Mary Mahoney and Lauren Mitchell of The Doula Project (Photo credit: Jackie Snow)

At 9 a.m. on a recent Sunday in a small conference room on the 13th floor of a Manhattan hospital (The Observer agreed not to name the facility), Lauren Mitchell, a 27-year-old gynecological teaching associate, invited a group of 15 medical students and one reporter to introduce themselves. “So go around, state your name, why you are here...and your star sign,” she prompted, sitting at the head of a conference table.

Awkward pause.

Astrology probably isn’t what any of them expected when they signed up for the class, which will account for the first 6 of the 40 hours of  classroom required to volunteer as an abortion doula.

One by one, the students introduced themselves. One was male, the rest female. There were a smattering of future OB/GYN’s, a few pediatricians, and an unusually high percentage of Earth Signs.

An abortion doula is a new concept, pioneered by the Doula Project, of which Ms. Mitchell is a cofounder. In essence, it’s the same as a birth doula—in fact, most practitioners do both—except that she provides support to women getting abortions who’ve chosen not to take their pregnancies to term, offering counseling, back rubs and reassurance.

A familiarity with the zodiac, it turns out, can come in handy.

“We often ask patients their star-sign,” Ms. Mitchell told The Observer in an interview after the class let out. She was petite and wore a denim dress. “When a patient is nervous or anxious, telling them a little about their sign can take their mind off the abortion—everyone loves to hear about themselves.” (It occurred to us that talking about birth signs might have the effect of reminding women of, well, birth, but we went with it.)

New York has been called the abortion capital of the U.S., a title granted by pro-life organizations and made official earlier this year in a column by Ariel Kaminer in The New York Times. Ms. Kaminer cited a health department report released in December of 2010 which found that about 40 percent of pregnancies in New York City end in abortion, about 90,000 per year. “New Yorkers seeking to terminate a pregnancy can choose from more kinds of procedures at more kinds of facilities with fewer obstacles—and more ways to pay—than just about any place else,” she wrote, noting that it was covered by Medicaid here, unlike many other states, and that there were few of the restrictions involving parental consent, waiting periods and viewing sonograms found elsewhere. Last week, a local blog devoted to bargain living, brokelyn.com, even published a guide to local providers.

Despite the failure last week of Mississippi’s “personhood” amendment, which would have given a fertilized embryo the status of a human being in the eyes of the law—criminalizing all abortion as well as some forms of birth control, like the IUD—state legislatures, buoyed by Republican election gains, did pass more than 80 laws restricting abortion in 2011, making it a watershed year for the pro-life movement. Meanwhile, pro-lifers are working on personhood initiatives in six other states. Ohio is considering a “heartbeat bill,” which would outlaw abortion as early as six weeks. Other states have adopted restrictions like mandatory ultrasounds, mandated counseling, and bans on coverage of the procedure by Medicaid and even private insurance policies. Today, 88 percent of U.S. counties have no abortion provider, and in non-metropolitan areas this statistic rises to 97 percent, according to the US National Abortion Federation, an organization of abortion providers. As a result, New York has increasingly become a magnet for women from other states who are seeking to terminate their pregnancies.

Given their string of legislative losses, there seems to be a shift of energy underway in the pro-choice movement, as activists back away from policy debates and instead turn their attention to practical matters, organizing to assist women in navigating the shifting legal landscape. In New York, they are offering hands to hold and backrubs, opening up their apartments to women from out of town, and helping them deal with insurance claims. “It is about finding the flesh and blood approach, rather than the theoretical one,” Ms. Mitchell said.

Rebecca Stanton, a professor at Columbia University, felt a little guilty when she and her husband purchased a roomy two-bedroom apartment in Manhattan, she told The Observer over tea, in front of the impressive view from her Harlem apartment. “We had all this extra space and it seemed sort of silly,” she said. A friend directed her to Haven, an organization that finds volunteers willing to house low-income women and their partners who are traveling to the city for abortions. Haven was founded in 2001 when Catherine Megill, an abortion clinic social worker, discovered that a number of patients were forced, due to financial circumstance, to sleep on park benches or in their cars.

Ms. Stanton remembered one family she hosted, who’d driven up from Virginia in a dilapidated station wagon. The bumper sticker on their car made her draw a hand to her heart. “It said, ‘I am the proud parent of an honor roll student at [so and so] middle school,” she recalled. The honor roll student was the one seeking the abortion. She and both parents crashed in Ms. Stanton’s extra bedroom the evening before the procedure.

The girl’s parents had already extended the lines on their credit cards to initially make the trip. That afternoon, an ultrasound indicated she was further along, by four critical days, than previously thought, tacking another $400 onto the medical bill. As Ms. Stanton busied herself ordering Chinese food, the girl’s parents called bank managers. When that didn’t work, they called in favors.

“The girl was very quiet,” Ms. Stanton recalled. “I am not even sure if she knew she was having sex. She was overweight, and her family didn't find out she was pregnant until she was 21 weeks along.”

Another volunteer, author and political activist Jane Weissman, opens up her spacious Greenwich Village apartment for Haven when she’s not traveling. Ms. Weissman said the roughest part of the experience is dropping the patient off at the clinic, sometimes walking her past protesters—each party knowing they will likely never see one another again. While most women Haven sees are getting second trimester abortions, Ms. Weissman said they often just want to go straight home after the second day, regardless of how they feel.

Approximately 4,000 women have been assisted by abortion doulas trained by The Doula Project, which was started by Ms. Mitchell and Mary Mahoney in 2007. The group partners with clinics and public hospitals to, as the website delicately puts it, “support people across the spectrum of pregnancy.”

“The mission of our project is to support people who would otherwise not have access to doula services,” Ms. Mitchell said. “So we see, for instance, people who are undocumented and can’t apply to Medicaid, or folks who are really lacking in resources.” They started the project after undergoing doula training in college. Ms. Mitchell says she went to a “hippie college, where it seemed everyone was training to be a doula.” The idea of an abortion doula, she said, was a way to stand out. Originally, the project caught some flack from the pro-choice community. As Marisa Meltzer wrote in a 2010 Slate piece, “Even as a pro-choice feminist, when I heard about abortion doulas my first thought was: Are women really so fragile that they need to hire a complete stranger to hold their hand at the doctor's?”

“We were concerned about that when we first started, that the pro-choice movement wouldn’t exactly embrace us,” Ms. Mahoney said, “because we come from the reproductive justice movement, which is more holistic and looks at people’s feelings and individual experiences, not just policy.” Ms. Mitchell added that some abortion providers were skeptical at first, as well, but that they now they find that the doulas make their job easier.

During the doula training, one instructor explained how to help clients who don’t speak English. She sucked in her breath, and moved her arms encouragingly. “I try to mime how to breathe, like an owl: ‘who, who.’ At first they think you are crazy, but they realize you are trying to help.”

Ms. Mitchell estimated that doulas see about 15–20 later term abortions a week, and about 75 first trimesters. In training, the instructors explain that many women seeking abortions are nonetheless not politically pro-choice. She handed out flash cards with real-life situations. The first read: “A woman tells you, ‘I just killed my baby.’ How do you respond?” The students broke into groups to discuss the question. Many came up with a similar answer: Explain that the procedure is legal because the fetus is not a baby, it just has the potential to be one.

That, of course, is the murky distinction that makes the issue so difficult for everyone it touches. As the executive director for Feminists Choosing Life of New York, Kelly Brunacini has thought a lot about about the flip-side, how to convince someone that a fetus is a baby: “The quickest way to change a pro-choicer’s mind is to let them see the procedure,” she said. “A lot of the argument is intellectual: ‘My body, my choice’ sounds really good. When you see an abortion or you go through the mourning process with a woman who has aborted, it becomes less intellectualized, and more real.”

To some extent, Ms. Mitchell sees her point. In an interview with The Observer, she joked that she sometimes wants to automatically reject the abortion doula applications of pro-choice activists, because it’s so hard to go from pro-choice rhetoric to supporting real people who don’t necessarily find their abortions empowering.“Those pictures pro-life activists flash are real,” Ms. Mahoney said. “That is what a fetus looks like when its head is crushed. When you see the procedure, you must decide, as a pro-choice person, whether you are in or out.” She’s thought about it a lot. “I have never been more in,” she said.

As restrictions on abortion have tightened, talk has grown among members of Haven and the Doula Project of creating a national network, an underground railroad of sorts, made up of women who would provide places to stay and/or transportation to and from clinics all over the United States. “Abortion doulas can offer someone to travel with, so they could have a support person the whole way, and not just your Mom or husband who is freaking out,” Ms. Mahoney explained. Other pro-choice organizations have begun raising money to help women pay for abortions, including The New York Abortion Access Fund, which earlier this year held a fundraiser, sponsored by Jezebel, that included a screening of Dirty Dancing.

During the doula training Ms. Mitchell demonstrated the manual vacuum aspirator for the class. Reaching beneath the conference table, she removed several small cups green Jell-O and placed them on the table. “I remembered the green this time,” she said, to nervous titters all around. “The last group, we had red, and I think it scared some of the doulas.”

Ms. Mitchell stood up and placed the end of the device, which resembled a very large syringe, into the cup. She pulled the handle. There was a loud slurping sound as the Jell-O was sucked into the chamber and liquified.

“Does it sound like that in the room?” we asked.

“Unfortunately, yes.”

“You should play music or something.”

Ms. Mahoney said that some clinics do in fact turn on a radio, but sometimes the song can be wildly inappropriate, i.e., “Papa Don’t Preach.” “One time ‘Everybody Hurts’ came on,” she recalled, “and the doctor slammed it off.”

The students then tried out the procedure for ourselves. The Observer found it fairly easy, but some students had more trouble. There were squeals when one glob of Jell-o flew across the room and landed on the table in front of us.

The purpose of the demonstration was to familiarize us with the procedure, but some pro-choice activists have begun to consider whether they would break the law if abortion became illegal. “Doing them underground is a major last resort,” Ms. Mahoney said. “I would be willing to, if things came to that.”

Such actions recall the work of the Jane Collective, which was one inspiration for the Doula Project. The collective was a feminist organization in Chicago that performed more than 11,000 illegal abortions in the 1960s, before the passage of Roe v. Wade. Women calling to make appointments would ask, “Can I speak to Jane?”

When the Jane Coalition was uncovered by the police, seven women were arrested. They were looking at lifetime prison sentences. But while they sat awaiting trial, Roe v. Wade passed and the group walked.

Since The Doula Project launched, a handful of similar collectives have popped up across the country. The Observer spoke with abortion doulas in places like Ohio and Illinois, for whom a ban on abortion is considerably more likely. They agreed performing them underground is a last resort, but not off the table.

What is more feasible, some advocates told us, is insurance fraud. At many public hospitals in New York, abortion is on a sliding-fee scale like any other surgery. With proof of residence and a low income, a patient can be treated for around $150, payable over time. “Find a friend in New York City, get an address and mail yourself something, go to New York the next week and get your abortion fee scaled,” one pro-choice advocate suggested.

Some pro-choicers are also considering medical school. Ms. Megill, the founder of Haven, is currently doing her residency in order to become a provider. “What is most needed is for doctors to go into this line of work and to be willing to set up clinics in places where abortion is unavailable,” she explained.

“The fact that medical schools don’t teach abortion procedures as a matter of course is criminal,” Ms. Stanton said.

While the pregnant 13-year-old made the biggest impact on Ms. Stanton, she said all of the women she has hosted had excellent reasons for terminating their pregnancies. “One woman said over dinner that she didn’t believe in abortion, she was a Christian. But she had two kids already. She said, ‘I know I have to take care of the two kids I have first.’ This was her making the best choice she could, between two things she believed in.”

Those behind the restrictions of 2011, believe that more laws will equal less abortion. New York has yet to pass any restrictions on abortion, and in fact, state Sen. Andrea Stewart-Cousins has introduced the Reproductive Health Act, which among other things, grants “the fundamental right of every female to determine the course of her pregnancy.”

“New York is primarily a democratic state” Ms. Bruncini said. “This is a tough state for us. I don’t think legislation can end abortion. That would have to be s shift in peoples hearts, a cultural shift.”

According to a recent report by the Guttmacher Institute, abortion rates declined by 8 percent between 2002 and 2006.

Correction: An earlier version of this story erroneously reported that the Doula Project had placed an announcement on its website stating that it would provide support to women taking Cytotec. It also misattributed two quotes to Ms. Mitchell that should have been attributed to Ms. Mahoney. The Observer regrets the errors.