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The long five minutes: Abortion doulas bring comfort during a complicated time

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Carolyn Van Houten

An abortion doula named Grace clasps hands with a patient during her procedure at a Virginia abortion clinic.

"Do you support reproductive choices of all shapes and sizes?" the flier had read, posted online in early April. "Become an abortion doula."

More than 50 women had seen the flier on Facebook or Twitter and responded to the email address at the bottom, not entirely sure what an abortion doula was. Twenty-five had been selected for a weekend-long training at a Virginia abortion clinic, and now, one Saturday morning in May, they'd arrived to see whether they were right for the work.

A doula, traditionally, was trained to support a pregnant woman through her delivery, explained a facilitator from a group called D.C. Doulas for Choice. Traditional doulas weren't medical professionals, but they could hold hands, offer distraction, supply heating pads. In a roomful of doctors and nurses focusing on the delivery of a healthy baby, a doula was focused solely on the emotional well-being of the mother.

D.C. Doulas, a volunteer-based collective, believed pregnant women needed equal support if they decided not to become mothers at all, the facilitator explained. And so, if the aspiring doulas in this room made it through training, and apprenticed through a series of shadow shifts, then this is what they were signing up for: To be in a surgical room with a woman through one of the most intimate emotional experiences of her life; to hold her hand while she had an abortion.

The facilitator asked everyone to share strengths they could bring to the table, and hang-ups they'd try to leave at the door. Bringing: openness, empathy and willingness to learn, said the aspiring doulas. Leaving: Nerves, distraction and preoccupation with their own busy lives. "Family judgment," said a doula named Grace. "My mother has told me she would disown me if I had an abortion."

The other women sitting around the table winced. Grace shrugged a little, as if to say, What are you going to do? The night before this training, she'd been worrying that her parents might ask about her weekend plans, but here she was, anyway.

The women the doulas helped would be strangers, the facilitators explained. The doulas would know them only by their first names. After they left, the doulas would never see them again.

Outside the clinic, abortion was vast and abstract. Inside, abortion was a five-minute procedure happening to actual people. To be an abortion doula meant being a part of the pro-choice movement at its most granular, most personal, where philosophical debates fell away.

On the first day of training, a doctor had come in, a chic, funny woman who walked through the mechanics of the procedure, passing around medical instruments: a tenaculum, metal dilators. On the second day, they went over a list of neutral phrases and topics for if they found themselves not knowing what else to say: "It is almost finished." "You're so strong." "Are you watching anything good on TV?" Ask what patients were planning to have for dinner - they wouldn't have eaten since the night before. Talk about their kids. Patients who already had kids loved talking about their kids.

"It feels a little vague," worried a woman named Lila, as they went over how to explain their roles to patients. "I'm circling around, like, 'I'm here for you,' but am I communicating what that would really, actually look like for me to be in the room?"

The final activity was role-play; the trainers had written scenarios on index cards. "Grace, are you comfortable going first?" a facilitator named Lindsey asked, selecting a card for the young woman who had said she needed to leave behind family judgment.

Another trainer lay back in a chair meant to mimic a surgical table. "I'm freaked out," the pretend patient told Grace. "The protesters outside are making me nervous - are they here every day?"

"They're here some days," improvised Grace, who, like other women in this story, is not being identified by her full name because of the sensitivity of the topic. "Some days they're not. What about them is making you nervous?"

"Will I have to walk past them on my way out?"

"If you're worried about getting to your car," Grace said, "we'll make sure you don't have to go out alone."

After the final exercise, one of the trainers asked everyone to make a circle and close their eyes. "If something is making you nervous - if you are feeling like being an abortion doula is not the right fit, then take a step forward now."

A few people shifted their weight and one started to raise her hand. But in the end, they all stayed in place, and they were all still in.

* * *

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Carolyn Van Houten

Grace talks to a patient in the recovery room after her procedure is over.

A month later, a couple of days before her first shadow shift, Grace went to a coffee shop to meet Tahira, the experienced doula she'd been assigned to shadow.

"Do you have any questions?" Tahira asked. "Nervous about anything?"

Tahira had been volunteering with D.C. Doulas for several years, she told Grace, long enough to know that she was supposed to offer just two fingers for patients to squeeze instead of a hand, but also long enough to know when to bend that rule.

"Sometimes, what they need is just to hear that what they're feeling is normal," Tahira said. "And it probably is."

Some women might cry, and that was normal. Some women might feel only relief, and that was normal. Some might feel guilty about their relief. Feel drowsy after anesthesia. Feel woozy, in the patient lounge, while they sat with the other women who had just come out of their own procedures. Have cramps. Laugh. Want to talk about nothing but the final season of "Veep." Normal, normal, normal.

"Sometimes women come who don't believe in abortion," Tahira told Grace. Women who felt it was immoral. But then these same women ended up at the clinic, and them coming there, despite what they thought they believed, was a normal thing that Tahira saw all the time.

Grace's first introduction to abortion, at least that she could remember, was at a Christian retreat. Someone had talked to the girls about how their virginity should be saved, as a gift. Someone else showed pictures of dismembered fetuses and said women who had abortions always regretted them. Life was beautiful, life was sacred.

When she grew up, she became a birth doula. She sat in rooms with women in labor, leading them through breathing exercises, hours on end, exhausted and exhilarated, watching as new life came into the world.

Earlier this spring when she'd learned she was pregnant, the timing wasn't good, but it wasn't horrible. She had a job and a boyfriend with whom she hoped she might have children one day. They talked about it a lot, and she thought about it a lot while she visited her family in their conservative state, wondering whether her mother noticed that she seemed more tired than usual.

If you ever have an abortion I'll disown you, her mother had said, but then Grace's second introduction to abortion was the clinic where she and her boyfriend had decided, after weeks of conversation, to make an appointment. She put her feet in the stirrups, and she took long breaths as she looked up at the ceiling.

When it was over, her primary emotion wasn't grief, she said, but assurance that she'd made the right decision. The clinic had been compassionate, her friends had been supportive, and when it was over she started to think about women who had to go through it alone. The spectrum of reproductive health was so wide, and filled with so much wonder and pain.

She found herself googling "abortion doula," a concept she was only vaguely familiar with. D.C. Doulas for Choice came up, and they had just posted a flier, and they were accepting applicants.

"We're going to come up with a mission statement," Lindsey, the facilitator, had said at training. A sentence-long definition of what this class of doulas wanted to represent.

"Nonjudgmental," someone called out, and Lindsey wrote it on the whiteboard. "Client-centric," suggested another. Lindsey wrote down everything, adding semicolons, transforming the suggestions into an unwieldy sentence. "Anything else?" she asked.

From the back of the room, Grace half-raised her hand.

"A doula is water," she said.

"Explain that?"

"Taking the shape of whatever role is needed," Grace explained. "Like water."

From the whiteboard, Lindsey nodded. "If someone getting an abortion calls it a baby, it's a baby," Lindsey said. "If she calls it a fetus, it's a fetus. If she doesn't say anything, don't talk about it."

She turned and wrote on the whiteboard: "A doula is water."

* * *

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Carolyn Van Houten

Grace returns to the clinic after walking a patient to her car.

An abortion was a five-minute medical procedure, and an abortion was a query into the literal meaning of life. It was the reason some people voted for presidents, it was a small collection of cells. Every possible thing that could be said about abortion had been said, but a lot had been said speculatively, because people with experience were too afraid to talk about it out loud. Abortion was a secret. Abortion was almost always a secret.

"How are you feeling?" Tahira asked the first patient of the day as Grace sat next to her, observing, on the morning of her first shadow shift.

"Not great," said the woman, curling her hands into the sleeves of her sweatshirt.

Twenty minutes earlier, Grace had turned off the "find my friends" app on her phone, so her parents wouldn't see her pull into an abortion clinic. She parked in the garage of an office park where protesters outside carried signs reading "Everyone deserves a birthday."

Now she was wearing turquoise scrubs and sitting in a carpeted room that had a Bible on the table and a small fountain plugged into the wall.

"You'll sleep just for a few minutes, but it will feel like you slept for hours," Tahira told the patient, answering a question about anesthesia. The anesthesia wasn't required, but a lot of women who came here requested it. "You'll wake up, and you'll have something to eat in the patients' lounge. We'll be with you the whole time."

"Could I ask you a question? I'm bad with needles. When I wake up, will the needle from the anesthesia still be in my arm?" the woman wanted to know.

The woman didn't offer why she was having an abortion. She didn't say anything about her pregnancy. Tahira had explained to the patient that doulas were free, voluntary, and there to offer comfort. The patient had responded, "I could really use that right now," and that was the only thing about her they knew.

A little while later, Tahira and Grace stood in the surgery room with the patient, a doctor, a nurse, an anesthesiologist. "Take a big breath, look at me," Tahira told the patient, as the nurse adjusted her feet and told her to scoot down on the table. The patient looked up at Tahira with big eyes. "Deep breaths, we're going to do deep breaths," Tahira said, as the anesthesiologist injected the sedative. "I know this is scary but you are tough."

They had been in the room with her for almost exactly five minutes. The sound of the doctor's medical vacuum was about as loud as a Dustbuster. There was blood in a tube; the doctor worked fast. Tahira and Grace stood with the woman in the baggy sweatshirt, while in the waiting room, there were six more patients to go.

Five minutes with the second patient: Talking about whether there was anything good on Netflix.

Five minutes with the third: Talking about workout regiments, whether it was better to go to the gym every day or let muscles rest.

Five minutes: "I'm so f----- up about this," the patient said, rubbing her eye with her fist. "That's OK, that's normal," Tahira said. "I'm so f----- up," said the patient again.

"Grace is going to be the official hand-holder," Tahira said to the next woman, deciding her trainee seemed confident enough to take the lead.

"How early did you have to get up to come here?" Grace asked the patient, knowing some women traveled hundreds of miles. The woman had gotten up at 5 a.m., she said, but she was used to it - her daughter was an early riser.

"Every kid I meet is obsessed with tablets," Grace said. "Any shows she's watching?"

"Scoot down," the nurse said to the patient. "These straps are to help keep your legs from moving."

Down the hall in the patient lounge, women whose abortions were completed sat in a row of recliners eating crackers and juice. They wanted to know whether someone could go out and tell their husbands that it was over. Whether they would be able to go pick up their kids and play laser tag later. Whether the other women thought God would forgive them. Why they had tears running down their faces when they didn't feel sad.

"Because there's a lot going on in there," Tahira said, finding a tissue. "You're feeling a lot of things right now."

Grace held one woman's hand, listening as she talked about her upcoming wedding. "You're getting married?" a different patient asked. "That's nice."

"It was just the worst timing," said the bride, as she gestured to her stomach.

"I know it was," the other woman said. "I believe you."

One woman sat in her armchair and sobbed, and when a clinic worker told her the hard part was over now, she said she wasn't sure whether that was true.

She was scared that the hard part hadn't happened yet, she said. That the hard part would be when her family reacted and she was left alone with her decision.

As the women left, one by one, they carefully folded their blankets. They tossed their paper cups into a waste can, and said, "thank you, thank you."

"You can stay as long as you want," Grace said to the woman who didn't know whether the hard part was over. It was a little after noon. She had seen seven abortions in less than four hours. "It's OK to cry. That's normal. You never know how you're going to feel."

* * *

It was nearing the end of summer and most of the trainee doulas had been through at least one of their shadow shifts. Not all of them, though. Two had decided the program wasn't a good fit. Another had accepted a job in California, and some hadn't been asked to continue with the collective - trainers didn't feel they had the right temperaments.

The collective's leadership decided they would be happy with a dozen committed doulas to come out of the May training.

The ones who remained were nurses and nonprofit workers, students and yoga teachers, most of them in their 20s or 30s, and all of them banking on the fact that five minutes with a stranger was volunteer work that could make a difference in an issue that went to the moral core of America.

And meanwhile, the U.S. House of Representatives scheduled a vote on a nationwide 20-week abortion ban.

And meanwhile, in nearby Maryland, one of the only clinics in the country to provide third-trimester abortions was closing down. The owner, rattled and exhausted by protests, had made the decision to shutter. He accepted an offer on the property from the highest bidder, which turned out to be an antiabortion group called Maryland Coalition for Life that had currently ran a crisis pregnancy center across the street. They would now be occupying the clinic's space.

Nationwide, abortions were down, which some conservatives saw as a moral victory and some liberals saw as a sex-education victory. Even the Virginia clinic where the doulas primarily volunteered now saw a dozen patients on a busy Saturday instead of the 20 or 30 they once had.

And meanwhile, Grace got a new client for her birth doula practice, a pregnant woman who was new to the area and who didn't know many other people. Grace went to her house, and they talked and got to know each other, and they planned for the woman to call Grace when she went into labor.

Back in the training, the group had done an exercise where a trainer read out loud statements related to abortion, and the aspiring doulas had to move around the room based on how strongly they agreed or disagreed: Abortion should be legal in the first trimester. In the second. The third. Thirteen years old is too young to have an abortion. Thirteen years old is too young to be a mother.

Nobody would be judged for their answers, a trainer said. The purpose was internal, to make participants aware of their own biases and hard lines, because in the clinic they would have to learn to leave biases behind. About half of the participants moved from one end of the room to the other, strongly agreeing or disagreeing. Grace often stayed more toward the middle.

That was what being pro-choice looked like to her at the end of the day - the quiet questions a client would ask herself before she decided which kind of doula, birth or abortion, she needed.

If I had an abortion I would be ending a life, one question read.

"Death can exist without it being murder," a doula replied, explaining how she could agree with the "life-ending" statement but still believe in abortion. "I can love animals and still eat meat. I can do this kind of work because of these gray areas."

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Lila, an abortion doula, gets a blanket for a patient in the recovery room at a Virginia abortion clinic.

In late August, Grace went out to dinner with Lila, a fellow trainee whom she'd met back in May at the training weekend, the woman who had worried about whether she was explaining the role of a doula correctly.

"There were some people that really wanted me in the room and knew that right off the bat," Lila said as they waited for their food and discussed their apprenticeships. "They didn't even have any questions before they said yes. And then there were others where I was trying to respect their space, because I wasn't sure if they wanted me around. But then later in the patient room ..."

"They would open up?" Grace guessed.

"Almost like they would break open."

Lila, in her shifts, had tried to dig through her brain for the Spanish word for "cramps," which she thought she must have learned in a post-college job in Honduras. Two of her patients did not speak English.

Lila, in her shifts, had talked with patients about food, so much about food: pretzels, Saltines, biryani, lasagna, the big feast that a patient was planning to have to celebrate the end of Ramadan.

She had listened to her trainer doula, Shelby, when Shelby told her to keep an eye on a woman in a sports jersey who had seemed particularly stoic. It was often the patients who thought they would be fine who ended up breaking into tears, Shelby said.

The woman had started to cry as soon as she came out of the exam room. Lila sat next to her stroked her arm.

"She kept repeating, 'I didn't want to have to do that,' " Lila told Grace now. "But I didn't know her story at all - if she was just coming off of anesthesia, or what it was that made her want to say this to stranger who was holding her hand."

"That's what I've found hard about this, Grace said. "Wondering about people like that. When they leave, what happens to them?"

"When she left, she wasn't pregnant anymore," Lila said, reminding Grace of something they had talked about in training.

Their clients had come to the clinic for one reason. If they left and they were no longer pregnant, then they had found what they were looking for.

* * *

The pregnant woman who had asked for Grace to serve as a birth doula called just before dawn on a weekday morning. Labor was being induced; she was heading to the hospital. It turned out that what she needed most was someone to be with her toddler while she delivered the baby. Grace spent the day going on walks, making craft projects, and nearly 24 hours later, the mother called to say that she had delivered a tiny, perfect newborn.

Life was beautiful, life was sacred, and it could turn out in so many ways.

The world outside marched on.

The U.S. House of Representatives voted to support the 20-week abortion ban that House Republicans had earlier proposed.

A GOP congressman ended up resigning, after news came out that he had supported the ban while privately encouraging his mistress to have an abortion.

On a Friday morning in early fall, Grace drove to the Virginia clinic. By herself this time - she had completed her training and she would be the only doula on call.

"Did you hear about what happened in Alexandria?" one of the clinic workers asked, just after Grace checked in. The day before, the worker explained, an Alexandria abortion clinic had been bombarded by a group of protesters who came into the lobby and refused to leave. "One of them was a priest," the worker said. Five of them had been arrested.

Grace changed into her scrubs. The changing room was really just a repurposed closet, and she stood inside it, gathering herself for a minute, next to boxes and plastic storage bins, before walking back out into the waiting room. Four women currently sat, flipping through magazines or staring at the floor.

A few minutes later, Grace sat in the small room with the Bible and the fountain, across from a woman whose long hair was neatly curled, but who shrunk into the chair with her arms crossed over her chest.

"Has anyone talked to you about the doula program here?" she asked the woman, who shook her head no. Grace explained what it was.

"Does that sound like something you would be interested in?" she asked. The woman nodded her head yes.

"OK," Grace said. "Then I'll be with you when you go in. I'll be with you the whole time."

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