Doulas Are Not Just for Natural Birth: How Doulas Support Families during Cesarean Birth
A common misconception about doulas is that they are just for those planning natural births. While doulas are well-equipped to support people in coping with unmedicated labor, those are by no means the only people who need support through their birthing experiences.
Why a Doula for a Cesarean Birth?
After I attended my first cesarean birth as a doula, I remarked to a friend (who had also birthed via cesarean) that I couldn’t imagine a mother or couple being alone in the OR through that process. “It was hard.” She said. “Even though a doula would be amazingly helpful for a natural birth, I realized I probably needed a doula there in the OR even more than if I had had an unmedicated vaginal birth.”
Even with a fairly calm, non-emergent cesarean, the OR is a scary place. There are so many people, most of whom you’ve never met before. Everyone is wearing masks and surgical garb so you can’t even see their faces when they speak. Things are happening all around you, and you have no idea exactly what is happening or why. Your whole world is that blue drape. You can’t feel your body and there are medications running through your system that might be making you feel nauseated, itchy, dizzy, faint, or confused. You know what’s happening on the grand scale - but the specifics are hazy. You’re also faced with the knowledge that the next few hours, days, and weeks are going to be difficult. You’re having major surgery and you have no idea how your body will react. You’re afraid for your baby, afraid for your body, afraid of the unknown.
All prepped to head in to the OR.
If your cesarean is happening in an emergency, multiply the panic, fear and number of people in the room. You’re strapped down, numbed up, and there’s nothing you can do but lay there and hope. This is a time of intense vulnerability. This is a time when everyone deserves to feel supported and reassured and encouraged.
What about partners?
In most cases, partners are permitted in the OR during cesarean surgeries. They are able to sit by your head and hold your hand around your IV, talk to you through their mask and stroke your hair through your hairnet. But partners are right there with you in the thick of the fear and uncertainty. They are just as vulnerable and need to be supported as well. A doula is there to provide reassurance and help the partner to stay calm as well. Usually there is a period of time where even the partner is not allowed into the OR while the surgical staff is preparing the patient. Having a doula there to talk to and wait with helps the partner to avoid panic and be a better support person during the surgery.
There’s also two patients during a birth. In the vast majority of surgical births, the baby is separated from the birthing person and the partner has a choice to make - support the baby or support the mom. With an extra support person, no one has to be alone.
How can a doula help?
Whether your cesarean is planned or unexpected, a doula will be able to talk you through the process and help you understand what to expect. The more you can anticipate what will happen to you, the more relaxed you can be. A doula can also help you to identify your options. It’s easy to get swept up in the standard process that a cesarean typically follows - many people don’t know that you can make requests and adjustments, from your IV placement to delaying cord clamping to having skin-to-skin contact and breastfeeding while being stitched up, there are things that can make your experience better and your doula can help you make them happen.
As a doula, I find it important to narrate what is happening to my clients. This way, they can anticipate just when that baby is coming out and be prepared. I share with them the time of birth, and explain to them what is happening with their baby on the other side of the drape until they’re able to see for themselves. Not being the first one to see or touch your baby is a necessary but difficult part of a cesarean; hearing about it can help.
Doulas also provide the same reassurance, encouragement, and praise as we would during a vaginal birth. People need to hear that they are doing well; whether you’re doing good work pushing out a crowning baby or doing good work breathing calmly through the pressure of surgery, it’s still good work. We answer your questions, and physically support you by holding your hands, stroking your hair or shoulders, wiping your eyes or giving you a visual focus.
If your baby is doing well after the birth, a doula can support you in initiating skin to skin contact while your incisions are being repaired. If you desire, we can help facilitate breastfeeding - something you will need a lot of support with due to the position on the OR table. If your partner is with baby, your doula will stay with you to support you and share with you details about what is going on.
We can also take pictures! It’s hard to have just one person supporting mom, baby and doing photography. Having a doula present allows you to get photos of those early emotional moments. Remember, this is still your baby’s birth day! It deserves to be documented.
Are Doulas Really Allowed in the OR?
It’s true that every hospital has different policies about who can accompany someone during surgery. It’s often the anesthesiologist who makes the ultimate decision, but more and more often doulas are permitted!
When putting together your birth plan or discussing your preferences with your care provider, always indicate that you want your doula to be there with you, no matter what your birth situation. Patients who are panicky or upset are more difficult patients, so explaining that your doula will help you to stay calm and relaxed during the procedure is a good argument for their presence.
Your doula will continue to support you as you leave the operating room and get into recovery. Even if your hospital or doctors do not allow your doula to accompany you in the OR, it’s still important to have that support as you are adjusting to the limitations of your body, learning to feed your baby and processing the birth. Doulas will continue to help you postpartum and provide you with resources that can help you process your birth experience, such as ICAN and other local support groups.
Whether you plan for a cesarean ahead of time or end up with one at the last minute, a doula’s support can make all the difference in how your birth experience goes and how you are able to process it.