When you think of a doula, what comes to mind?
Hopefully, you have a picture of a compassionate, non-judgemental, professional labor support person whose focus is on helping you through labor and delivery. You may have considered the prenatal education that many doulas offer - pointers on books, local classes, breastfeeding preparation, or whatever else interests you. Maybe you thought of how wonderful it will be to take the pressure off of your partner/spouse as your sole support during what may prove to be a physically and emotionally challenging experience. This will allow him or her to focus on the process and delight in the adventure with you in a way that only your intimate partner can. Perhaps your vision ends with a photo of happy faces clustered around you holding your baby - tired, elated, and falling in love with this new little person.
This is a wonderful image of doula support, and one that I think gives the impression of what is termed "normal" birth. That is to say, vaginal delivery. In the U.S., however, Cesarean rates have risen above 30%, which means that many women are choosing surgical delivery, or the circumstances of their pregnancy and labor are sort of choosing it for them. If a woman has contracted with a doula, planning a vaginal delivery, and the circumstances change to a Cesarean, one may wonder if or how the doula continues to be needed.
Me with clients while baby is checked by pediatricians.*
First, let's be clear: it is my belief that if a woman chooses a Cesarean, then it is necessary...for her. In the birthing community, there is an ongoing bruhaha regarding Cesareans: what's "necessary", what isn't, whether people should be allowed to elect them, whether the method is being pushed by the medical community. As a doula, what matters to me is that my client feels like she is making the best decision about how to proceed with her baby's birth, whether it is what I would choose for myself is irrelevant. I believe that women and families should have options, and that we must safeguard their right to choose what they feel is best for them. I see those options as a spectrum, with very medical on one end, and unattended childbirth ("UC") on the other. The spectrum includes all manner of things, such as epidurals, IVs, vertical birth, water birth, homebirth, elective Cesareans, birthing with the dolphins, whatever a woman feels is appropriate for the health and safety of herself and her baby.
So, first, let's look at a fairly common scenario - let's say I'm contracted with a woman who is planning a vaginal delivery at a hospital birth center. She spends early labor at home with her partner, and calls me sometime in the morning to say that they're ready for my support. I go to their home, or meet them at the birth center if they've already transferred. I massage, dance, hip-squeeze, wipe her forehead, hold hot compresses, coo, encourage, and whatever else is needed for as long as she needs it. Now it's late at night, and something has occurred that makes everyone believe that the best option is a Cesarean delivery.
Everything changes. Bright lights are turned on, mama is prepped for surgery, partner is shown how to don the surgical frock, I am told whether or not I will be allowed into the OR (ultimately it's the anesthesiologist's call). My client is wheeled away for more prep. I wait with partner, offering continued support and encouragement. Partner is escorted to the OR. I wait.
If I am allowed into the OR, I continue to offer support to my client and her partner. Now it's mainly verbal, or perhaps stroking her head to help her stay calm and relaxed. Perhaps her partner needs a lot of support in order to stay present. If baby is already out, I may be requested to go to baby or to stay with mama while partner goes to baby. I'm probably handed a camera. I move around discreetly, doing what I can to help while staying out of the way of the medical staff.
If I am not allowed in, I simply wait. I tidy up the birthing suite. I make sure that there is a cup of ice chips for when mama returns, as it may be all she's allowed for awhile and she will be thirsty. I make sure there's food and drink for partner. I go ahead and gather my labor support supplies, to help me be ready for my departure when the time comes, and to help create a clear transition between the laboring time and the "baby's here!" time.
In a non-emergency Cesarean the time from incision to baby out is about ten minutes. From baby out to mama all closed up is about 45. The post-op recovery may take place in the birthing suite (which is my experience thus far), so that's where I continue my support once mama and baby are wheeled back in. The nurses will be busy with charting, taking readings, etc. I focus on the family's well-being in other ways. Is baby nursing? How's the latch? Is mama nauseous or shaking (from the anesthesia)? How can we help her? If mama feels talkative, we might discuss the day she's had, as I check in with how she's processing the experience.
I continue to offer verbal encouragement, and physical support as needed (More pillows? Need socks back on? Want more ice chips?). My role is to be a calm, familiar presence. I offer a counter-balance to the hectic process of surgery and strange faces - they have known me for months, I was helping throughout the labor, we have a connection - this is very reassuring as the mama tries to get comfortable with a huge change of plans. In a nutshell, there is still a lot for me to do, and it isn't all that different from what I do after a vaginal deliver, when my support is less about "breathe, look at me, let is wash over you", etc. and more about becoming a non-intrusive helper to the new dyad. At some point, usually an hour or two after birth presuming initial recovery is going well, I excuse myself and go home. Just as with a vaginal delivery, I check in the next day either in person or by phone/text. I may go and visit at the hospital, I definitely plan to visit a week or so after they get home (it depends upon my availability and the family's desire).
Papa holding baby on Mama's shoulder. (Doula = photographer)
Even though the baby's transition from womb to air was different, the support I offer remains more or less the same. A doula is still a vital help to the family, no matter how they end up welcoming their baby to the world.
This is getting long, so I'll discuss elective Caesarian in my next post. Please feel free to leave any questions in the comments section!
* Pictures posted with clients' permission.
