Why You Need a Doula for Your Cesarean Birth
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It is Cesarean Awareness Month, and as a doula, I have supported many cesarean births (as one in three birthing people in America give birth this way). When I first started supporting birth long ago, vaginal births felt “easy” to support. It was everything I learned in my doula training. It wasn’t until my first cesarean birth that I felt outraged…irritated…disappointed…and very, very annoyed.
Did I feel these feelings because my client had a cesarean birth? No, not at all. Was I disappointed in my client? Absolutely not. I felt disappointed in the system, and I felt like the system had failed her. I asked her nurse if I could go back to the operating room with her and her response, in front of my client, was exactly this: “what’s the point of having a doula when you’re being cut open?” I felt mind-boggled and like a deer in headlights. From my perspective, my support should have continued through the entire process - because why wouldn’t it? I couldn’t think of a reason not to be there, but I also couldn’t formulate a response. While I realize she was asking a rhetorical question, I am now very prepared to answer should I ever get asked this again.
Not allowing doulas in the operating room for cesarean births gives the impression that cesarean births are undeserving of support, that this type of birth is lesser than, that if you have to change your birth plan for one reason or another, that support is useless at that point, and that once you are in the operating room, you have to forego everything you ever wanted - which I now know is the farthest thing from true. There is already a lack of prenatal education on cesarean births. In 12 hours of hospital based education, less than 30 minutes is spent on cesarean births. This is not an “out of sight, out of mind” situation when one in three people give birth in an operating room. Sending someone into this space for what should be a wonderful moment, without support, without education, and with less than three minutes of “informed consent” is absolutely asinine.
There are three types of cesarean births:
Planned: knowing in advance, prior to labor beginning that a person will need to have a cesarean (for reasons such as: medical concerns identified in pregnancy, breech babies, placenta previa, etc.)
Urgent: during labor a need for cesarean arises, but it is not an emergency which means a person can wait a few hours before prepping for the operating room (for reasons such as: cephalopelvic disproportion, stalled labor, etc.)
Emergent: during labor a need for cesarean arises, and baby needs to be born immediately for safety reasons (placental abruption, cord prolapse, fetal distress, etc.)
I feel very fortunate to now live in an area of North Carolina, where most hospitals are pro-doula. UNC Women’s Hospital has created an OR Doula program now, which allows doulas who have undergone this training to be in the operating room as an additional support person.
After supporting numerous cesareans, I realized that just being a doula wasn’t enough. I am now the Advocacy Director for the International Cesarean Awareness Network. I encourage everyone to have a look at their website (and become a member) - even if you are planning an unmedicated, home birth. Birth can take numerous twists and turns and ICAN is fantastic for education, information, and support.
Are you planning a cesarean birth? Even if you’re not, understand that if you have a cesarean, a doula is beneficial. I now know how to answer the nurse who asked me that question. Cesarean births need doula support for all the same reasons vaginal births do - for education, information, support, and advocacy. Did you know you can advocate for music and essential oils (should you choose) in the operating room? Did you know that skin to skin and delayed cord clamping are recommended and encouraged during cesarean births (assuming your baby is healthy)? Will you (or your partner) be in the right frame of mind to advocate for this alone? Even if your hospital does not allow doulas in the operating room, a doula is still beneficial for preparation before your birth and also in recovery after your birth.
Are you a doula supporting a cesarean birth? Understand that the anesthesiologist is the shot caller in the operating room. Also understand, anesthesiologists are not the most friendly. Their people skills are lacking (think about it, most of their clientele is asleep). Be kind. If your client would like to have you in the operating room, do your best to advocate for this and ensure you are talking to the right people. Know your place in this space - it is a sterile environment, and you want to be sure you are not causing more harm than good. Not allowed in the operating room for one reason or another? Deep breaths - take the time to regroup, get something to eat, and refresh yourself so you can meet your client in recovery and be ready to provide immaculate postpartum support.
And don’t forget - check out the International Cesarean Awareness Network!