As Kayla Jones, 28, kisses her 2-year-old daughter, Lola, good-bye this morning, she doesn’t know if she’ll spend the day working with women who are joyfully welcoming or somberly ending their pregnancies. Jones is a licensed practical nurse at Buffalo Womenservices in Buffalo, New York — the only free-standing clinic in the U.S. that offers both childbirth and abortion services.

In 2014, Jones was the first woman to give birth here at Buffalo Womenservices Birthing Center of Buffalo, an out-of-hospital space that encourages mothers to labor at their own pace with minimal medical intervention. It is a homelike place with a birthing tub and childbirth classes full of expectant mothers learning about the technicalities of breastfeeding and chanting, “My body knows just what to do.” Jones gave birth without pain medication, and “I surprised myself that I could do it! If I could do it, you can do it.”

At her grandad’s house on Buffalo’s economically depressed East Side, Lola plays a pink plastic keyboard and sings. “I love you, baby, I love you, baby.” Jones doesn’t see a conflict between her decision to have a baby as a single parent and her patients’ decisions to do otherwise. She had four abortions and a miscarriage before having a baby herself, and often tells worried patients that she turned out just fine: “I get to tell my story about 20 times a day. Their eyes always get really big and they say, ‘You look so innocent!’”

“I work here because I used this service before and I believe that every woman should have access to an abortion. They know when it’s the right time for them to have a baby,” she says.

Jones’s reasons for having abortions were clear. “I had to finish school. I was young, I hadn’t even finished high school yet [when I got pregnant the first time]. I was finding out who I was.” Now, Jones comfortably occupies the common overlap between abortion and motherhood. Fifty-nine percent of U.S. women who had abortions in 2014 were mothers. When she decided to keep her last pregnancy, “It was different because I felt like I had a career now and a stable home and a car. I felt like I was mature and I had the patience to have a child.”

Jones grew up poor, and her job at the clinic enables her to support her family while doing work that she believes in. With the election of Donald Trump and his appointment of a handful of extremely anti-abortion staff members comes fear that clinics like Buffalo Womenservices will be shut down and the women like Jones who rely on them left in medically dangerous situations. Womenservices is the only local facility that accepts Medicaid for abortions past nine weeks of pregnancy. Dr. Katharine Morrison, the clinic’s head doctor, isn’t worried about being shut down because New York is a liberal state. “But I’m sickened to death over what our country will look like going forward,” she says. “Women will be able to obtain an abortion in only a few states just as prior to Roe v. Wade.” Jones and the rest of the staff see the choice to terminate a pregnancy and the choice of a birth approach as inextricably linked by the necessity of female bodily autonomy and respect.

Jones talks with her mother, Susan Furst, while getting ready to leave with Lola. Jones is the only person working in the household, and she supports her mother, daughter, and two teenage siblings. She also helped care for her mother after a recent operation.

Donald Trump’s campaign platforms made Jones worry about more than the future of women’s reproductive rights. “My mother depends on Section 8 and SNAP benefits,” she says. “If these benefits get cut, what’s going to happen? How are we going to eat? People think that everybody that receives benefits are lazy or they don’t work. I work! I’m not lazy! If a woman finishes high school and she goes to work, she still can’t afford to feed her family.” Jones and Furst wept together when the election results were announced.

Jones is grateful for her support system though: Furst and her daughter’s paternal grandfather babysit regularly, and her mother encouraged Jones to apply for the job at Buffalo Womenservices while she was working at fast-food restaurant Tim Hortons.

Jones and Lola leave the house. The family moved six years ago to a suburb that had better subsidized housing options than Buffalo’s, but suburban living brings isolation: Jones would like to enroll Lola in Head Start, but public transit isn’t easily accessible here and Jones needs the family’s only car for work.

It’s not an easy life, but Jones has been through worse. She grew up poor in Buffalo, sometimes coming home to a house without electricity on.

In 1998, Dr. Barnett Slepian, a doctor working at the clinic, was murdered in his home by an anti-abortion extremist. After Dr. Slepian’s death, protesters turned their anger toward the clinic’s current doctor, Dr. Katharine Morrison, and graffitied “Dr. Morrison is a murderer” on a nearby building. Dr. Morrison moved her family — including her 3-year-old daughter and 12-year-old son — to New York City for safety in 2000, and flew or took an eight-hour Greyhound bus trip to work Thursday through Saturday each week for six years. “I did what I needed to do to protect my family,” she says. The building now has tight security, with a metal detector, guard, locked doors, surveillance cameras, and strict requirements about identification and large bags.

Jones talks with Dr. Morrison, her boss and mentor, in front of a Donald Trump piñata at work. “I got the piñata as a protest,” Dr. Morrison says. “I don’t use the words ‘fascist’ or ‘Hitler’ lightly — my mother was a refugee from Germany — but he is a fascist. One of the first things a fascist does is scapegoat people.” Dr. Morrison was present when Jones gave birth to her daughter at the birth center.

Jones studies for a pediatric nursing final at Trocaire College, the Catholic school where she works toward her associate’s degree so she can become a registered nurse. (As a licensed practical nurse, she must be supervised by an RN.) Hydrocephalus, encephalopathy, hepatopathy … She’s struggling, and worried that she won’t pass this test. School is expensive and time-consuming, but she’s determined to become her family’s first college graduate.

Dr. Morrison performs a procedure on one of her gynecological patients. In addition to performing abortions and attending births, Dr. Morrison does routine gynecological care.

An instructional breastfeeding video plays before a Centering Pregnancy meeting in the waiting room at Buffalo Womenservices. The group prenatal class educates patients expecting to deliver at the Birthing Center, one of two free-standing birthing centers in New York State, where women can give birth in a supportive, safe environment outside of a hospital. Dr. Morrison believes that women should be able to choose how to give birth as well as whether to do so.

Jiyong Kim Mai has a prenatal visit with midwife LuAnn Conte at the Birthing Center of Buffalo.

Lactation consultant Meghan McCarthy teaches a breastfeeding class during a group prenatal care meeting called Centering Pregnancy as Birthing Center coordinator Mary Badame listens.

Jiyong Kim Mai touches her round belly during a Centering Pregnancy meeting. She gave birth to her first son here at the Birthing Center of Buffalo as well.

Jones pours antiseptic into cups before patients arrive at Buffalo Womenservices. The liquid will be used to cleanse patients’ cervixes before their abortions.

Jones fills a syringe with Versed, a sedative, before patients arrive at Buffalo Womenservices. The medication will be used in combination with a painkiller and anti-nausea medication to provide patients with conscious sedation during their abortions.

The first step for a patient seeking an abortion here is an ultrasound to confirm how far along her pregnancy is. This patient waits after Jones performed her ultrasound to confirm her gestational weeks. If she is too far into the pregnancy, she will be referred to a clinic in New York City that can perform abortions until the state limit of 24 weeks because they have the necessary anesthesiologist. In 2012, 91.4 percent of abortions took place before the 14th week of pregnancy, and 7.2 percent were between 14 and 20 weeks. Only 1.3 percent of abortions were after 20 weeks gestation.

A 25-year-old patient watches TV in a waiting room before receiving a first-trimester abortion. This patient was confident in her decision and angry that her own gynecologist had pressured her to continue the pregnancy, and that an emergency room employee revealed her pregnancy to her mother. “If I do have kids,” she says, “I want to be more progressed in life. I love my life right now and I don’t want to change it.”

Counselor Lyndsey Marsh and Jones hold the 25-year-old patient’s hands while Dr. Morrison performs the first-trimester abortion.

Birthing Center coordinator Badame and Dr. Morrison laugh with Jones during a lunch break. Morrison mentors Jones, helping with some school fees. Jones credits her experience there with changing the way she understood birth and newborn care. She continues to breastfeed her 2-year-old daughter.

Counselor Marsh holds a speculum while talking with a 16-year-old patient before her first-trimester abortion. The counselor uses a plastic model reproductive system to explain the procedure: how the cervix will be dilated and the pregnancy terminated, reminding the patient that abortion is a safe procedure — it carries less than a 0.05 percent chance of major complications.

The 16-year-old patient meets with a counselor. All patients seeking abortions here must meet with a counselor who explains their options: adoption, keeping the baby, or abortion. The counselor confirms that the patient is making her decision without coercion from family or partners, and will cancel the appointment if she seems unsure.

The doctor also reconfirms each patient’s decision one final time just before the procedure begins.

The 16-year-old patient touches her belly in a waiting room. In 2014, 3 percent of abortion patients were 15 to 17 years old.

Nurse Karen Pfaffenbach holds the 16-year-old patient’s hand while Dr. Morrison performs a first-trimester abortion. Unlike 38 other states, New York permits minors to receive abortions without parental involvement.

Jones walks a 24-year-old patient to the door after her first-trimester abortion.

An 18-year-old patient reclines just after her first-trimester abortion.

Jones takes a patient’s blood pressure after her abortion. Almost half of U.S. pregnancies were unintended in 2011. Twenty-one percent of all pregnancies (not including miscarriages) ended in abortion.

The waiting room at Buffalo Womenservices.

Jones leaves Buffalo Womenservices after work. The protestors are legally prohibited from stepping outside of the yellow lines on the sidewalk.

Anti-abortion protestors JoAnn Thomasello and Joan Brandon picket outside of Buffalo Womenservices. “I consider myself a feminist but I never burned my bra,” says Brandon. “I always encouraged my daughters to do whatever they wanted to whether it was climbing a tree when they were little girls to making careers for themselves before they married because I wanted them to be at home with their children when they did marry. [Abortion] is the most important basic issue in life. Stop murdering our babies.”

Jones reads to Lola at home as Jones’s brother, Noah, gets ready to go for a walk. Jones takes on a lot of responsibility at home: Noah, who has Asperger’s, was recently beaten up by a bully, and Jones met with his principal several times and attended the bully’s court dates.

Jones bakes cupcakes with Lola at home.

Alice Proujansky is a documentary photographer covering women and labor: birth, work, motherhood, and identity.

Co-published with Cosmopolitan.