Doulas – Not Just for Vaginal Births

No matter how it should be, the fact is that 1 in 3 women birthing in the U.S. births by cesarean. There is a common misconception that you don’t need a doula if you’re planning to birth by cesarean. Whether you are excited, terrified, or even angry about your cesarean birth, you deserve to know that doulas still play an important role in cesarean births.

Doulas and a birth by cesarean – do they really make a difference?

A doula can play a valuable role for expectant families who have a birth by cesarean, whether scheduled or unplanned. A doula help you plan for a cesarean birth. We also provide continuous support before, during (if allowed by your medical provider), and after your surgery. There are many things that we can do to make it the most positive cesarean birth experience possible, keeping intact as many elements of your birth plan as possible.

We help you before you go to the hospital

You may have always known you would birth by cesarean. Or this may be a complete shock. You may be feeling fear, anger, inadequacy, joy, excitement at the news you will birth by cesarean.

You may need someone safe to process your emotions with. Doulas are trained on reflective listening and holding the space while you work through your emotions.

If you had a birth plan for a vaginal delivery, we can recommend ways to tailor that to a cesarean birth.

It is becoming more common for things like delayed cord clamping (waiting for at least 1 minute after birth to cut the umbilical cord) to be allowed in the O.R.

We can also add things to your birth plan that are specific to birth by cesarean.

Using a clear drape instead of a blue one so you and your partner can see the birth of your child. Some hospitals even have drapes with holes cut in them so parents can do skin-to-skin (placing baby on mom’s chest right after birth) without baby ever leaving the operating table. Check out these awesome photos of families who have been able to do skin-to-skin in the O.R. Even if they will not allow skin-to-skin, we can help you make it clear you want your baby to remain in the room with you and we can assist you or your partner with this in the recovery room.

Last, we can help you think of “ways to set the mood”.

You might not think you need to add things like, “During our birth by cesarean, we would not like our providers to discuss matters unrelated to our birth.” As a pregnant person, this may seem obvious. You don’t want your providers chatting about other patients, their weekend plans, or the last time their kids drove them crazy. But sometimes when your surgery is going well, your provider is relaxed and might absentmindedly small talk with co-workers in the O.R. This may seem harmless, but it can feel like you are giving birth at an office watercooler.

This is your one chance to birth this baby; you’re not unreasonable to ask that the focus be on that.

Whether these things can happen varies by your provider, your hospital, and the reason for your cesarean birth. You are more likely to get to snuggle your infant after a cesarean for done for conditions related to the parent’s body (like placenta previa or many previous cesarean births), and less likely after a cesarean for done for conditions related to your baby (like drops in your baby’s heart rate or intrauterine growth restriction). But even if the birth by cesarean was done for baby, these things still might happen if she is doing well after they evaluate her.

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We also support you on your baby’s birthday.

Your doula can meet you at the hospital prior to your surgery. You will have many new people to meet, including your nurse, anesthesiologist, O.R. staff, and any medical students or residents that will be present during your birth. This can heighten the anxiety felt by you and your partner.

Your doula is a familiar face.

Your morning will include some combination of a history, physical exam, IV placement, consent forms and ultrasound. Your doula has been present for the pre-operation routine before and can help ease your tension by keeping a steady, calming presence. We can act as a sounding board for your fears or concerns and help you relax by providing pre-operative massage or relaxation exercises. We can help set the mood as a calm celebration of your birth instead of a birth factory. If you have a planned birth by cesarean, your doula can even train your support person ahead of time, just in case your doula can’t go back to the O.R. with you. You may not have wanted a cesarean birth, but we will help you “own it” so you can still look back fondly on your delivery.

The easiest answer on whether a doula can join a client during her birth by cesarean is: it depends. We personally would love to be in the operating room (O.R.) during your cesarean birth. There appears to be a lot of variation not only by hospital but also by provider on whether this is something they allow. We recommend asking your medical provider about this during your third trimester prenatal appointments, before you're in labor!

Sometimes the doctor or midwife agrees that a doula can go back to the operating room but the anesthesiologist doesn’t agree. This is likely logistical – the support people tend to sit by the client’s head (where the anesthesiologist is doing his or her work) not by her belly (where the OB/GYN is doing his or her work).

Due to this, they often say only one support person can come back to the O.R. This is difficult on parents because, politically, they may feel like they should choose their partner (after all, this is the birth of their child, too!). But the client might actually want to choose the doula because “she’s been there before” and may know better how to help the client during the surgical birth.

Having to make this choice places an unnecessary hardship on parents. It is up to the client to advocate for her doula to be with her for a cesarean birth!

I can ask every person who comes in, but they don’t work for me. They work for you! Your statement that a doula would let you have a better experience might make all the difference on whether your provider allows it.

If your provider does allow your doula to join you, we can be a great asset in the operating room.

We can continue to reassure you that you are supported and cared for. You will be numb from the waist down but we can gently massage your scalp or hand. We can continue relaxation and breathing exercises. If you would like, we can walk you through the procedure as it happens so you feel connected to your birth. If your hospital and provider allow, we can take photos of your birth and of you and your partner. We do not speak for our patients, but our calm presence and attitude towards celebrating your birth can be a reminder to the staff that you are awake, present, and involved in this process. If you can do skin-to-skin, we can help arrange baby on your chest or your partner’s chest in the O.R. If you’re not able to, your partner may go to the infant warmer to see and take photos of your new baby. We will stay with you to ensure you never feel abandoned or forgotten during your surgical birth.

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We can help after your birth by cesarean.

How you feel after your surgery will depend on many individual factors. But, it is safe to say you will be sore and probably somewhat groggy. You may need additional, hands-on help with beginning breastfeeding or finding a position to nurse your baby that doesn’t hurt your incision. A doula can help you and your partner with post-op positioning and latching. We can assist with creating a good environment in recovery and in your postpartum room so you recovery gently.

We also provide postpartum support.

Personally, when a client has planned cesarean and we know we will not spend time assisting her with labor, we offer two postpartum visits instead of one. We can also be hired as postpartum doulas for additional support after delivery. If we were able to go back to the O.R. with you, we might be more likely to remember the details than you partner because we were less overwhelmed by the unfamiliar sights, sounds, and smells. We can hold space while you emotionally debrief from your birth experience. Last, we can direct you to additional resources like the International Cesarean Awareness Network (ICAN) or local support groups.

This article is a helpful resource as well.

We hope you will agree with us that all families can benefit from a doula, whether they plan the most unmedicated birth or a birth by cesarean. Now, join us in spreading news so that one-third of women no longer go unsupported!