Approximately one-third of all births in the United States will occur by cesarean section. Some of these surgeries will be the unplanned culmination of unexpected circumstances. Other c-sections will be scheduled due to personal choices or medical reasons. No matter the situation, a family experiencing a cesarean birth will need solid, unwavering support as they process the questions and strong emotions that come with birth. For some, that support is best provided by a trained doula.
Wait, you can have a doula at a c-section? Indeed, you can! While the public often associates professional doula support with natural childbirth, the well-trained, nonjudgmental support of a doula can be especially helpful in the uncertainty that may come with a cesarean birth. While some hospitals may still preclude doulas from the operating room, policies around the country are slowly changing to recognize and encourage doula support before, during, and after surgery.
Katy Rank Lev, a Pittsburgh mother of three young sons, hoped for a vaginal birth for each of her children. Each birth ended in the cesarean delivery of a healthy baby boy. Katy had the professional support of a doula—a decision that proved valuable. Her doula took photos, explained steps that were being taken, and helped position and support the baby as Katy breastfed for the first time after surgery. Katy recalls, “My doula did small things that made a great difference, such as dabbing a nice smelling oil under my nose when I was upset at the smell of the cautering iron. These are all things my husband would never have known how to address, and he was able to focus just on supporting me and meeting our son.”
A doula can have a remarkable impact on a birth by cesarean. Even before the big day, a doula will be serving her client as a source of information and encouragement during the pregnancy. Once a contract is signed, a doula is available (in many cases, around the clock) to field questions and share words of support. She can help guide a client’s research in preparation for birth, and she can encourage good communication between the client and the client’s medical provider. On the day of the birth, the doula will fulfill her usual role by working to create a peaceful, relaxed environment. If the birthing parent is laboring, the doula will provide physical comfort measures and emotional care. She will be a source of information if labor is in progress or if the cesearean procedure is planned. In the moments before the c-section—whether it is the longer preparation before a scheduled surgery, or the quick moments before an urgent procedure—the doula can bring calm to the room. She can coach the mother and her partner in slow, calming breathing while listening attentively to any concerns. She can create a positive atmosphere with laughter and affirmative words, and she can give attention to the small details that will make the birthing family comfortable.
In terms of a doula’s place in the operating room, policies vary from one hospital to another and among different providers. When a doula is permitted to accompany a client and partner into the OR, the doula can come alongside the birth partner with information, encouragement, and commentary on the procedure. Katy remembers, “[My doula] was able to tell us what was happening….while everyone else was busy taking care of me during the surgery.”
A doula can be a positive distraction if the mother is feeling anxious. She can also be a great reassurance to the birth partner. In very practical terms, the doula can take photos, provide a cool cloth, reinforce breathing techniques, and help the mother hold or simply kiss the new baby. The initial moments after the birth can be a little awkward as the effects of anesthesia can make handling the baby difficult or impossible. The doula can help make these first encounters between parent and child smooth and beautiful.
If additional care is needed and the baby must be moved to the nursery or neonatal intensive care unit, birth partners often struggle with where they should be and how they should help. When a doula has been employed, the mother and her partner may feel more secure knowing that the birth partner can remain with baby while the doula continues to support the mother in recovery.
Early breastfeeding can be challenging after a cesarean, but with support and good positioning, breastfeeding can be accomplished. A trained doula will know which positions facilitate comfortable breastfeeding after a c-section. Katy certainly appreciated breastfeeding support from her doula. She acknowledges, “After the surgery, my doula helped me to hold my baby in place so I could begin breastfeeding as soon as possible. I was a seasoned pro at nursing by the third baby, but still didn't have full use of my arms [due to anesthesia], so she helped my husband to position my baby and help me to hold my breast.”
“I would definitely recommend a doula,” Katy continues, “no matter what type of birth you are attempting. [Our doula] was an invaluable comfort and presence for me each time.”