It’s gotten harder to end pregnancies across the Midwest. Abortion doulas in Minnesota say they’re here to help.

When Kathy Chinn starts her seven-and-a-half-hour  volunteer shift as an abortion doula, she braces herself for a busy day. She often sees “back to back to back” patients undergoing surgical abortions, as many as 15 in a day. 

Chinn is a retired Minnesota Department of Health sexual health specialist; at Planned Parenthood, she uses some of those job skills as a logistical and emotional support person for women undergoing abortions. 

“I room them, explain the procedure, get them a warm blanket, and then there’s a gap of time before the team comes in,” Chinn said. “That’s when I get to help them feel more comfortable, and we can engage in a little chit chat.”

There are two questions she always asks. First, is the patient the type of person who likes a lot of information, a play-by-play of what’s happened; or do they just want to know that they’re generally making progress and when each of the three main steps is done? Second, do they want a hand to squeeze, or just distraction with no touching?

“And then we just kind of go from there,” Chinn said.

Chinn is one of a growing number of volunteers performing this relatively new role in reproductive healthcare. The first known organization for abortion doulas was formed in New York City in 2007. 

Doulas are most frequently associated with births: Birth doulas provide physical and emotional support to women before, during, and after labor. But the term also can apply to people who assist patients through other aspects of reproductive care, including abortions. Doulas who work with people in both areas—births, miscarriages or stillbirths, and abortions—often use the term “full-spectrum doulas.”

No one appears to track how many people are volunteering as abortion doulas, and there’s no official certification or licensure to become one. SPIRAL Collective, a Minnesota reproductive-justice nonprofit, has trained 500 abortion doulas since the organization’s founding in 2012. That number likely accounts for most of the abortion doulas in Minnesota, most of whom serve as volunteers. 

In June 2020, the U.S. Supreme Court ended universal access to abortion. Since then, the number of people seeking abortions in Minnesota has increased, according to clinics (the Minnesota Department of Health has not released 2022 data yet). That decision made Minnesota a refuge state for abortion-seeking women from North Dakota, South Dakota, Wisconsin, and Iowa, where abortion is now restricted. Traveling patients have increased the need for volunteer support, adding a layer of logistics and complexity. . People often need help getting to Minneapolis, finding and paying for a hotel room, and getting from the hotel to a clinic or pharmacy and back. 

“Then there’s travel back to their original home,” said Mai’a Williams, one of three executive directors at SPIRAL Collective. “It’s a lot more coordination, and there’s a patchwork network of organizations trying to fill in all the gaps.”

Most often, the people requesting help are underprivileged: 75 percent of abortion patients are poor or low-income, according to the Guttmacher Institute, a reproductive-rights research and policy organization, and not all abortion clinics take public health insurance. “Even if abortion is covered by state Medicaid, a clinic may not take it because the reimbursement rate is so low,”  said University of Minnesota School of Public Health Ph.D. student Nicole Quinones, who  also serves as a research consultant for a clinic based in Memphis. “So you have to come up with money out of pocket.”  

Poorer patients are more likely to need transportation to and from a clinic. They’re also more likely to need help arranging a place to stay if they’re coming from out of town. Women seeking abortions are also disproportionately Black or brown: 28 percent of women seeking abortions in the United States are Black and 25 percent are Hispanic, although these racial and ethnic groups make up 13.6 percent and 18.9 percent of the overall population.

“People of color and Black people in particular have a harder time navigating the abortion space,” Quinones said. “Black people are more likely to be impoverished or face unjust systems due to systemic racism. It’s so complicated and there are so many more barriers if you’re impoverished, if you have a job that doesn’t allow you to take the time off.”

Before becoming an abortion doula, Chinn assumed “it was mostly white, teenage girls getting abortions,” she said. “That is not at all the reality. Most are already parenting, and they come from every social and economic walk of life, every ethnicity and language.”

A hand to hold and a lot more: What an abortion doula does

Williams uses words like “emergent” and “improvised” to describe the system of volunteer work helping people get abortions; there’s no one organization or entity overseeing the current network.

Abortion support services vary from clinic to clinic, based on individual rules governing who can be in the exam room and how much support paid staff can provide. Some, like the Planned Parenthood on Vandalia St. in St. Paul, try to schedule volunteer doulas to cover every hour the clinic is open. Others use staff or interns to provide many of the same services that abortion doulas do without using the term “doula.” 

But whereas birth doulas often operate on their own and connect with women throughout their pregnancies—and generally charge a fee for their services—abortion doulas in Minnesota connect with patients either through SPIRAL Collective or directly at the abortion clinic. They usually only assist the patient the day of the procedure, and their services are almost always free. Patients can request a doula through SPIRAL or directly through some abortion clinics. SPIRAL Collective sends volunteer doulas to Minnesota clinics and hospitals that offer abortion care and to homes or hotels where people are undergoing abortions that are performed with medication. 

Patients can dictate how much they want a doula to be involved. For a clinical abortion, standard practice includes meeting with the patient before her appointment, accompanying the patient in the waiting room, and often staying with her throughout the procedure.

“There’s a lot of time in the waiting room, and it can be kind of scary,” Williams said. “A lot of it is sitting with them.”

Since Chinn meets women for the first time on the day of the procedure, she said it’s helpful to be emotionally smart. “You have to be able to read the room and tune in,” she said. “Some people don’t want to talk at all; some people do.”

Although the clinical procedure is called “surgical,” it’s so straightforward and safe, Chinn said—no cutting involved—that it’s easy to focus on helping people relax.

“The emotional support is 100 percent the same as a birth,” she said. The physical support can be similar too, she said.

“I’m not putting people into different positions like with births, but if I see where the tension is, I will physically try to help them relax that area,” she said.

For a medical abortion, the support can look much different. This type of abortion, usually offered until about 10 weeks’ gestation, requires taking two pills. Patients can take the pills in person at an abortion clinic or through a telehealth appointment. Patients can also get the medication through an online pharmacy and self-administer them.

Residents of states where abortion is banned may travel to Minnesota to legally obtain and take the pills, which induce a miscarriage-like process. 

Abortion doulas can assist people coming to Minnesota for this type of abortion in several ways. They can help patients pick up the pills and deliver care packages that include heating pads, maxi pads, thermometers, tissues and snacks. They can stay with the patient at their home or hotel room, or be available for consultation via a phone or video chat. Finally, nonprofit organizations can also help people seeking the procedure find and pay for lodging. 

Do abortion doulas make a difference?

Women often express immediate relief when they learn that a support person can be in the room with them during their abortion, said Quinones, who has worked as an abortion doula. They would say, “Oh my gosh, thank you, I would like someone to hold my hand and be there with me,” she remembered.

If the patient is upset, it’s especially helpful for a doula to be in the room, Quinones said, so that the medical staff can focus on the physical procedure. 

After a test period with abortion doulas, patients at St. Paul’s Vandalia St. Planned Parenthood clinic offered overwhelmingly positive feedback, Chinn said. These results led the clinic to build volunteer doulas directly into its schedule. 

Research on this burgeoning field is limited to a few randomized-controlled clinical trials and a handful of qualitative studies. It’s impossible to draw firm conclusions from that work, but the publications point out some possible benefits. 

In a 2015 study published in the American Journal of Obstetrics and Gynecology, 96.2 percent of the 106 women who used doulas recommended the support (and 60.4 percent said they would be interested in training to be doulas themselves). Women who used doulas were also less likely to need other clinic support resources, the study found. 

However, another study published by the same journal in 2016 found that people who did not use doulas were equally satisfied with their care.  In that study, 97 percent of women who received doula support said it helped their experience. But the researchers didn’t find any significant difference in “satisfaction, emotional response, sense of empowerment, or perceived ability to cope” between those who used doulas and those who did not.

Women who have used abortion doulas told researchers in 2014 that they appreciate doulas for a variety of reasons. One patient described her excitement that an adult could be present with her since her parents could not. Another said that listening to the doula took her mind off the pain. “I was just listening to what she was telling me to do and I was doing it,” the patient said.

There are some reasons to believe that Black and brown women who face more barriers in accessing abortion might benefit the most from additional care. For example, Quinones said that barriers often lead to delay in getting care.

“So, we will have people who face these barriers more often at a later gestational stage,” Quinones said. “All that is to say that yes, doulas can be very beneficial, especially as someone who can provide some sort of stress relief during the procedure itself.”

‘Being a doula for me is about supporting people through all kinds of outcomes’

Like many abortion doulas, Mai’a Williams started as a birth doula. As a mom who has had an abortion and a miscarriage, Williams said it was critical to have support during those events. When she’s in the support role, she said, she gets to see the relief most patients feel afterward.

“Their life just opened back up,” she said, “and being able to support someone to take a certain amount of control over their own lives is amazing.”

Abortion, she added, is an ancient practice.

“There’s always documentation to people ending pregnancy,” she said. “It’s one of those knowledges that people have always learned or relearned, no matter where they are. It feels very fundamental. And to be honest, I just feel that there’s something very human about the work.” 

When Kathy Chinn—an experienced  birth doula—had the opportunity to extend her training to abortions about 10 years ago, she signed up. 

“Being a doula for me is about supporting people through all kinds of outcomes,” she said. 

The gratitude patients express afterward makes the work especially rewarding, doulas said.

“I’ve held so many hands in that role,” Quinones said. “It really is a very gratifying experience.”

Chinn agreed. “They just directly say, ‘Thank you so much. I was so scared and you made it better.’” 

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