I've been an ‘abortion doula’ 2,000 times
BBCDoulas typically give women emotional support during childbirth, but in New York some help women through abortions too. Vicki Bloom has been in the room for more than 2,000 procedures since joining the non-profit Doula Project in 2010.
One of the things Vicki Bloom found most surprising when she first became an abortion doula was just how many of the women - most of them already mothers - wanted to chat about their children.
"I had thought that would feel weird while they were terminating a pregnancy, but actually it makes a lot of sense," says the 50-year-old doula and former food scientist.
"Making sure they can take the best care of the kids they have factors into a lot of people's choice to have an abortion, so their kids may be on their mind.
"I also feel like some people may want to talk about how they take care of their kids to get reassurance that they are a good parent and a good person."
There's a misconception, says Bloom, that women who have abortions are somehow different from those who have children. In fact more than 60% of women having abortions in the US already have at least one child, according to the Guttmacher Institute, a reproductive health research organisation.
When they take their place in the operating theatre, Bloom will be there in her hospital scrubs to hold their hand, calm them, comfort them, talk to them and wipe away any sweat or tears.
The time they spend together is normally shorter than for a birth, but in many ways the support Bloom provides is the same.
"I will stand up by their head and be looking into that person's eyes, ready for whatever they need, while the doctor is doing the procedure," she says. "Even in clinics where staff are amazing, having someone in that dedicated role can be so valuable."
For later-stage abortions, which require women to go under general anaesthetic, Doula Project volunteers will offer to be there not just before, but also while the woman is unconscious.
"Witnessing is a big part of what doulas do," says Bloom. "Some people find it a great comfort to know someone they know, and who they connected with, will be there during the procedure, even if they're asleep."
Childbirth doulas in the US tend to be expensive and their stereotypical clientele are affluent white women. By contrast, The Doula Project was launched in 2007 to give free support to women from lower-income backgrounds and marginalised communities.
"We think women deserve good care and support however their pregnancy proceeds - whether it results in birth, miscarriage, stillbirth, foetal anomaly or abortion," explains Bloom. All doulas who work for the project must be willing to do abortion work as well as birth work.
The Guttmacher Institute finds that abortion is increasingly concentrated among women living below the poverty line.
The Doula Project's birth programme works with women in New York with annual household incomes of under $30,000. On the abortion clinic side, The Doula Project offers to work with every patient who walks through the doors.
One of the main clinics the project works with is for first trimester procedures - up to 12 weeks and six days - and it also works with a hospital-based clinic which does procedures for pregnancies up to 24 weeks, the legal maximum in the state of New York.
During a typical shift Bloom sees about six women, and usually at least one of them is under 18. As the mother of a 14-year-old son herself, it is often those teenage girls who stay in her mind long after her shift has finished.
"One of the most difficult things about my job is that I can't fix somebody's life, no matter how much I might want to. I can't fix their bad relationship or their lack of a job. I'll make a connection with a person whose life is really complicated and help them in that moment with this one thing, and then I'll never see them again," she says.
Before getting through the doors of the abortion clinic, patients will most likely have had to walk past a crowd of anti-abortion protesters.
Deeply divisive though it is, nearly one in four American women has had an abortion by the age of 45.
Bloom will never ask why a woman is there, but often they want to volunteer their story.
During the procedure a lot of women will come out and say things like, "I really wanted this baby but I don't have enough money," Bloom says. Or, "I feel so sad about this but taking care of my two kids right now is enough." Then there are others for whom the procedure is not traumatic or difficult at all.
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Bloom says the protesters at the main clinic she works at are relatively low-key, perhaps because the facility is multipurpose. They pray the rosary, hold candles and hand out flyers.
"I say hello to them, and they try to hand me things which I don't take," she says. On the days they are there, a security guard waits at the door to escort women into the building.
Bloom grew up in the New Jersey and has spent most of her life in the New York state area. The first time she remembers properly thinking about the abortion issue was as a teenager, when she was dating a boy from a Catholic family and was invited to go to a pro-life rally in Washington DC with them.
She instinctively felt uncomfortable about the idea and started researching the issue. "I was a science geek, so I came away knowing a lot more about the biology of pregnancy, but also came out feeling very strongly that women should be able to safely do what they need to take care of themselves, without other people or the government interfering," she says.
Once in a while it's not protesters outside, but the women on the operating table who challenge the abortion doula.
"Occasionally a client who feels bad about what is going on with themselves might lash out a bit - 'How can you live with yourself, knowing that you wake up in the morning and choose to be part of this?' - but I know they're coming from a place of internal conflict and pain, and I actually don't feel conflicted at all about what I do, so I can respond to them with compassion," she says.
People's politics don't always match up with their personal lives, says Bloom, who has supported a number of pro-life Republicans through abortions. "That's some very hard cognitive dissonance," she says. "Some of them might change their mind about abortion, and some of them might not - they might just feel bad about themselves."
The clinics regularly receive women who have travelled from less liberal states where getting an abortion can be difficult.
The Doula Project recently created a "zine" with suggestions for self-care for women it isn't able to reach with direct help.
In the eight years since she joined The Doula Project, it is the abortion work which Bloom has found most rewarding.
As she puts it: "Making a deep connection, making a difference - and then letting it go - is super-powerful."
Illustrations by Mick Moran for DIY doula self-care
