It’s a commonly held belief that there is no point having a doula if you are having a planned cesarean, and I want to debunk this myth.
I too, once believed that I couldn’t justify charging to support a woman who was having a planned caesarean.
There would be no on call period, no phone call in the middle of the night, no unpredictable length of birth care.
Or would there?
Last year I got called unexpectedly (as I was busy packing the car for a week end away) by a client, pregnant with twins, who was only in the 32nd week of her pregnancy. She said “they are taking them out now”. I abandoned my week end plans and made it to the hospital with 15 min to spare.
I was also called by a woman who unexpectedly found that they were moving her cesarean a week earlier. She asked if I could come to the hospital immediately.
I have also been hired just to cover the on call period for a mother planning a cesarean, just in case she would go into labour before the scheduled date.
I have worked as a doula for 7 years, and having supported several planned cesareans births, I’ve learnt that there isn’t such a thing as predictability, and also that doula support can be just as needed, just as useful as it is for a planned vaginal birth.
I’ve learnt that, as every woman who births vaginally has her own set of individual needs, so do women who are having a planned cesarean birth.
So, if you are having a planned cesarean birth, you can benefit from the exact same support you get from your doula as you would if you were hiring her for a planned vaginal birth.
Doula support, as beautifully coined by Maddie McMahon, is a three legged stool of support, emotional, practical and informational support.
This support applies regardless of the way your baby is born.
So what can a doula do to help you before, during and after a planned cesarean?
When you are having a planned cesarean ,there are still many aspects of what will happen before, during and after the birth to think about.
Having someone at your side who knows the hospital system in and out and how to navigate it, and help you push for what’s important for you, is very valuable.
It is very much like going to a restaurant : you need know everything that’s on the menu to make your choice. If you’re a vegetarian and I only offer you meat stew this isn’t a great option for you isn’t it?
I once supported a friend who was very keen on having what is known as a gentle cesarean. Her local hospital completely refused to support her choices, so I suggested she might want to try another more supportive hospital. I pointed out that, as she was having a planned cesarean birth, she could go where she wanted. She ended up finding the perfect hospital and obstetrician and having a beautiful and empowering birth.
Sometimes, women who prefer to have a planned cesarean for all sorts of very valid reasons, can find themselves having a battle on their hands to get this choice respected. Having a doula on your side to help you navigate your rights can be invaluable in this situation too.
So knowing all the options and having help navigating them and knowing how to get what you want is what having a doula is all about.
A doula can also help prepare you emotionally for what is going to happen which can help you feel more in control.
She can help you plan for your recovery after the surgery and how best to manage life with a new baby post cesarean.
She can help you access a whole network of medical and complementary practitioners too.
Alex Heath, doula
“Doulas definitely help clients to negotiate an elective cesarean in the first place. Using knowledge of hospital pathways, language and mindset to support them in asking for an elective cesarean if that’s what they want…”
Pippa Moss, doula
“Helping with any preferences/alternative birth plan. Letting their clients know there are “gentle” cesarean options they may not know about, optimal cord clamping, gown on back to front to facilitate skin to skin etc. Calming nerves before surgery”
Kristina McKeown, doula
“Being aware that as a doula you may be one of few people fully supporting them in their choice. There still a lot of judgement in choosing a cesarean birth and just having someone to talk that through can be really helpful.”
Ceci Goldaracena, doula
“My client was booked for a elective cesarean. “Past Due date” and with a preview cesarean. She could not have an induction. We worked a lot in the birth plan for a gentle cesarean. Went together to hospital that morning and started to work in keeping oxytocin and happiness in high levels. Turns out that after a couple of hours when the medical team was ready they did a last monitor and she was having labour contractions. We asked to stop the A plan. Lots of walks , stairs,dancing and laugh…baby was born that night naturally.”
On the day-waiting for the cesarean
When you get scheduled for a cesarean birth, you get told to come to the hospital at a certain time, without having eaten any food. It is not uncommon for the wait to be longer than expected-because emergency cesareans can take priority, so having a doula at your side whilst you wait can help you stay as calm and relaxed as possible whilst you wait.
Sarah Budden, doula
“My role was all about the before. I spent 5 hours pre surgery distracting – playing cards, talking about Homes under the hammer, looking at pictures of their first born, getting dad involved in some foot massaging. She was scared. I was there to make the wait less intense, to stop her legs from shaking and discharge some adrenalin.”
During the cesarean
Having a doula there means that there is a familiar, friendly face to keep you calm in theatre. Your doula can hold you whilst they place the spinal anesthesia. She can hold your hand during the surgery. The birth itself is usually quite quick, but the longest part is the stitching afterwards. Is you are having your baby skin to skin in theatre she can help facilitate this too, and even help you to feed your baby then if you wish to do so.
Most hospitals have a one partner policy only, however hospital policies are only guidelines and should be adapted to the need of the birthing family.
I have been present in theatre with a couple.
I have also been present with the mother when there was no partner, and I have been present with the mother when it felt like the right choice for a couple (for example when the father felt uncomfortable being in theatre, or when the father needed to stay at home to look after other children).
Nicola Collins, doula
“I supported an elective as one of my first births and it was so calm and beautiful. I helped with putting birth preferences together and going to appointments. Worked through any worries and concerns she had before the birth. On the day she was fourth down and we just chatted and laughed and I reassured her and reminded her of the golden thread breath when she was a little anxious. She had a bit of a tricky start as couldn’t get the spinal working properly for 40mins and all I could be was a voice of reassurance and give her my support. Finally got going and section went great and I just kept talking to her and keeping her informed about what was happening. Then I got to take photos of the baby being lifted out which was amazing and then mama got skin to skin straight away and even baby had latched on just before we left theatre. Back in ward, I helped with anything that mum needed. Breastfeeding support, got her food and drink. Called her parents and kept them updated. Let her have a little rest and just sat with her while she slept”
Claire Walker, mother
“When I got pregnant with my twins I knew I would have a planned c-section due to an emergency c-section with my first daughter. I had no hesitation in hiring a doula as the emotional support on the day was what kept me calm and relaxed as I could be. Having someone that is just there to support you before and after who will listen and comfort you is priceless.
My twins were born 8 weeks early so had to go straight to NICU. I wanted my partner to go with them as I didn’t want them to be alone and also to make sure our wishes for them where kept. I also didn’t want to be left alone in the theatre so asked for my doula to be around in when my partner left. This really helped me to stay calm as I knew my babies had dad with them and I also had someone to support me as it can be very lonely even in a theatre full of doctors and nurses. Having someone to talk to and hold my hand stopped me panicking. It also meant that when I was taken to recovery I wasn’t by myself. It was very hard being wheeled past other mothers with their babies, I don’t think I would of have coped if I didn’t have my doula with me. She also helped me hand express my colostrum into syringes. Just having someone with my while my partner was with the babies was amazing, she kept me calm just by being by my side and holding my hand.”
Nuria Pozas, doula, from her client
“Nuria who accompanied me was very helpful, caring and professional. Even though I had a cesarean she helped me all the way through specially with my fear and later on with my emotion. She was also a great support after the birth and gave me useful advice regarding to breastfeeding and newborn baby.”
“I had planned a home birth but knew if my labour was anything less than ‘perfect’, I would need another c-section, so the presence of a doula was necessary (no other support was possible as both our families are far away). There was meconium in my trickling waters so I was sent to the hospital. There was no question about it – my doula, who had been with me since 2h after labour started, came with me (my husband stayed at home to be with our first daughter) and it was the most amazing experience because, unlike my husband, my doula wasn’t squeamish (obviously!) so I asked for the drape to be lowered and saw my baby come out. I didn’t have to keep chatting to my doula to prevent her from fainting, as I had done with my husband with our first daughter. She took pictures and films. Having a doula was a no-brainer in pregnancy, and it was the best decision ever considering how my birth panned out 🙂
“My decision to seek the support of a doula was driven by the fact that I wanted a vbac in the face of a number of “risk factors” and to help me navigate and to support me through a medically complex pregnancy. The anomaly scan revealed that my son would be born with a complex health condition. After the diagnosis, my pregnancy became enormously stressful, requiring regular monitoring and checks, and involving the healthcare professionals who would be involved in my son’s postnatal care strongly advocating a range of birth interventions that I had always intended to avoid. In the final month leading up to the birth, we came across more complications, which led to me reluctantly deciding that an elective cesarean birth was the safest mode of arrival for both me and my baby. My birth doula was incredible. She helped me research my “risk factors” and the options open to me, knowing how important to me it was that my birth choices were well informed. I felt empowered and heard out, and although I was sad to abandon my vbac plans, with her help I felt at peace with my decision.”
Immediately after the cesarean
In the recovery room, your doula can help support you to to feel comfortable, look after you and help you to feed your baby. You will be having cannula in your hand still, and be hooked to equipment like fluid delivery, blood pressure monitors etc which can make handling a newborn a little trickier.
If your baby has to go to the NICU (which can be more common with elective cesareans as they often occur earlier in pregnancy), then your partner can go with the baby, and this means that you aren’t alone in recovery. In this situation, your doula can also help support you to express colostrum to feed your baby.
Recovery nurses will look after your vitals etc, but they won’t stay with you every minute of the few hours post surgery, and they won’t be a familiar face, someone you know and feel safe with. Your doula’s presence can help you feel more comfortable and safer. I have had women hiring me for this reason alone.
Bryony Vickers, doula
“Calming nerves after surgery. Having someone to sit with you in a dedicated way after you have had surgery is invaluable. I think women forget that they can feel not great after surgery. We can help to hold the baby, get skin to skin, help other parent with learning baby care – dressing, nappies, holding etc. Helping with getting food, drinks, with knowing what is normal, what will happen next.”
Jo McCracken, doula
“I was touched once when a client of mine had to have a section and, once she was in recovery, she did nothing but moan for me to be there. Finally a midwife came to get me and said, ‘We need you in recovery. She won’t listen to any of us’. When I arrived, she burst into tears and said, ‘thank goodness you are here now’. So, maybe, calming nerves after surgery too.”
On the day, we knew that only one birth partner would be able to accompany me into the theatre. Nonetheless, my doula was waiting for us in the lobby at the crack of dawn. Her presence helped to diffuse and lighten the atmosphere. I was nervously anticipating and looking forward to the birth rather than dreading it. Knowing what was really important to me, she was able to prompt discussions on the day. It had previously been agreed that my newborn would be taken away to nicu. We agreed that my partner would accompany him. The team agreed that my doula could enter once my partner left to take his place and to keep me company. She remained with me in recovery when I otherwise would have been left alone. She maintained contact with my partner and gave me regular updates on how my baby was getting on. She advocated for me with the midwives in recovery, passed me drink and food, talked to me, made me laugh. Having my birth doula made my pregnancy and my caesarean birth a very positive experience, despite it being complex, stressful, and not what I had wanted it to be, and I am completely convinced that it would not have been so positive if it wasn’t for her wonderful support and friendship.
In the postnatal ward
A few hours after the birth, once your vitals have stabilised, you will be transferred to the postnatal ward, where you will stay usually a minimum of 24h or so.
Postnatal wards are often understaffed, especially at night, and it can feel very frustrating if your baby is crying and you can’t pick her up (you’re still immobile due to the spinal or epidural anaesthesia for a few hours), and if you ring the bell, it can take a while for someone to come.
Having a doula supporting you there means that someone can help you with simple tasks like getting you a drink or a snack, passing your baby to you, changing your baby’s nappy, helping with feeding, and generally making sure you are comfortable.
Sometimes the partner can do this, but sometimes the woman has no partner, or the partner may need a rest, or need to go home to look after other children etc, so having a doula there means that you won’t be alone whilst you cannot move whilst the spinal or epidural wears off. It also means that someone can be there to support you whilst you take your first wobbly steps or have your first shower.
If you end up staying in the postnatal ward for a few days, then having a doula can also mean that someone can give your partner a much needed break, that your doula can hold your baby whilst you have a nap, or even bring you some much needed home cooked food.
After the cesarean-at home
When you get home, your doula can help you with settling in at home with your new baby (or babies!), helping you with feeding, with finding positions that feel comfortable to do so (feeding lying down can be a godsend for some post cesarean mums), and generally being a much needed extra pair of hands around the house, so you can rest, get to know your baby, and recover from the surgery.
I have supported many mothers post cesarean, both as a birth and as a postnatal doula. This has taught me that, similarly to a vaginal birth, everybody’s experience of recovery is very widely varied. I have seen mums bounce around 3 days for cesarean looking pink and healthy, and also at the other end of the spectrum, mums having issues with retained placentas and/or scar infections which meant that their recovery journey was long and protracted.
Partners usually only get a couple of week’s parental leave, and post cesarean mums are more likely to need antibiotics and have a longer stay in the hospital. On many occasions I have seen mums stay in the hospital for 3 to 5 days, so by the time they got home their partner only had about a week’s leave left. It can feel very scary indeed to be alone at home with a new baby when you are not only recovering from surgery, learning to look after a new baby, but also are more limited in your ability to get around (I’ve seen mums who lived in a remote areas getting very lonely as they couldn’t drive their cars for several weeks).
Ultimately no new mum should ever be alone coping by herself in the first few weeks post birth, she needs a community around her to support her, and this is even more true for post cesarean mums.
Kate wilson, mother
Our doula, Candie, provided us with a huge amount of support both before and after the birth. She was with us in recovery and helped us to initiate breast feeding – which was so important after a traumatic experience with our first child. She then visited us at home and provided lots of support in helping us to adjust to life as a family of four. She supported me with breast feeding as Charlie had a tongue tie, she played with my older children and made sure I rested.”
Georgia Wakins, doula
“I supported a third time mum after a cesearean recently and there were lots of practical things I could help with for all three kids, but the most satisfying thing was the blissed out expression she had after I gave her a back and shoulder massage. The oxytocin and endorphins released with physical touch can be amazing for post-op discomfort, just like for labour.”
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