How One Doula Provides Abortion Support

Sierra Holland on why abortion stigma is violence, how there is no one way to support someone having an abortion, and why abortion work must include the continual work of antiracism and abolition. 

Sierra Holland is a full spectrum doula who provides birth support, education and preparation, and abortion support at her practice, All Bodies Birth. Holland’s doula work expands from reproductive support to reproductive justice through inclusive and person-centered care. As per her site, her practice is “unequivocally pro-queer, pro-trans, pro-Black, pro-brown, pro-sex worker, pro-immigrant, and pro-abortion.”

Abortion support and individual needs vary from person to person, but having someone to help meet those needs, whether through physical, practical, or emotional support, might make the experience more manageable. 

We wanted to check in with Holland about what abortion care might look like and around the Texas abortion ban on abortions as early as six weeks. 

XE: Thanks for joining me today, Sierra. I’m so curious about your background; how did you get interested in birth work?

SH: I grew up on a farm with a mother who was first a vet tech and later a labor and delivery nurse—the transitions and cycles of life were so normalized for me from a young age, and I credit my ability to do this work with my whole heart now because of that. My teen years were like a rubber band—I desperately wanted to be different from my family and my small town, so I went into academia, yet my research took me right back into reproductive healthcare and advocacy work. While I was working on my Ph.D. in Sociology, which specialized in the intersection of sexualities, family building, and medical sociology, I had the opportunity to learn alongside some incredible queer families who participated in my dissertation project. Their openness in sharing their experiences as oppressed people gathering their resources and community support to build creative, expansive, beautiful families changed me and showed me all the ways people can show up for folks in their reproductive lifespans. Apparently, I began talking about this nonstop, because my wife finally enrolled me in a doula training, and I dove headfirst, while also finishing a Ph.D.! When the pandemic began, I felt the call from my community to move deeper, and I began training as a community midwife to provide affirming, full-scope midwifery care for people of all genders and sexualities. That is the bulk of my work these days, although I am still supporting my community as a doula for transitions like abortion, gender affirmation, and fertility.

XE: I love that progression—you were predisposed at a young age! Did you go through specific training to be an abortion doula? 

SH: When I began training as a doula in 2017, there were few programs that taught "full-spectrum" work. I didn't even know what that phrase meant at the time, but I knew that holding space for transitions meant way more than being present at a person's labor. Having grown up on a farm, I hold a deep reverence for the liminal space in which people (and animals) move from one state of being to another. I decided to seek out other trainings and do my own self-study before calling myself a full-spectrum doula, and have been lucky to train in abortion support with Full-Spectrum Doula Circle, as a PAIL Advocate with QUILT, and as a Peer Counselor with Exhale Pro-Voice. I'm currently learning from the Institute for the Study of Birth, Breath, and Death because I know that the work of bettering myself as a companion is continual.

XE: How did you get interested in providing abortion support? 

SH: Becoming a full-spectrum doula has been a continual evolution and, to be honest, a raising by my community of fellow queer healers and companions. I saw a need and felt called to participate in filling it. There have certainly been influential moments along the way: my own aloneness and difficulty accessing Plan B in my rural town after a sexual assault as a teen, my friend's experience of homophobia in medication abortion care in a "progressive" city, learning of a close family member's abortion much after the fact because of the shame my family carried. At those junctures, I wished deeply for a companion—not just for the person accessing abortion care, but for the providers, the loved ones, and the partners who were affected, too.

XE: Your first time serving as an abortion doula, what was that like?

SH: I worried I wouldn't be "enough"—that I wouldn't do enough, bring enough tools, say enough of the "right" things. But I showed up for that person anyways. I'm sure it was imperfect, but they were certainly not alone.

XE: What do you think about the abortion bans in Texas? How do abortion restrictions and stigma (in America and beyond) add to the emotional toll of receiving an abortion?

SH: The stigma is a kind of violence. It delays care, disrupts healing, and holds people in positions of powerlessness in their own lives. I feel strongly about normalizing abortions—any number, at any time, for any reason, by any person because I see all too often the damage done by society and influential others when a person has abortions.

XE: For so long, there hasn’t been much support in our culture for people who receive abortions; it’s still such a stigmatized procedure which is why I find abortion doulas so necessary. I think about the Buddhist Japanese tradition Mizuko kuyo, (ceremony for those who have experienced miscarriages, abortions, or stillborn births) and how it provides intentionality around that experience and grief one may feel. Part of what’s so difficult about having an abortion is there aren’t many dedicated places where you can put that grief, stress, or emotional hardship. Can you describe any rituals you might provide with someone while you’re serving them? I can imagine it’s not a “one size shoe fits all” type of support and part of the practice is showing up and catering to whatever that person needs. Is that right?

SH: It's definitely tailored to the individual, and not every person wants ritual or ceremony around it. If they do, sometimes it comes much later on, perhaps upon milestone moments like would-be due dates, anniversaries, others' baby showers, etc. My first step is always to ask a person how they are thinking and feeling and speaking about their pregnancy, and then meet them in that space. For some, it is a baby with a name and a planned future, and I might help that person write a letter to their baby or craft a memorial altar. For others, it is an embryo that needs to be removed and they might prefer to meditate on the embodied process of passing tissue with prayers, songs, or movement. There's no one way and there's no right way to honor an abortion. There's also no need to craft ritual if it doesn't resonate with people—maybe it's experienced as a quick appointment they have on their lunch break and then they move on with their lives. All valid.

XE: Absolutely, everyone’s needs are so different and there’s no right way, other than the way that’s right for that individual. On that note, what other forms of support might an abortion doula do?

SH: Sometimes abortion support is very practical—getting someone a ride to their appointment, picking up their meds, making them a meal, providing care for other children or pets, contacting a loved one—and sometimes abortion support is deeply emotional—listening, validating, affirming, holding. Usually, it is a unique mix of the two.

XE: Just like how there’s no one way to provide abortion support, there’s no typical abortion story; can you share some of the spectra of stories you’ve heard?

SH: I have heard abortion stories from every single type of person imaginable. There is no one type of person who has abortions and no one story. The stories aren't mine to share, but lots of people have participated in ethical story sharing through the platform Exhale. I encourage people to read those!

XE: How do you mentally or spiritually prepare? What about self-care after holding space for others?

SH: For me, there is always a moment of release after supporting someone through any type of transition. Sometimes it comes immediately, as I cry in the car on the way home, and sometimes it comes days or weeks later, as I'm walking my dog in the woods and thinking about the immense privilege I have in making choices to craft a life that sustains and fulfills me. The incredible care that my wife takes of me is the reason I can keep doing this work—whenever that release comes, I know she will hold me in it without question or judgment.

XE: What informs your practice as an abortion doula?  

SH: Attempting to bar people from safe and equitable abortion access is a deeply racist and classist practice, and to be an abortion doula means sitting in the continual work of antiracism and abolition. I aim to always be intersectional, affirming, and intentional in this work.

XE: Anything you wish you could say to legislators? 

SH: People will always have abortions—that's not a question. The question is whether those abortions will be safe, accessible, and grounded experiences or not, and whether the people who provide and facilitate those abortions will be supported in doing so.

XE: Anything else you’d like to share?

SE: Anyone who has a heart for this work can show up and support others during their abortion experiences—no fancy training, certification, or flashy tools necessary. This work is deeply rooted in community care and mutual aid, and it will continue on regardless of legislation, legality, or social acceptability. Local, independent clinics keep our communities safe and they need us to show up for them however we can. You do not need a reason to have abortions. Your abortion experience is valid. Having multiple abortions is ok. 

Xenia Ellenbogen (she/they) is a freelance sex and mental health writer. She focuses on sex work, LGBTQIA+ issues, menstrual equity, gender, and trauma. She holds a BA in writing from The New School. Twitter: @_xeniae

Photo by Priscilla Du Preez on Unsplash