An abortion doula holds hands with a patient during the procedure at a clinic in Falls Church, Virginia.
CNN  — 

Saquaya Ruffin didn’t know what an abortion doula was until the clinic staff asked if she wanted one.

Her mother came with her to the appointment at Planned Parenthood in New York, but she wasn’t going to be allowed in the procedure room. Ruffin agreed to the doula, figuring it would help to have someone with her.

Ruffin says the doula helped her stay calm as the staff administered anesthesia. She soothed her anxieties about being awake for the abortion and held her hand throughout. Her role was subtle, but Ruffin appreciated her presence.

“I didn’t expect to be so emotional about the procedure,” Ruffin says of her abortion three years ago. “Having a doula there helped with that.”

Ruffin’s abortion doula belongs to an emerging field of care workers who support people through the process of ending a pregnancy.

As getting an abortion in many states becomes more complex with the overturning of Roe v. Wade, doula organizations who spoke to CNN say they’re seeing a surge of interest from volunteers who want to provide that support – even as these doulas’ work becomes riskier and more challenging.

Abortion doulas can help pregnant people process their emotions

Abortion doulas aren’t midwives or medical practitioners. Their main role is providing emotional support and information to women and non-binary people who are navigating abortion.

That could mean holding someone’s hand during the procedure or lending an ear as they talk through whether or not to terminate a pregnancy. It could mean ensuring their appointment is with a reproductive health clinic, as opposed to a crisis pregnancy center that intends to dissuade people from having abortions. Or it could mean offering tips on how to manage abortion’s physical side effects.

Siobhan Diores knew something about the complicated emotions she was experiencing when she got pregnant two years ago. She herself is an abortion doula.

Most clinics don't allow companions or doulas during the pandemic, so Siobhan Diores meets with a client on Zoom before their appointment to calm any nerves and set expectations for the procedure.

But even though she is trained to help others navigate the procedure, having someone she could talk to throughout the process was a huge comfort.

Diores says she already had an infant at home and her marriage was on the verge of ending, so having another baby at the time wasn’t financially or emotionally feasible for her. Still, she found the stigma of abortion, as well as a sense of loss, weighing on her.

Over Zoom and via text messages, her abortion doula helped her process those feelings.

“I needed somebody to help me move through the full cycle of emotion so that I could keep showing up for my work for other people,” she says.

Because of her own experiences, much of Diores’ work now centers on supporting clients for whom abortion is a difficult decision. She’s also a full-spectrum doula, meaning that she supports people not just through abortions, but through pregnancy, birth, miscarriage and other fetal loss.

While some organizations offer abortion doula training, the field isn’t licensed or regulated, meaning that the work can vary widely. Some abortion doulas are volunteers who partner with clinics or hospitals, while others, like Diores, are independent professionals who offer their services at a cost.

One of the first organizations to promote the concept of an abortion doula was The Doula Project, a New York City based nonprofit that started in 2007. The group’s founding members were involved in the reproductive justice movement and say they noticed that people getting abortions didn’t have the same resources and support as those giving birth.

Over the years, the organization has expanded its services to support people across the full spectrum of pregnancy and today, its trained volunteers work with Planned Parenthood clinics, public hospitals and other providers in New York City to help those who need it most.

In the current political landscape, that support is more needed than ever, says Vicki Bloom, one of The Doula Project’s leaders.

“People deserve to be treated like people when they’re having medical procedures,” Bloom says. “Culturally right now, we are not providing that kind of care for people who are having abortions. We’re not treating them with respect, with love, with honor that they’re making decisions that make sense for them in their life.”

Increasingly, they also handle logistics

Abortion doulas’ responsibilities have evolved as abortions have gotten harder to obtain.

“Typically when folks think of an abortion doula, they’d be thinking of the handholder in the clinic,” says Jenna Brown, program director and lead teacher for Birthing Advocacy Doula Trainings. “But in my experience, the majority of the work that abortion doulas do is in support of logistics preceding care.”

That’s especially true of the volunteers at the Colorado Doula Project. Colorado – where abortion is legal at all stages of pregnancy – was already becoming a sanctuary state before Roe was overturned. With abortion in some surrounding states now illegal or soon to be illegal, the Colorado non-profit is experiencing a “massive increase” in clients, says executive director Gina Martínez. And the needs of its clients are great, she says.

An abortion doula speaks with a patient after the procedure at Falls Church Healthcare Center in Virginia on November 24, 2017.

The group’s abortion doulas pick up out-of-state clients from airports, arrange accommodations and drive them to appointments. The organization also helps pay for the additional travel costs that now come with getting an abortion, from childcare to hotels to gas money.

“If you have the money for the abortion but you can’t get there, it doesn’t really matter,” Martínez says, referring to pregnant people who can’t afford to come to Colorado for the procedure.

But as some conservative states pass or consider laws that target anyone who helps terminate a pregnancy, abortion doulas now must assess whether they can continue to do the work.

A recent executive order by Colorado’s governor to shield abortion providers in the state has, for now, provided a sigh of relief for the Colorado Doula Project. But the threat is never zero.

“The possibility of legal risk, as well as targeted violence, is always a worry,” Martínez said in an email. “Colorado Doula Project abides by all federal and state laws, and does not operate outside of Colorado, ever. But even so, laws in the US are routinely applied in ways they were never intended.

“So even when we’re confident we are within the law, that doesn’t prevent someone from targeting us based on their misconceptions and violent beliefs.”

Even in an increasingly hostile climate, many doulas are willing to brave the risks

As abortions become harder to access, some fear that doulas’ services will, too.

Brown says some doula organizations in states with restrictive laws have halted operations over the potential legal and security risks they face, with no indication of when they might be back up and running.

“We’re seeing right now a lot of collectives – particularly in states that have trigger laws – completely pause their work in order to protect the folks who are part of the collective,” Brown says. “I think we just don’t know … yet about what threat there is to people’s safety who are providing this type of community care work.”

Others, like the Mountain Area Abortion Doula Collective in Asheville, North Carolina – where abortion remains legal – have considered the risks and decided to keep going.