Reflections on the "Abortion Doula"

The Cut has shared a piece that I find both fascinating and revolting: A woman named Alex Ronan reminisces about "My Year as an Abortion Doula."

The title itself is enough to offend. The linking of abortion with the very concept of a doula is grotesque. A doula is the woman's coach, comforter, and companion as she gives birth, welcoming a child that she would give her life to protect. Abortion is the antithesis of birth. It is the rejecting of a child whose life is being taken at the mother's behest for reasons of her own. It is impossible to imagine two events more diametrically opposed, be it physically, emotionally, socially, morally, or spiritually.

Ronan acknowledges the gulf fleetingly as she notes, "Some birth doulas were reluctant to consider the needs of women terminating pregnancies as at all similar to their patients carrying them to term." This entire concept, it seems, is one that Ronan is not comfortable exploring. That one sentence says all she is willing to say.

Ronan touches a bit less fleetingly on mainstream abortion's reaction to the idea of "abortion doulas." 

[M]any pro-choice doulas, doctors, and nonprofits were unwilling to acknowledge how difficult and painful many women find abortion. To some on the left, drawing any more attention to the messiness of the procedure and the decisions surrounding it would mean potentially undermining the work of the political movement.

This disconnect between the politics of the movement and the realty of the practice is something Ronan likewise elects not to explore.

She begins her tale with the story of a woman she calls "Dee," the very first woman she guided through what was intended to be a routine second-trimester abortion. Slender seaweed sticks called laminaria were being inserted into Dee's cervix, where they were to wick up moisture and expand, dilating the cervix to facilitate removing the fetus as its life is ended.

Somehow, during this process, Dee began to bleed alarmingly. She was rushed to what I presume was a surgical room to have the abortion completed immediately.

The resident begins to perform the procedure as the attending barks commands. “Pull,” she says, “harder.” The body does not want to let go. The resident will not stop. It strikes me as strangely similar to birth, only the opposite word and a different outcome. Pull. Pull. Pull. What’s called the products of conception bucket is mostly filled with bloody gunk. I make out a doll-size arm, fist curled. It feels like I shouldn’t look, but I can’t turn away. 

Pulling the fetus out in pieces was a pointless ordeal for everybody; Dee continues to hemorrhage and is saved only by a hysterectomy, which of course would have gotten the fetus out of her body, albeit not out of her womb, and would have achieved an equally lethal outcome for the child.

Ronan is, predictably, shaken. "In the hallway," she says, "I stumble a bit, groping at the wall, slide down until I’m seated. A janitor comes by and points out the nearest bathroom, which I walk to slowly. I lock the door, splash water on my face, and sit on the toilet."

She does not, however, elaborate on why she is so strongly affected. The reader is presumed to know. Witnessing open abdominal surgery when one had been expecting only an innocuous-looking laminaria insertion would certainly rattle one. All the blood, the urgency, and the moment when one life was ended as another hung in the balance, would leave even a seasoned professional flustered. Knowing that a woman of childbearing age has just lost her uterus, likewise, could be very disturbing, particularly if the woman had intended to have children later, when the circumstances were more auspicious.Ronan tells us nothing of that. Nor does she reflect on the sight of the tiny arm and the certain knowledge that the rest of the mangled remains of what had, moments before, been a living human being were also in that gory bucket. Like the reaction of most doulas to "abortion doulas" and the abortion advocacy vs. abortion reality disconnect, this is something that Ronan shies away from.

What Ronan does explore a bit more, though still tenously, is the context in which women are resorting to abortion. She describes a training session with other new "abortion doulas."

An 11-year-old in for an abortion who asks for birth control when she’s alone with the doctor. Her mother works nights; she’d been left with a friend who has a twentysomething son. She calls him her boyfriend; he will go to jail. A woman who says she’d like to do another ultrasound to see if it’s definitely a girl, because she’ll only keep it if it isn’t. A drug addict covered in track marks with two kids in the foster-care system who refuses birth control.

“What do you assume?” Mitchell asked of each case. “How can you be supportive?” We talked about what would be hard for us to overcome, things we might say or do and how we might feel. I felt embarrassed by my assumptions, and the limits of my compassion. I judged these women on the worthiness of their reasons (“Would she really only keep a boy?” I wondered) and found myself questioning why those who come in for late-term abortions had waited so long to decide. Later, I learned from Mahoney that all the examples were real cases that had come from her first six months working as an abortion doula.

The lesson, intentionally or not, achieves many goals. It steels the neophytes to whatever tragic or outrageous situations they might encounter. It teaches them to respond to these tragedies or outrages by suppressing their own moral judgment and substituting a political judgment that abortion, as a right, trumps all else. Regardless of how repugnant one might find sex selection abortions, abortions as a primary method of birth control, or any other distressing situation, all of that must be put aside. The only thing that matters is getting the patient through the abortion as smoothly as possible. Everything else must be put aside.

No questions are to be asked about the sexual abuse of an 11-year-old girl by the grown son of her babysitter. How does one decide that it is unacceptably "judgmental" to even ask oneself if this situation should be allowed to continue? Any normal human being would want to rescue the girl, to contact the police or child protective services or a rape crisis hotline. It takes special training to learn that "being supportive" means never asking tough questions, either of the patient or of oneself. One must look only at the patient, and only in this moment. One must avert one's eyes from the abuser as well as from the fetus.

Ronan tells more about the patients and their reactions to the abortions. Some cry and shake. One cheekily chatted up the abortion staff and offered them discounts at her jewelry store. Ronan finds the distressed ones much easier to work with, though she stresses that she is not judging the matter-of-fact ones. She says that "Pain breaks down barriers" and makes it easier to do her hand-holding and hair-stroking. She doesn't touch on any incongruity between the banality of abortion as a routine medical procedure and the tiny arm in the bucket. To do so, after all, would be to judge, which seems to be the only sin recognized in an abortion practice. They've been taught, after all, to see no sin in a grown man impregnating an 11-year-old girl.

Ronan's story continues on a predictable path, gliding over the surface of abortion practice, never asking any hard questions of herself or the reader. "Kindness," she says, " is more important than truth." I find myself wondering if the real kindness is to the patient, who must force often force herself into tunnel vision just to get through an abortion she doesn't want but sees no way to avoid, or if the kindness is to the "abortion doula" herself, who wants to keep uncomfortable truths at bay. It's best to just focus on distractions, on superficiality, of just getting through the present. Never mind what's on the other side. Never mind the tiny, bloody fist and the tiny person it was once attached to. 

Ronan's closing paragraph is telling:

I have, by this point, seen lots of women and lots of fetuses, and the sight of the second doesn’t change my feelings about the first. The mourning for what could have been is countered by an appreciation for what is — a woman’s life, allowed to proceed as she wants it to. When it is over, I say, “You did great. You were so brave,” and I tell them they’re done now, because sometimes they don’t know. “It’s all finished,” I say.

It's finished for Ronan. She accepts the mangled little bodies as the price that is paid for "a woman's life, allowed to proceed as she wants it to." As if that 11-year-old girl is a woman whose life, after she leaves the facility, will proceed as she wants it to. For her, for all but the most flippant women, it's not over. It's never over.

"Most first-trimester abortions," Ronan tells us, "are vacuum aspiration. The machine sounds like a sucking through a straw when you’re at the bottom of the glass. The vacuuming is sometimes painful, but I think patients find the sound harder to bear. LiteFM stations play in the background. Most first-trimester abortions take fewer than four songs. Sitting in bars with my friends on summer nights, I hear the same songs and wonder after the women."

But evidently not enough. Not enough to ever question whether or not what they did that day even helped her at all.