Mothering the mother in ALL circumstances: doulas and cesareans

I recently had the opportunity to do a consultation with a mother who is considering hiring a doula for her medically necessary scheduled C-section. Being me, I fear that I might have barraged her with a garrulous deluge of overinformation, but the interest was definitely there, and a good connection was made. (It would be a new experience for me, too, so my eager enthusiasm may have added to the overload.) Hopefully she'll be able to process what we talked about in her own time, along with the folder full of printouts I gave her.

So, what ARE the advantages of having a doula present at a cesarean, especially a planned one? As I wrote in the previous post on cesareans and birth plans, isn't the whole idea to use them (plans and doulas) to avoid having cesareans in the first place?

Yes and no. It's true that a woman seeking a natural or minimally interventive childbirth is doing herself a great favor by seeking out doula support. But A) There are, of course, rare times when complications can arise, even in a well-supported normal birth, and a cesarean truly is a lifesaving situation. Should the doula pack her bags and take off at that point? Of course not. She probably will not be allowed in the OR if the father is present, but there are other ways she can continue to be of great service, as I'll discuss in a moment.

And B) On a broader note, doulas are there to enhance ALL birth experiences for all women, and priority one is to support mom's own choices, helping her to achieve her own goals. The mission statement for doulas is often summarized as, simply, "mothering the mother". Yes, of course we do everything we can, within reason and within mom's parameters, to help her avoid a cesarean if she doesn't want one (and most women hiring doulas obviously don't), but we are not just vaginal-exit-only cheerleaders. This seems more obviously logical if the need for a c-section arises out of a spontaneous labor, but though it's rarer, there's no reason a doula would not be valuable, in some different ways as well as some very much identical ways.

So, then, what are some of the specific things a doula can provide to a mother having a cesarean? Let's say for the sake of argument that this needs to be a scheduled event (though much of it applies regardless). I would say there are three primary advantages to having a doula in this situation.

First of all, a doula can help the mother develop a birth plan that makes the absolute most out of the situation. The choices will have to be approved by the doctor and hospital, of course, but as I wrote in my post on c-section birth plans, there are actually a multitude of choices to be made. Some of those choices may be brought up by your doctor, but many others may not - they might even be new to him or her, and there are good doctors out there who are willing to try new things and learn and grow in their practice. Check out that post for a detailed discussion of the options available. The same doula can educate the parents about the whole overall process as well, if their doctor isn't able to take as much time explaining things as they'd like.

Secondly, it is a truth that more babies born via cesarean may have to spend some time in the NICU. Should that happen, typically the father will go with the baby - leaving mom alone and unsupported. The delivery of the baby, once everyone is prepped and ready, only takes a few minutes (5-15, depending on circumstances), but putting mom back together again takes significantly longer, generally 45 minutes to an hour, and that's assuming there are no complications. This can be a very difficult time for mom if her baby has been taken away, and having the doula step in for emotional support and companionship can make a huge difference.

The third major advantage is helping to get breastfeeding established. This is more challenging for moms in terms of positioning, even for experienced mothers with existing children, and can be particularly confounding for a first-time mom who is learning to nurse for the first time. Milk can also take a bit longer to come in (remember, though, 3 to 5 days is perfectly normal), and sometimes cesarean babies can be sleepy due to medication. If the baby is having to stay in the NICU, a doula can help mom to get pumping right away, establishing her supply and providing the baby with the best possible nourishment for him or her. All of these extra challenges are much easier to face with doula support.

Now, there are definitely some L&D nurses who are very good with breastfeeding, but, it must be said, there are sadly some who are not. Many a breastfeeding relationship has been sabotaged by hospital practices, even with an uncomplicated vaginal birth. And even the nurses who are good can be in short supply if you happen to be there on a particularly busy day. Same goes for actual lactation consultants. Some hospitals have them, but availability (and quality, too) can be limited.

Those, as I said, are the big ones. There are a lot of other little things that a doula can help with along the way - guiding both mom and dad through the admissions process; helping mom relax during the prep for surgery, including the epidural or spinal (a big fear for a lot of women); taking pictures as much as is desired and possible; keeping communication going between parents if they are separated by a NICU stay, and keeping mom up-to-date on baby's status; establishing skin-to-skin contact as soon as possible, which can be difficult if mom is having trouble with uncontrollable shaking from the anesthesia; running interference with relatives if needed, even running errands for the parents.

But hold on here, are you even allowed to have a doula in the operating room? In some cases, no. If the need for one arises during labor, it's true that it is very unlikely that a second support person will be allowed, though the doula can be standing by should dad have a hard time with the procedure or become ill or pass out - rare, but it does happen. (The other advantages of doula support still remain.) But if it is a scheduled cesarean, it is possible that special arrangements can be made in advance. As doula Rachel Wickersham explains:

Though it is possible your caregiver may initially be resistant to the idea of a doula in surgery with you and your partner, you may be able to convince him or her of the possible benefits to you - especially if you work with a doula who attended at least a few. And this may not be as far fetched as it may seem. I know of at least one practice in which there are doulas who specialize in cesarean.

I came across one mother's story of how invaluable her doula Shelly was for her own cesarean birth at Fort Wayne Doula Network. After attempts to turn Alison's breech baby via external version were unsuccessful, the family reluctantly decided to proceed with a C-section.

Shelly was very sympathetic and reassuring to us both. Mostly without words. Which we appreciated. She and Doug left the room while they prepped me for surgery. When they came back we made sure Shelly had her camera. Although we cried through the c-section a little it was very exciting too.

From the moment they got the baby's little bottom out Shelly started snapping pictures and showing them to me so I felt more a part of what was going on instead of so disconnected. It was great to have Doug and Shelly there so one person could be with me and one with the baby at all times until I joined him in the recovery room. She also unlatched my arm to touch the baby better after my pitiful attempts to stroke his little head while restrained for the surgery.


Shelly was intregal in getting me nursing the baby within 40 minutes of birth (not bad for a c-section!) She continued "nursing" Doug back to health a little bit by getting him what he needed and also helping out so he could get to the post partem room to rest for a bit. I was wheeled to my room with my sweet baby latched on and nursing like a pro!

Once we were settled in our room for a little bit Shelly asked if it would be ok timing for her to slip out for a bite to eat and to develop the pictures. When she returned she had an album of all the pictures she'd taken. I cried as I flipped through them... I would continue flipping through them MANY times over the next few weeks until I had memorized them so it actually felt like my memories instead of the actual memories I had of trying so hard to see everything and be a part of it while my baby was so far away at the little bassinet as they measured and treated him (the whole time he's just wailing for Mama)

I can't describe how much it meant having Shelly there. I am trying to in this email, and I tried to when I wrote her a thank you note after coming home from the hospital. But she was much more than a doula to me that day. She was a mother figure that I so needed. She filled that role when I needed it most. She was concerned for me and excited for me and I felt as if I'd always known her. She was truly the only advocate I really felt I had that day with me. My midwife was not able to be there during the c-section, and Doug was still kind of coming around and trying to get to feeling better himself. It was a very emotional day- but thanks to Shelly and her support the deliriously joyful emotions outweighed the negative. I had a happy, healthy (Big) boy and was well cared for with my medical needs.

Shelly helped give me memories by taking pictures of what I otherwise would not have seen. I can't tell you the value of that. It's priceless. I wonder if a doula isn't maybe even more needed w/ a c-section than a normal labor/birth- for the emotional side of it anyway. Even though it's such a shorter period of time. I guess everyone's experience is different. Shelly helped make the overtones of the day very happy. I just don't know how many different ways I can say it.

Two other great pieces I've found online do a great job of explaining the value of doulas with C-sections: Doula for a Cesarean Birth, by Robin Elise Weiss and the aforementioned "Is it worth hiring a doula if I'm going to have a C-section? by Rachel Wickersham.

Did a doula help you during your C-section? Have you been a doula at cesarean births? Please share your stories!

UPDATE: Make sure you check out the video about the "Natural Cesarean", a piece that began circulating after this post was originally published. The demand for this approach definitely seems to be growing!