When Julia discovered she was pregnant, she felt a mix of emotions: Happiness at first, and then uncertainty. The young mother knew she wanted to have another child at some point in her life. But the timing didn’t feel right.
Julia, who’s in her early 30s, said she was financially unstable and had a rocky relationship with her then-boyfriend. She juggled caretaker duties between her preschool-aged child and other family members. These circumstances weighed into her decision to end the pregnancy. Julia said she obtained abortion medications in New Mexico where abortion is legal. She sought the assistance of a doula afterward to navigate the effects of the pills and answer questions she had.
El Paso Matters agreed not to use Julia’s real name to protect her identity because she lives in Texas, which bans nearly all abortions. It remains legal for pregnant people in Texas to travel out of state for abortion procedures, and the patient taking abortion pills is not subject to criminal or civil liability. But various lawsuits have tested legal protections.
Doulas are non-medical professionals who provide emotional, educational and physical support to people during and after pregnancy. They can work with medical professionals, such as OB-GYNs and midwives, but cannot give medical advice, perform medical procedures or give medications. There is no regulated certification or training requirement to practice as a doula in the United States, but people can receive training and certification through organizations such as DONA and their local birth center.
Doulas can set their own prices for services, with some doulas in El Paso charging around $1,500 for prenatal, birth and postpartum support packages. Some doulas accept health insurance.
A full-spectrum doula supports the full range of pregnancy and can be present for childbirth, but some specialize in just abortion and miscarriage, said Melissa Lopez Sullivan, director of the New Mexico Doula Association. Even people who do birth work don’t always think about how not every pregnancy ends in the birth of a living baby, Lopez Sullivan said.
“Even if there’s a miscarriage, there’s very little treatment or attention in the medical system paid to the emotional wellbeing of the person,” Lopez Sullivan said. “Apart from the physical recovery, that is incredibly important.”
“When I think about that, in all aspects of pregnancy care and loss, the doula is the person who stays with you from the beginning to end no matter what happens, and is able to treat you with kindness and respect during the most trying experiences of your life, which can also be birth,” she said.
Julia’s doula, Catalina Camacho, is one of the few doulas in El Paso to support people who have experienced a pregnancy loss.
Camacho works as a full-spectrum doula and obtained accreditation through the New Mexico Department of Health. Most of her clients are Medicaid recipients in New Mexico, but she’s also begun taking private clients in Texas.
In Texas, her pregnancy loss services are limited to aftercare. Camacho said she cannot help people secure an abortion and she does not distribute abortion pills – both of which are illegal in Texas.
It’s important to have doulas who specialize in pregnancy loss because it’s a topic that’s not discussed much despite how common it is, Camacho said. One in every four to five pregnancies end in a miscarriage, also known as a spontaneous abortion. In 2024, there were about 15 abortions for every 1,000 women of childbearing age nationwide, according to the Guttmacher Institute, a reproductive health research and policy organization.
“I know that people hold a lot of grief during miscarriages and it’s a pain that’s minimized a lot,” Camacho said. “Like, ‘Oh, you can try later.’ Or, ‘You didn’t even know them (the baby).’ Just very insensitive things.”
“A lot of this care in general, like birth and abortion and miscarriage care, has been very medicalized,” she continued. “I feel like that type of care needs to be more in the hands of community members.”
What is an abortion and miscarriage doula?
Lopez Sullivan said a pregnancy-loss doula can support a client in various ways, from practicing breathing exercises, providing heating pads and evaluating what’s normal and what might need medical attention.
Sometimes a client just wants to sit in silence with someone as they process their grief.
“These can be confusing times and put people in difficult circumstances, especially if they’re going back to a state like Texas,” she said. “People living in restrictive states come to access life-saving health care and when they do that, they feel alone, scared and away from home. One thing we do to make them feel less alone is to help them navigate the process.”
The Guttmacher Institute estimates that in 2023, about 14,200 patients from Texas traveled to New Mexico for abortion – accounting for about 70% of all abortions provided in New Mexico. That was the first full year since the U.S. Supreme Court overturned Roe v. Wade, ending the federal constitutional right to an abortion.
Medication abortions account for most of all abortions in the United States. A two-step regimen of mifepristone and misoprostol, FDA-approved drugs, can be used to terminate pregnancies within the first trimester.
While unintended pregnancies and first-trimester terminations make up the vast majority of abortions, some people decide to end wanted pregnancies because of fetal abnormalities incompatible with life or health conditions that threaten the mother’s life.
“I think what’s so good about abortion providers and doulas is that we don’t ever try to convince people to do anything,” Camacho said. “We just provide all the options, all the information, all the evidence and let people decide what they want. Sometimes people have asked me, ‘Wait, aren’t you gonna try to convince me to have an abortion?’ I’m like, ‘No, I actually don’t advocate for people doing a certain thing.’”
Julia said Camacho educated her on what to expect after taking abortion medication. She passed small blood clots on the first day, and then experienced light bleeding for a week after.
“I felt secure in my decision and relief once it was done,” Julia said. “Cati (Camacho) continued to ensure I didn’t have any warning signs and checked in on me emotionally. Not once did she show a biased opinion and she was able to give me clarity and reassurance throughout the entire process.”
There are more than 200 doulas in the New Mexico Doula Association, Lopez Sullivan said. Some have state credentials after New Mexico passed House Bill 214, the Doula Credentialing and Access Act, in 2025. Credentialed doulas can bill health insurance agencies and are bound by HIPAA, federal law that protects patient health information from being disclosed without consent.
Lopez Sullivan cautioned people who are looking for a doula to support their pregnancy journey to interview doulas, more than one if possible. Some birthworkers are anti-abortion and doulas who are not credentialed may not be bound by HIPAA to protect their clients’ health decisions. Doulas who are anti-abortion may not advertise their political agenda on their social media or website.
“If your value system is one of bodily autonomy, oftentimes you’ll see pretty clearly if that doula is aligned toward one way or not,” she said. “They tend to be pretty transparent. The risk to me comes for that in-between, inconspicuous, CPC (crisis pregnancy center) area where there’s a presentation of certain neutrality that isn’t really true. That can get you into trouble.”
How El Paso women began guiding people after pregnancy loss
In 2025, Camacho and Bella Luna, an El Paso doula and lactation consultant, hosted miscarriage and abortion aftercare classes for birthworkers. The classes covered what the body experiences during a pregnancy loss, common management techniques, aftercare for cramping and other symptoms, and reasons for additional medical attention.
Luna, whose work focuses on breastfeeding, said the classes felt necessary because their doula training in Texas skimmed the topic of pregnancy loss. Doulas have expressed fear working in pregnancy loss aftercare, even if it’s legal, because they’re scared of being criminalized somehow, Luna said.
For Día de los Muertos last year, Luna created a pregnancy and baby loss altar for community members to bring photos and tokens of their loss, and connect with others. Luna clarified that loss goes beyond stillbirth, infant death and miscarriage. It can include abortion, failed IVF and failed adoption.
“I work at a hospital here and do full-time lactation support, but even in the hospital setting, I have to go and counsel mothers who have experienced a loss and most likely will still produce milk,” Luna said. “I see it pretty often, like with fetal demise, but I was never given formal training … like no trauma-informed nothing.”
Camacho said she received training in self-managed abortions in 2018 from the nonprofit Women Help Women and a few years later began working for a virtual clinic, Just the Pill. The clinic offered telehealth services and prescribed abortion medication in Colorado, Minnesota, Montana and Wyoming at the time. Camacho worked as an abortion doula and patient navigator doing intake, helping between 200 to 300 clients a month, she estimated.
After the dismantling of Roe v. Wade in 2022, protocols changed overnight, she said. Texas has passed a slew of anti-abortion measures since then, including House Bill 7 last year that allows private citizens to sue abortion pill providers and manufacturers.
Camacho now runs Desert Flame Doula Services as an independent doula and co-founded Chuco Community Doulas with Luna. The group received a $15,000 donation from Austin-based nonprofit The Bridge Collective in December and is in the process of applying for grants, Camacho said. Faith Roots Reproductive Action, a nonprofit abortion fund in New Mexico, became the group’s fiscal sponsor to oversee its funds.
Chuco Community Doulas is a way to reach people who are looking for doulas with similar backgrounds, they said.
Luna said many doulas in El Paso serve primarily military families through TRICARE, the health care program for service members, and that the local doula workforce needs more diversity. Military spouses who work as doulas leave the community when their partners are transferred. Her group, she said, is among the few made up of bilingual doulas from the area who plan to stay in the community long term.
“We are some of the few that are from here, are bilingual and aren’t gonna leave in like four years when our husband gets sent somewhere else,” Camacho said. “I think there’s also a big need to get funding for Texans too because Medicaid is not going to do it here in Texas … That’s one of our other goals as Chuco Community Doulas, to offer services to families that cannot afford it and to find the funding to pay local, bilingual doulas.”
The post Pregnancy-loss doulas guide El Pasoans after miscarriage, abortion appeared first on El Paso Matters.
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