Doula by choice

Late on a Wednesday night in April before Queensland’s coronavirus restrictions had eased, Brisbane grandmother Jo Bolger answered her phone and inadvertently became Australia’s first practising abortion doula. The next morning, she packed her hand sanitiser and drove to a hospital to meet the client about whom she knew just snippets – international student, completely alone, second-trimester termination.

“As soon as I saw her, I knew it was her,” the 54-year-old says. Bolger took the woman’s bags and signed her in.

“There were crosses on the seats to make us sit far apart because of COVID but I just said ‘bugger that’ and held her hand,” she says. “She thanked me for being there and I said, ‘Not a problem, I’m here for you throughout the whole thing for as long as you need. You just lean on me.’”

A doula, derived from the Greek for “female servant”, provides emotional and informational support, traditionally during pregnancy, to help develop a birth plan. Then in childbirth, they offer comforting breathing techniques, massage, and hot and cold packs to help with the pain, while acting as a strictly non-medical intermediary between the midwife and patient.

In addition to the orthodox doula role, Planned Parenthood clinics in the United States have for the past few years offered abortion, or “full spectrum”, doulas. Bolger is one of nine Australian Doula College students trained in March for such a duty by Brisbane’s unplanned pregnancy options counselling service, Children by Choice. The plan to start connecting doulas to particularly vulnerable women in Queensland was halted by the pandemic, which rendered any abortion access difficult – the nation’s main provider was running out of facemasks and chartering private flights for surgeons to get to rural patients – but this particular woman had no one else to turn to, so Bolger stepped in for an impromptu launch of the new support program.

Second-trimester terminations are rare. Between 1 and 3 per cent of abortions are undertaken after 20 weeks’ gestation, and about half of these are for foetal abnormalities occurring in wanted pregnancies, while others involve a very delayed diagnosis, or complex socioeconomic or psychosocial circumstances. They can be surgical terminations, or, as in this woman’s case, through the administration of the drug RU486 over two days. With Bolger in attendance, she took the first pill, mifepristone, which brings about the abortion, and then went home.

The next morning Bolger arrived back at the hospital where the woman took the second pill, misoprostol, to help expel the foetus. At this stage in a pregnancy, the procedure is essentially a chemically induced labour. It can be painful and traumatic, and can take hours – in this case, the process lasted all day and well into the night.

“I didn’t have clean undies or a toothbrush,” Bolger says, “but as a doula it doesn’t matter, you just make it work.” Hospitals were allowing one visitor per person in the labour wards. “The midwife said to me, ‘Who are you?’ and I said, ‘I’m her doula,’ and she said, ‘It’s not a birth,’ and I said, ‘I know, she needs support.’”

Bolger and her client talked all day. The woman had lost her job in the pandemic and said she would be disowned by her family in her country of origin if they knew about the pregnancy. She revealed the man involved had been violent and then left her.

“This was her only way of surviving,” Bolger says, of the abortion. “She didn’t think she could give her baby the support, love and finances it needed.”

The woman was sure it was the right decision but said she felt at moments like a murderer.

Bolger, the matriarch of a blended family, is a mother of five, two of whom she gave birth to and one of whom died a few years ago. She told her client, “The time is not right, and as a mum you have to be strong, and so when you know you’re not ready for it, you’re not ready.”

Bolger held the woman’s hand and held back her hair. She wiped up vomit and she cleaned up blood. She hadn’t packed food and got by mostly on salt-andvinegar chips. Just before midnight she fell asleep in a hospital bed next to her client. The next morning Bolger drove her client home, walked her to her door and gave her a hug. She left knowing that if the woman needed support she had a counsellor to talk to.

Children by Choice’s project officer, Rachael Smith, believes the service will be especially helpful for women who don’t feel safe telling anyone about their pregnancy, either because they’re experiencing violence or they’re travelling to Brisbane alone from a close-knit rural or remote Queensland community.

“The amount of times we’ve had to frantically ring around and say, ‘This client is arriving on a flight, how

can we get her to the clinic?’” she says. “‘How can we make sure she gets to her accommodation? How can we safely do that in a structured way?’”

Part of the usual counselling process involves asking the client to imagine a compassionate person upon whom to model the kindness they could offer themselves at a difficult time. “Now that person isn’t imaginary,” Rachael says. “It is the doula, and she has a name and a face.”

Bolger’s work is selfless, in her words quite literally – “doulas leave themselves at the door, and once you step in it is completely about her and her needs” – but her few days of unpaid support are unremarkable when you trace the decades of women who have volunteered to make sure others can safely access abortion in Australia.

Children by Choice began in the 1970s without any financial support from the government, and it was mostly run by volunteers. They answered phones and directed women to a secret network of Queensland doctors; they took collections to pay bus fares for women to get to Sydney, where there were more options; they minded the children of young unsupported mothers; and, on a May morning in 1985, when police raided two Queensland abortion clinics, they hastily cut the names of clients from their files in case the cops came knocking. The organisation now has paid staff, but it still sometimes calls for donations via Facebook to fund abortions for clients who are homeless or experiencing violence.

It is estimated that between a quarter and a third of Australian women will have an abortion in their lifetimes. Caroline de Costa, a Cairns-based obstetrician and gynaecologist of 45 years, wishes patients of decades past hadn’t had to do so alone, especially before safeaccess zones were enacted around clinics. A doula might have been a helpful buffer between a lone patient and the religious picketers waving foetal dolls and pushing pamphlets of misinformation into her palm or spraying holy water on her path.

“I think it is more important to have a doula for an abortion than for a normal birth,” de Costa says. “Even women giving birth in an unplanned pregnancy often have a partner or support person there, but there are women having abortions who conceive in casual or violent relationships who are completely unsupported, and that is a common scenario.”

Chronic under-resourcing to provide access to what is a common procedure has meant reproductive healthcare providers in Australia have long gone above and beyond for their patients (de Costa mentions a surgeon in regional Queensland who used to drive home patients who had no one to pick them up afterwards), but it is not their place to offer emotional support.

To be a doula is not to walk behind a woman, nor in front, but beside her, says the founder and director of the Australian Doula College, Renee Adair.

“I would hope at the end of the day that the woman feels that she had support and kindness, and that someone stood by her decision and her back,” she says. “You’re not projecting what you think is best onto them, and that is the beauty and essence of doula work.”

Abortion might be decriminalised in most parts of Australia, but Adair says the stigma lingers.

“The guilt and shame about our bodies is a legacy that we still carry, and with that comes the inability for some women to be honest and make decisions about their own body without feeling like they have done something bad or wrong.”

Bolger has no strong views about abortion.

“I just feel that it is not my choice,” she says. “My view on life is that no matter what happens we need support and we need to be listened to without judgement.”

Her daughter once told her it was a “big thing” to support someone through.

“[I replied,] ‘If you needed me, I would be there for you and this girl had no one,’” Bolger says. “The difference between a mum and a doula, I think, is a mum gives unconditional love but has an opinion, and a doula gives unconditional love but with no opinion.”

“I think it is more important to have a doula for an abortion than for a normal birth,” de Costa says.