of the emotional intimacy that arises from our work when it’s based on a fiery commitment to the cause rather than on compensation.

As the years went on, however, we would learn that in New York City “volunteerism” often equated itself to “middle class” and even more often to “white middle class.” Abortions typically took place during the day, during the week, when many people could not afford to miss work. Though we were and continue to be in awe of the incredible caring capacity of the doulas who joined, we cringed at the thought of creating another racialized, class-based hierarchy in medicine. We would struggle to diversify our base in the face of a meager budget and ever-growing client and clinic needs. (As this book is being written, we have passed our first budget to pay abortion doulas a small stipend.)

As we were coming together in 2007, the birth doula community in New York City was at the cusp of an explosion of a new generation of doulas. In addition to the ongoing abortion debate, the heat of the “home vs. hospital” birth argument was at its zenith. Maternal mortality and C-section rates were on the rise and people were speaking up. Abby Epstein’s eye-opening documentary The Business of Being Born was released soon after we became birth doulas. Suddenly, it seemed that everyone had a “birth plan” and everything was “natural”—natural products, natural labors, and natural approaches to parenting.

Meanwhile, a few months prior to the NYC Birth Coalition meeting, National Advocates for Pregnant Women (NAPW) convened a conference that brought birth and abortion activists together in one room for the first time in most of our memories. The NAPW’s 2007 National Summit to Ensure Health and Humanity of Pregnant and Birthing Women offered a crucial platform for activists and was in some ways iconoclastic: it engaged with reproductive justice activists as well as with staunchly anti-abortion birth activists. It was trying to build alliances across political dominions in a way we hadn’t seen before—for example, it created contact between abortion providers and birth activists who feared that they would go to hell for sharing space with them. But as Lynn Paltrow, founder and executive director of NAPW, discussed at length with both communities, the “justification for locking women up and forcing them to have court-ordered C-sections stems from the same legal justifications developed for restricting abortions. [In other words] there is no difference in the legal theories used to restrict abortion and those used to justify forcing a woman to have cesarean surgery.”

In trying to connect both communities, Lynn describes the work of the NAPW conference as “pragmatic” because both communities were advocating for the same women—just at different points in their reproductive lives. She also hoped that bringing the two activist communities together would “detoxify the abortion debate by making it richer and more complex [and] by saying, you can’t just talk about ending a pregnancy.”

According to activist and scholar Marlene Gerber Fried, director of the Civil Liberties and Public Policy program (CLPP) at Hampshire College, “Historically, the frame of choice wasn’t about having children, but rather the choice not to. And while there was much overlap in individual players and organizations who worked between the two worlds, for decades they were usually very siloed.”

CLPP was also instrumental in bringing together voices from both movements at their annual conference. The CLPP Conference facilitates one of the largest platforms for activists, especially young activists, in the country, often influencing themes and ideas among organizers for the year to come. In 2007 a number of doulas were invited to speak at CLPP. Those talks followed the conference’s Abortion Speak-Out, a night where people share stories about their own abortions. The Speak-Out is known for being a beautiful space for those who come to listen and those who come to share. The Speak-Out would be a huge inspiration to us, in many ways a cornerstone of our compassionate practice, as we developed as an organization.

Between the burgeoning success of The Business of Being Born, the connection reproductive justice advocates were facilitating between birth and abortion, and a new activist-flavored onslaught of birth doulas saturating New York City, the timing for the Abortion Doula Project seemed perfect. We continued to formulate our mission.

Pérez says now:

In that first year of creating [the Doula Project], I remember a lot of exploring what it would look like to take the skills and role of a birth doula and apply it to the abortion context. I remember a lot of hypothesizing about what someone having an abortion would want from a doula. We were wrong about a lot of the assumptions we made, but it makes sense that we were wrong. We were really charting new territory.

With this new territory came several months of starts and stops. We were all young, busting our asses at our full-time jobs, navigating a city that left us worn to the bone at each day’s end. Weeks would pass, and the Abortion Doula Project would feel like nothing but a misty memory. One day, Pérez announced she was moving to Washington, DC, to pursue new personal and professional opportunities. Unsure of whether to proceed without her, the two of us (Lauren and Mary) met up to determine the fate of the organization. We decided that we were finally “gonna do this,” although we would now approach it as a duo.

To us, and to many others, the idea of providing compassionate emotional, physical, informational support was intuitive, whether we called it “doula care” or any other name. We knew that there were social workers, counselors, nurses, doctors, clinic escorts, and many others who were providing this care before “abortio...

Table of contents

• COVER
• TITLE PAGE
• COPYRIGHT
• DEDICATION
• CONTENTS
• Thank God for the Doulas!
• Introduction: An Organization on the Fringe
• Part 1. The Beginning
• Part 2. Doulas for Doulas
• Part 3. Ambiguous Losses
• Part 4. A Crisis of Self-Care
• Part 5. Activist Practice
• Conclusion: Always a Doula
• Afterword
• Glossary
• Timeline
• Acknowledgments
• About the Authors