While D.C. is likely to protect abortion access, Grimes would not rule out breaking the law to facilitate the procedure if a federal ban were to take effect. She said she might try to help people access medication abortions, a five-day regimen of tablets that can end a pregnancy at home, or deliver emergency contraception to clinics in states with bans. But if she does so illegally, Grimes could lose her law license.

The prospect of doulas participating in covert networks in some ways harks back to the Jane Collective, a group created in the 1960s to help women access abortions when they were largely illegal. But Elizabeth Mosley, a public health researcher who has studied doulas, said post-Roe abortions would be safer for women: Patients could order abortion pills by mail, rather than trying to find someone to illegally perform the procedure.

In some ways, Mosley said, the Janes were part of a centuries-long tradition of abortion doulas. Women have always helped one another end pregnancies, she said, whether that was by using herbs or helping find providers through legal or covert means. Abortion doulas are not nationally regulated, and many work independently, making it impossible to know how many are operating across the country.