This 'full spectrum' doula helps with birth, miscarriage and abortion

TERRY GROSS, HOST:

This is FRESH AIR. I'm Terry Gross. My guest, Vicki Bloom, is a doula. Typically, doulas provide support for women during pregnancy and childbirth. But Bloom describes herself as a full-spectrum doula, working with people no matter how the pregnancy proceeds, whether it results in birth, miscarriage, stillbirth or abortion. Since 2010, she's worked with The Doula Project, a New York City-based collective that partners with clinics to support pregnant people, whether the result is childbirth or termination. The doulas are volunteers, which enables The Doula Project to fulfill its goal of providing free emotional, physical and informational support to low-income women and to marginalized communities.

Bloom is a member of the Leadership Circle of The Doula Project. She says she's especially drawn to support people who may fall through the cracks of the medical system or feel unheard through the process of birth or abortion. Note to parents of young children - we're going to have an adult conversation about reproductive issues.

Vicki Bloom, welcome to FRESH AIR. Can you give us a brief overview of what the work is as a doula in childbirth and what the work is as a doula in abortion?

VICKI BLOOM: So a doula in general is a non-medical professional who provides pure support. They're not there in a medical role, so they're not doing any of the medical procedures. They're there for that person as a human being, as a person. In the birth experience, that may be helping them figure out what they want, helping them find their voice and helping them in the moment to moment to manage what's going on as they're giving birth. In the abortion context, it may look more like, again, physical comfort techniques. You bring a lot of the same physical techniques in. It might be massage, handholding, hot pads, cooling someone's brow. All of those things may come up again. But it's also, in that sense, holding space for that person, whatever they're feeling, letting them feel in the moment, helping them feel safe, helping them feel like they're having an experience that they need to have in a way that feels comforting to them.

GROSS: Are you seeing a lot more medical abortions because of the end of Roe, or have medical abortions just taken off because they're easier? Like, what kind of changes have you witnessed in the past few years?

BLOOM: Medication abortion has been on the rise for a number of years now. And at this point, more than half of early abortions in the United States are done via medication. One big change that happened is originally in most states, possibly all states - I'm not sure - but originally, if you go back a number of years, in order to have a medication abortion, you needed to go into a clinic or go to a provider. You'd have a consultation with that provider. And you would take the first pill, the mifepristone pill in the office. And then you would take the other pills, the misoprostol pills. You would take them home and take them at home 24 to 48 hours later, because that's the medical protocol.

But when the pandemic happened, there was a temporary federal law put in place that basically allowed medication abortion to happen entirely via telemedicine so that you could consult with the doctor over video or over the phone and have those pills mailed to you and then be able to complete the medication abortion entirely at home. And then in late 2021, that rule was made permanent. So in any state where you can have a medication abortion, they can do it via telemed. And that's the reason, actually, that The Doula Project developed this medication abortion hotline, which we have, which is a 24/7 hotline where people can text in and get support - from their medication abortion, because it's becoming more and more likely that they're completing that abortion from their home rather than from a clinic.

GROSS: Given how comparatively easy it seems to take, you know, a few pills as opposed to having a clinical abortion, which involves the suctioning of the uterus, why would anyone choose now to have an in-clinic abortion as opposed to a medication abortion?

BLOOM: I wouldn't necessarily say that a medication abortion is easier. It's different. When you go in for an aspiration abortion into a clinic, it's very fast. You go in, and the actual procedure can take less than 10 minutes. And then there may be some after-effects of some bleeding, some cramping, but it's quick. When you take a medication abortion, it's a few days of a procedure. You're going to take the first pill and then wait 24 to 48 hours. And that process of the uterus releasing its contents has a lot of bleeding, a lot of cramping, a lot of nausea sometimes. And it's physically a much rougher procedure, even if it's logistically for many people a much easier procedure and also a more private procedure.

GROSS: When you're working with a woman who is having an abortion, whether it's in clinic or medication, do you sometimes find that they still have doubts, that they're going through it, but part of their mind is still questioning it? And if so, what role do you play in helping them think it through?

BLOOM: I don't do a lot of choice counseling. By the time people come to me, they certainly usually have made a decision. But I find very frequently that I tell my clients that a right decision does not always feel like an easy decision. And I'm really with them through whatever talking through they want to do, whatever emotional experience they may be having. People have all kinds of emotional experiences during abortions. They may have a mix of relief and grief. They may be thinking about a what if even at the same time that they have made a decision that they feel comfortable with.

One thing that sometimes happens is that people who may have been politically not very supportive of abortion find themselves in a situation where they need an abortion and have decided to have one, but they have a lot of cognitive dissonance about that. And I am very compassionate about that because theoretical things and real things can feel very different to people. What I'm not compassionate about, and this does happen, is when someone comes in, gets the support, may have their abortion, and then may walk out to protest the next day.

GROSS: When you are working as a doula for somebody having an abortion and this person opposes abortion for political or religious or whatever other reasons, but feels it necessary to have one, what's the experience like for you? How do you work with them? What special needs do they have?

BLOOM: I'm often frustrated when I work with clients who have that orientation, but I do come to them with a lot of compassion because they're coming into that experience with a huge amount of cognitive dissonance. They're going in doing something that they feel is necessary but also, in a certain sense, wrong. I have been in clinic and had a client say to me, I'm here because I have to be. How can you live with yourself when you wake up every morning and walk in here knowing that you're helping people kill their babies? It's hard to hear, for sure. It's hard to hear that kind of an attack. But I know that that person is really working through the fact that they feel that this is necessary and also, in a certain sense, that they're very uncomfortable for it.

I have very little tolerance, at least from a general basis, for people who think that they're different than somebody else who might have this procedure, who think that they're special somehow, because this is a common experience for a lot of people. And every person who comes to this has to come to it with sort of understanding what's going on with their body, what's going on with their world. But nevertheless, that person who is having to do something that, in a sense, they don't feel good about is somebody who's having a very hard time and who really needs a lot of compassion.

GROSS: With medication abortion, you know, you're taking the pills at home. What kind of support does a woman need when she's having that kind of abortion?

BLOOM: They might need all kinds of support. The Doula Project did start our medication abortion support hotline for people to reach out during the process of their medication abortion if they needed support. A medication abortion can take many hours. And for many people, those hours might be in the middle of the night, which is why we run it 24/7. People will need any informational support. I think one of the biggest things that people want to know during a process when something happening is, is this normal? Because it can be sometimes startling. There's more blood than people expect sometimes when the uterus is releasing all at once and - you know, and there's a pregnancy. So there's more there than there would be for, say, a typical period. Or they may want help with figuring out the nausea. They may be having that 3 a.m. dark moment of the soul where they just need somebody to talk to because they're feeling alone.

Someone who's having a medication abortion at home may have lots of support there, or they may be sitting in a room by themselves not telling anyone that's going on and maybe even trying to keep it secret from a family member or a roommate who might be in the home. So it's really anything that someone might need to just make sure that they are feeling OK and that they feel supported because that can be a lonely or scary experience.

GROSS: Well, let me reintroduce you and then we'll talk some more. If you're just joining us, my guest is Vicki Bloom. She's a full-spectrum doula who is in the leadership circle of The Doula Project in New York City. We'll be back after a short break. This is FRESH AIR.

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GROSS: This is FRESH AIR. Let's get back to my interview with Vicki Bloom, a full-spectrum doula working with people no matter how the pregnancy proceeds, whether it results in birth, miscarriage, stillbirth or abortion. She's in the leadership circle of The Doula Project in New York City.

One of your missions is to work with marginalized communities, including people who are lesbians, trans men, people who identify as nonbinary. And I'm wondering, when people who are having birth - particularly the people who identify as trans men or nonbinary - when they're giving birth and they're using female reproductive organs, does it change their relationship to their body?

BLOOM: In the context of abortion, a trans man or a nonbinary person who identifies more on the masculine side of the binary may find it extraordinarily dysphoric to find themselves pregnant. And that may be something that comes up that we discuss as a doula when we're in that situation where they're having an abortion, that they may feel - you know, feel tough about having gynecological care in general, and that a doula who is experienced with that community is able to help them navigate that. In terms of a nonbinary person or a trans man who has chosen to become pregnant or who has found themself pregnant and has chosen to give birth, it really varies very widely in terms of how people are engaging with their body. I think that people overall, if they are choosing to go through a pregnancy, are really reconciling themselves to the fact that their body is doing something that is not typical for their gender identity.

The part that can be very hard is the context of the birth industry or the people around birth where, you know, if you go to a parenting class, you don't expect to have pregnant masculine people in the parenting class necessarily. And not all instructors are good on that. In the context of a hospital, I find myself with some of my clients doing what is often called code switching, which is to use different language depending on who's in the room. So I may use he/him pronouns or they/them pronouns for my client because that's what they prefer in their life, but they've chosen not to engage that topic with every person in the hospital. So once a doctor walks in the room, we may be using she/her pronouns for that person just because they didn't want to deal.

GROSS: When you're talking about pregnancy, you use the word pregnant people as opposed to pregnant women. And I presume that because you work with so many nonbinary pregnant people who don't identify necessarily as women or trans men who certainly don't identify as women. Can you talk about that language change a little bit and how you feel about it?

BLOOM: I feel very good about it. I think that this is something which has started to propagate in at least more progressive parts of the birth community and the reproductive justice community because we want to make sure that everybody who this affects, which is really everybody who has a uterus, is included. We don't want to be exclusive where we feel like certain people for whom these things are important feel left out. And so I think it's a good move in language to be inclusive in general. My goal as a doula, as I said, is to make anybody who's going through reproductive health experiences feel comfortable and feel safe and feel like they're seen for who they are, and some of those people don't identify as women.

GROSS: What are some of the emotional highs and lows you've experienced as a doula in helping women through childbirth or abortion?

BLOOM: Well, I'd say in terms of lows, some of those experiences where I'm working with somebody, especially in the abortion context, where, like I said, I might only be with them for under an hour, and they've got a lot of complicated, rough things in their life that they're expressing to me in the moment. And, you know, I might work with someone who might be having relationship trouble, might be having some conflict with a partner over abortion, might be pregnant as the effect of a rape or an assault, might just really be having financial trouble. And I know that I can help them in the moment with this one thing, but I can't fix their life. Even if they've unburdened their whole life to me, I'm in a role for a moment. And there can be a lot of sadness there to have to let go, especially in a clinic context. You might be working with eight clients in a day, and I need to be able to refresh, take a few deep breaths, ground and then be there for the next person.

Some of my colleagues in the Doula Project used to always say that it was good in New York City that nobody cared if you cried on the subway because they would come out of clinic and there would just be so much emotion and so much going on that they would cry. On the other hand, I have had hilarious conversations with people during their abortions. I once spoke to somebody who worked in a fast-food restaurant in Times Square in the overnight shift, and she spent her whole abortion telling me about the crazy people who walk into this fast-food restaurant at 2 a.m. in Times Square. And she and I and the doctor were just laughing and laughing through the whole thing. And then the doctor's like, you're done. And she said, oh, OK, and, you know, we moved on. And there was a lot of joy there.

You know, we also - I've also worked with people who were experiencing a loss. I've worked with - I worked with a client once whose partner had died a few days before she gave birth. And so she was giving birth, and there was some joy in having the baby and some joy in seeing him in the baby, but he was gone. Anything can happen during these experiences. It's a microcosm of everything in life, the highest highs, the lowest lows. And as a doula, you have to be there for whatever comes up because you don't know what's going to come up for somebody. And your goal is just to be in presence with people, however things come together.

GROSS: Well, Vicki Bloom, I want to thank you very much for talking with us.

BLOOM: Thank you very much. It's been a pleasure to talk to you today.

GROSS: Vicki Bloom is a doula and is in the leadership circle of the Doula Project in New York. After we take a short break, TV critic David Bianculli will review the eight-episode drama "Fatal Attraction," a reworking of the 1987 film. This is FRESH AIR.

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