Thursday, February 17, 2011

A Doula for Your Cesarean Section

Yesterday I had an extremely awkward conversation with my pregnant professor. It was one of those moments where I maybe should have kept my mouth shut, and refrained from spewing the birth-related word vomit all over someone who didn't ask for it. It happens! Especially when the topic of elective cesarean sections come up.

An elective cesarean section is one that is schedule ahead of time by the doctor and mother.

Reasons for this are:
1. suspected macrosomia (big baby)
2. mother and doctor want the convenience of picking the date and time of delivery
3. mother is tired of being pregnant
4. mother is "overdue"
5. baby is breech
6. medical conditions for the mother (hypertension, etc)
7. medical conditions for the baby (suspected deformity, etc)

Birth workers get very touchy when the idea of an elective cesarean section comes up if it is not for reason 6 or 7, above. The first 5 reasons (with some grey areas, like going past 42 weeks) generally create more dangers for mom and baby when compared with spontaneous vaginal labor and delivery.

Having a Cesarean before labor begins on its own increases the chance that a baby will be born premature (as due dates are merely estimates and can be wrong, and ultrasounds in the third trimester are known to be off by up to 3 weeks and 2 pounds). Premature and low birth weight infants, especially those born by cesarean section, have respiratory and sucking problems and spend more time on the ventilator and in the NICU. They also cost billions of dollars in health  care.

When cesarean is elective with no emergency present, the woman's chance of dying from the procedure it self is nearly three times that of a vaginal birth. Moreover, the mother has a much longer recovery period from the major abdominal surgery, which makes caring for her newborn much harder.

When an elective cesarean section occurs for a medical reason, such as fear of uterine rupture (after considering VBAC!), one can still create a Cesarean Birth Plan and Bring a Doula!


Yes, thats right, A DOULA CAN HELP YOU WITH YOUR PLANNED CESAREAN SECTION.
Which is what my birth-related word vomit was all about yesterday - the support a doula can provide for a mom and her partner during a cesarean section.

Informational Support
For a planned or even the possibility of an emergency c-section, a doula can provide a ton of informational support. The biggest of which is helping you to create a cesarean birth plan. How can I plan for a surgery in which I will play little to no part? you might ask. Many people do not know that they have many options and a doula can inform you of these.

Would you like to specify a double suture as opposed to a single suture? Or have your urinary catheter placed after your spinal epidural? 
Would you prefer that the surgeons keep the chit-chat to a minimum? (I have heard stories of women lying there scared and uncomfortable while the doctors and nurses talk about things completely unrelated to the procedure)
Would you prefer that your baby be brought to you (if baby is healthy) as opposed to immediately placed on the warmer?
For more help with cesarean birth plan options, see this post (or talk to a doula! :)

Additionally, a doula can help you and your partner know what to expect with a cesarean section, and also inform you of the newborn options that you are allowed to decline if you wish, and so on.


Emotional Support
The doula can help allay fears before, during and after the surgery. If you are disappointed that you have to have a cesarean section rather than a vaginal birth, the doula is there to discuss your feelings with you and your partner She can help you practice relaxation techniques, and talk to you during the procedure to keep you calm. She can help keep partners calm, especially during prep time, so that they are effective support for mom as well. She can still be your advocate in the ER - remind the surgeons to please describe, or not describe, the procedures as they are doing them, that mom would like to do skin-to-skin as soon after birth as possible, etc.

After the birth, the doula is there for you while you process your feelings about the birth. While in the recovery room, the postpartum room or at home, its great for moms to have someone to talk to. She can recommend resources like ICAN and other support groups.


Physical Support
Just having someone else there can be a bigger help than is realized. If dad wants to photograph and touch his baby while the baby is in the warmer, the mother is left alone on the surgery table. If the baby must go immediately to the NICU, and dad goes with the baby, the mother is also left alone. This can be a scary time to be alone - the procedure continues for around 45 more minutes as the surgeons suture you back up, and you continue to feel discomfort and concern for your baby. The doula can stay by your side throughout all of this, if the obstetrician allows. This varies from doctor to doctor and must be discussed ahead of time.

The doula can also help with breastfeeding after birth. This is no small feat after having abdominal surgery! The doula can help you figure out how to hold the baby and get the baby to latch, in addition to all the regular breastfeeding support typically provided postpartum.


You will be surprised how much having this kind of support can really help with your recovery!

photo: doula network of fort wayne, which also has on their webpage a story written by a mom who was glad she had a doula at her cesarean section!

So, who knows if I positively informed my professor, and helped her consider the support a doula can provide even for a c-section, or if I just annoyed her with unsolicited advice. Its a fine line we walk sometimes!

6 comments:

  1. I had a doula for my 2nd cesarean (it was unplanned, emergency - we had been working towards a vbac, but baby came very early in distress). She was VERy helpful in the hospital - as the go-between. She helped clarify "policy" vs preference, helped make my NEEDS known - like having baby brought to my chest immediately, not put in a warmer, and making certain baby wasn't given formula or a paci, and didn't get separated from us. Having a cesarean is hardly the "easy" way out of birth - in fact, it presents a lot of challenges not present in vaginal births; particularly afterwards, with pain meds, pain, difficulty walking/holding baby, longer recovery time, etc. Doulas should support all moms in birth & post partum - cesarean moms too.

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  2. Awesome. There's a blog about c-section support here too: http://dynamicdoula.blogspot.com/2010/11/c-section-and-doula-support.html

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  3. thank you, Kelly, for contributing your story! :)

    And thanks Alexandra, I love the blog post you shared. Very informative!

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  4. Up here in Canada, it's tough for a doula to get to be in the OR with the client. Most OBs do not allow the doula to attend. I was recently at an unplanned cesarean section with my client, and waited for her in the recovery room. She had become very panicked/clausterphobic in the OR and was shaking uncontrollably. While the nurses were busy taking her blood pressure and checking the stiches, I got the baby on her breast by holding her up for her. Mom immediately calmed down and stopped shaking as soon as baby latched on. We also spent a lot of time discussing the birth and she needed quite a bit of emotional support after such a scary experience. I think doulas can be a big help!

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  5. I had a doula for my first birth and had a horrible experience. She was unprofessional (texting at the foot of my bed). She provided more stress on me and my family than help. She was ill-informed about what I was going through. (I opted for a natural birth that ended up in a c-section due to the baby's positioning) I am pregnant again and am opting to follow the advice of medical professionals. I briefly considered a vbac and a doula, but decided against it. Also, I have been successfully breastfeeding my child for 2 years and plan on doing the same for our new baby.

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  6. This is fantastic! I have been atteding more planned c-sections this year and finding new and important ways to support women through the experiences. This article is a great resource to send to clients who may not understand what a birth doula can offer them, but know they want more support. Thank you! Sarah, www.sagemamadoula.com

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