Doulas might sound like something that only pretentious white ladies in Marin need — earthy granola ladies who show up in their Priuses speaking in slow, calm voices and talking about the ~magic~ of pregnancy. I definitely had this vision of doula services before I started interacting with the people providing them, and my comeuppance proved to be a fascinating look into the industry of birth (and death) in the United States.
People who work as doulas develop close relationships with their clients and families to provide a very unique form of personal, structural, and institutional support. They aren't physicians, they don't take the role of nurses (though some are actually licensed nurses as well), but they are compassionate people who bolster families through both exciting and devastating times in their lives.
For patients navigating an often intimidating medical system, a doula can be educator, advocate, and emotional supporter — doulas help people develop pregnancy plans, and they stand alongside their patients whether they're getting abortion care or giving birth.
In a culture where pregnant patients are pushed into procedures they don't want, especially if they aren't empowered when it comes to self-advocacy, doulas can help people have more positive birthing experiences, and better experiences with abortion, as well. (There are also death doulas, a completely different but also very important group of awesome people doing great work.)
Unfortunately, doulas can be very expensive — depending on where people are and what kinds of services they need, working with a doula can cost hundreds of dollars, and that's just not within reach for many low-income people. This is also the group of people that really need doulas the most, because they're the ones fighting the most institutional injustice, and that's where the bad-ass Doula Project, based in New York City, comes in.
The organization, which is the longest-running doula collective in the United States, is entirely volunteer, and members provide a variety of doula services to their clients, all of whom make a family income of less than $30,000 — above the artificially low poverty line, but low enough that these families can't realistically afford doula services.
The Doula Project assists patients not just with prenatal care and births, but also abortion, including abortions related to miscarriages or fatal fetal anomalies, which can be extremely emotionally stressful for everyone involved because it hurts to lose a much-wanted pregnancy, especially in a culture that doesn't talk widely about miscarriage despite the fact that it's extremely common. Low-income people can experience added stress when dealing with all of these things, and having a friend at their side can make the difference between a horrible experience and a positive one, a traumatic and terrible event or one that's still traumatic, but less fraught with disturbing memories, shame, and humiliation.
"As doulas, it's our job to provide compassionate support to everyone we work with, no matter where they're at in life, no matter what they're dealing with — I like to describe abortion doula work as loving someone unconditionally in five to seven minute increments. I think everyone deserves that kind of support during a procedure that is at best somewhat uncomfortable and at worst surrounded by a lot of very intense and sometimes very painful emotions."
That's Sarah McCarry, who acts as Media Coordinator for the organization (when she's not writing awesome books).
"The vast majority of our clients are low-income people and people of color who are already facing significant barriers to accessing safe, affordable health care," she explains. "And you don't need me to tell you that abortion is still an incredibly stigmatized medical procedure; I've never worked with a patient who didn't express an incredible sense of relief after their procedure, but that doesn't mean they might not also be negotiating complex feelings around their decision. And for people who are losing wanted pregnancies because of miscarriage or profound fetal anomaly, the procedure can be absolutely devastating."
The organization partners with Planned Parenthood and several area hospitals to provide care, and for doula programs interested in following suit, they have an extensive training program based on their years of experience — The Doula Project is almost a decade old. Its mission and values focus on compassionate, respectful, and supportive care for pregnant patients, no matter where they are in their journeys, putting the care that everyone deserves into the hands of as many people as possible. Their mission also notably utilizes inclusive language to make people of all genders welcome, a slowly but delightfully growing trend in reproductive justice communities.
They're also constantly expanding (for one thing, they started out with a focus on elective abortion services and rapidly identified other unmet needs). That expansion, though, comes at a cost, as they're faced with lots of people with a need for services and not enough people to provide them — which is where NYC residents can come in, because those interested can participate in their next training, coming up in June (the application deadline is on May 13).
Not sure what to expect? Sarah told me about that too:
Once a year or so we conduct a thirty-hour intensive training that covers everything from recognizing internal biases to the hands-on aspect of how a vacuum aspiration procedure works (that's the legendary papaya workshop). We teach hands-on comforting and support techniques, small talk workshops (you can spend a LOT of time in the procedure room alone with a patient before the doctor comes in), a variety of stress-reduction techniques to offer patients, and other doula-related skills; we also talk about the barriers to access many of our patients face, cultural competence, supporting patients who are trans or gender non-conforming, supporting patients with disabilities, supporting patients who don't speak the same language as the doula. We also offer ongoing trainings throughout the year for our volunteers.
For those interested in learning more about full spectrum doula services and the model while also helping low-income New Yorkers during difficult, wonderful, challenging, and unexpected periods of their lives, it's a great opportunity. (For those of us not living in New York, or not able to donate time, The Doula Project is always in need of funds, and I would note that it's particularly satisfying to donate to a reproductive rights organization every time Donald Trump starts quacking about the subject, although it can get financially ruinous very quickly so set a monthly cap, my friends.)
Sarah notes that a growing body of research suggests that birth outcomes improve when clients work with a doula, which is evidence enough that they should be available to anyone who wants to work with one, Prius and granola or not.
Photo: Alick Sung/Creative Commons