Beyond Birth: Full Spectrum Doula Care Post-Roe

This article was originally published as part of the Parents.com series “Black Maternal Health Week is a Time to Recall Our Power.” The collection as a whole was awarded a 2023 Folio Eddie Award for Best Series of Articles in the Parenting/Family category. I’m forever grateful to have had the support and encouragement of SeQuoia, Celeste, Jasmine, and the rest of the Kindred by Parents team as we worked together on such an important topic.

Ever since the Supreme Court’s Dobb’s decision overturned Roe vs. Wade in 2022, birthing people across the country have had to navigate increasingly complex systems of healthcare, and now struggle to access quality reproductive services more than they have in decades.  These gaps in care leave all birthing people more vulnerable than before, but Black women and other marginalized birthing groups are at even greater risk of poor birth outcomes. People of color experience drastically higher rates of maternal mortality than their white counterparts. While public healthcare often fails to support and protect individuals throughout their reproductive journeys, doulas offer an alternative to hospital-centered birth experiences, providing personalized, comprehensive reproductive care for underserved populations across the country.

Certified doulas have such a positive impact on birth outcomes that some state Medicaid programs now recognize and cover doula care for birthing people—yet preparing to give birth is only one reason people might seek out a doula. In many communities, “full-spectrum” doulas are increasingly central to effective and comprehensive reproductive care.

SeQuoia Kemp, a certified doula with a B.S. in Nursing, has provided full-spectrum doula care in upstate New York for more than a decade and has seen maternal mortality rates in her county nearly triple. She knows unequivocally her services are desperately needed by more than only those who continue a pregnancy. 

“When I refer to myself as a ‘full-spectrum’ doula, that means I provide care whether or not that pregnancy ends in birth, across the full spectrum of ante-natal experience,” Kemp says. 

As both a provider and an activist, she explains, being direct when talking about her work helps foster awareness. “If I’m in a political space, I’ll identify myself as a certified community-based doula and an abortion doula, to make it clear that I support and uplift people who terminate pregnancies for whatever reason.” 

Providing care to pregnant people, whether or not they continue with their pregnancy, is central to Kemp’s ethos. As CEO and co-founder of Sankofa Reproductive Health and Healing Center in Syracuse, New York, as well as CEO of Doula4aQueen, she knows how important community-based doula care can be. 

Community-based doula collectives have filled gaps in both basic medical and reproductive care for decades, often offering services for free or at a reduced cost. Largely supported by donations and grants, such collectives sometimes offer a community’s only reproductive health support. 

Having access to even a basic level of doula care often drastically improves birth experiences, especially for those birthing people who may lack family and community support. However, in many communities and circumstances, physical and emotional support needs extend far beyond the birth experience.

While birth-centered doulas primarily offer services assisting individuals throughout labor and delivery, services offered by full-spectrum doulas encompass so much more than pregnancies that end in birth. This is especially important for individuals navigating a broader range of reproductive experiences that might lead to or stem from pregnancy, including prepartum and postpartum care, as well as many forms of loss: stillbirth, miscarriage, pregnancy loss, termination for medical reasons (TFMR), and abortion.

Chanel A. Frias (formerly Beard), LMSW, underscores the importance of the care duality full-spectrum doulas provide to individuals terminating pregnancies, as they often bridge the clinical and emotional needs of their clients.

“The disenfranchisement of grief within this experience is really important [to acknowledge] because in this political climate there’s been so much vile, unempathetic discourse around women’s bodies and their decisions about their pregnancies,” Frias says. 

“And that has fueled even more shame around this topic for women who decide to terminate.”

Frias, who will be leading an Abortion Healing Circle at Sankofa, notes the importance of emotionally processing a termination. 

“There’s this shame-driven discourse around abortion, and women internalize that and feel as though they don’t have a right to have any emotions [beyond shame] about what they did,” Frias adds. “That’s why it’s important to hold space for women to experience this entire spectrum of emotions with no judgment, with emotional safety, validation and support.” 

Even given the many benefits inherent to postpartum care for abortion patients, doulas in some parts of the country struggle to overcome social stigmas in their work.

“Abortion care is still very taboo,” Kemp says. “It’s not something you talk about. Even if you have to get an abortion there’s this idea that certain reasons . . . are more valid than others.” 

Conversations about pregnancy termination, regardless of the circumstances, are often shrouded in secrecy, shame and silence. 

“There’s the societal notion that . . . it’s the worst thing you could ever do,” Kemp adds. “It’s important for us to validate that this was the right decision for [them] and prepare them to navigate this in the future . . . so they won’t bring this guilt and shame with them into the next pregnancy.

“My doula trainer and my co-founder, Astaire, teaches that all pregnancies do not end in birth. That’s the bottom line, and it’s just a fact,” Kemp says. Above all it’s important to her that her clients feel “validated and held in those sacred [reproductive] spaces.”

Kemp has seen first-hand the struggles faced by Black women and other marginalized birthing groups in her community as they grapple with the absence of constitutionally protected reproductive care.

Even in a state like New York that protects access to terminations post-Roe, Kemp acknowledged that a top priority for Sankofa is to reaffirm its commitment to providing full-spectrum care. To this end, Sankofa supports clients seeking abortions with staff specifically trained and certified in abortion care. 

Leeandra Torrance, a certified full-spectrum doula, received her abortion care training through the Mountain Area Abortion Doula Collective and has offered abortion doula services at Sankofa for the past six months. 

Torrance, who shares candidly about her reproductive history, has experienced a miscarriage and an abortion, as well as the birth of her daughter. It’s important to her to have the opportunity to share her story and insights with her community as she works, hoping it helps the women she serves feel less alone.

Torrance’s clients seek medical intervention to terminate pregnancies for many reasons: escaping domestic violence, detecting developmental abnormalities in the fetus, maternal health concerns, lack of financial stability and myriad others. “It helps to have been in their shoes, to be able to express that I understand them,” Torrance says.

Thanks to a Planned Parenthood grant, the abortion care services Sankofa provides are free to community members, though Torrance noted that education is equally important to removing barriers to care. 

“So many women don’t even know that we have this service, so education is important,” Torrance says. “You can get emergency Medicaid right then and there, and a lot of people don’t know that–they think they need insurance or to pay out of pocket, but you don’t. That’s why it’s important to get the word out, so women know these options are available for them, that they have support.”

Kemp and Torrance agree that providing emotional support for those they serve is critical. 

“The bottom line is people need care, they need love, they need support,” Kemp says. “So sometimes I just sit there with them, and we eat pizza and we watch TV, and other times we talk about how it felt. I try to just make it seem like this is just everyday life and . . . we’re going to get through this together, because that’s what I would want if I had a miscarriage. That’s what I would want if I had to decide to terminate a pregnancy. And that’s what I would want if I did give birth to a baby and needed someone there to support me after I gave birth.”