Doula Care for a C-section

C-Section Doula Care

Is a Doula a useful member of the team for a cesarean birth?

There is no other major surgery of it's kind where you will be handed a newborn baby immediately afterwards and expected to care for it, and there are very few other major surgeries where you will be wide-awake and fully conscious of what is taking place.

A c-section is a very remarkable and sometimes overwhelming experience for both the mother and the father, so having a familiar, caring presence with you during surgery can offer immense relief to both parents. While many medical professionals question the need for doula support during an elective c-section, for the reasons already stated above it becomes somewhat of a “no brainer” to have a Doula present.

When an unscheduled (aka “emergency”) c-section becomes necessary, the mother may still have some time during which she is required to continue coping with a difficult labour and so a doula is able to keep her going until pain relief can be administered. The pre-admission area can also be quite busy and add to the stress of the father – especially in the event that things have not gone according to expectation. This can also be a time of disappointment at some unexpected twists and turns in the path – and I see part of my job as giving both parents a chance to express their feelings since, as a doula, I’ve spent a great deal of time fully trying to understand their hopes for such an important day in their lives. Providing that calm, reassuring presence during this time, and allowing parents to express fears, concerns and worries about surgery need to be addressed right at that moment – and no other person present is usually in a position to do this.

Once in theatre, your doctor and other medical team members around you will be focused on their own tasks. It can give both the mother and father a huge amount of relief to have someone truly focused on their well-being and immediately able to answer any questions about all the strange sensations that go along with surgery.

Having had a c-section myself, I remember clearly how vulnerable I felt laying naked on the operating table with so many people around me – all of them very busy! My partner was with me but was equally helpless to understand what was going on or explain it – and while my wonderful doctor was busy with her work, she was hardly in a position to really offer support over the top of the screen and from behind a surgical mask (which made hearing anything she said almost impossible).

I was surprised to realise just how much of what was going on that I could actually feel, and I could even still manage to move my toes despite the spinal anesthesia. There was a lot of tugging and movement, along with a big drop in my blood pressure, and perhaps the oddest sensation was when a great deal of pressure was applied to my stomach but I only felt the pressure up towards my shoulders. I was quite terrified at this point!

When providing doula care to someone during a c-section, I am continuously checking in with the mother as to what she’s feeling. For the father, I make sure he’s not feeling too overwhelmed by all that’s going on – especially if he’s someone who is a bit squeamish around blood (which is about 95% of the Dad’s I’ve met so far). Some fathers who are particularly squeamish have chosen not to go into theatre at all and are relieved that someone close to the mother can still support her.

Once the baby is born, it’s now the Dad’s job to go with him or her to the resus area where the peadiatrician will do a variety of tests and ensure that the baby is beginning to breath well. Without a doula, the mother is often forgotten about to some extent, and most of the time she is unable to see her baby or know exactly how things are going. The doctor will be busy removing the placenta and then beginning the approx. 45min process of closing up the incision.

This is a great time to have a doula there to be able to have a better view of how the baby is doing and to let the mother know. I also make sure to take photos of whats happening to the baby and then show them to the mother right away, so that she can still feel connected and part of the process. This offers a great deal of reassurance to the mother!

Should all be well with the baby s/he can be brought to the mother and placed on her chest. Should there be a problem, the father will accompany the baby to nursery and the doula will stay with the mother.

When the baby stays with the mother, having a doula can mean that skin to skin with the baby is possible the moment they arrive in the recovery area, and that breastfeeding can begin. This may be one of the most difficult positions in which to try and breastfeed, but ensuring that latching takes place within the first hour can make a huge difference in future success as it’s when the baby is most primed to do it. Although difficult, the positive reassurance from a doula can help make the mother feel much more adequate despite how challenging things can be at that moment.

Should there have been a need to take the baby to the nursery for further observation, having a doula to go and enquire on behalf of the mother can speed up the process of reuniting them. In the very least, it gives the mother a voice in a place where she can’t be (but so desperately longs to) and her doula can also then return as soon as possible to give her an update on what is taking place. Sometimes it is through the doula that the baby can still join the mother in her room by wheeling in the incubator, so the mother can see and touch her baby in the very least.

In most cases a doula will simply be helping the mother get settled into her room, and adjusting feeding positions to try and get breastfeeding going. Other jobs might be organising something to drink for the mother, or the father, and taking a few family photos.

Obviously the role of a doula extends far beyond the birth itself, as a doula will continue to visit the mother both in hospital and then later at home. She can offer a helping hand with other breastfeeding issues that may come up, keeping an eye on the third day blues (to avoid Post Natal Depression) and sometimes to help with the first bath or to answer questions about any newborn skin issues.

As you can see, there is still a huge amount of value that a doula can provide during a c-section – both before and after!

Top Ten Signs Your Doctor Is Planning To Perform an Unnecessary Cesarean Section on You

Written by By Dr Jonathan Weinstein, MD, FACOG

  1. Arrives on the labour ward immediately after office hours and says, “I just don’t think this baby is going to fit.” 
  2. Third Trimester, Routine Office Visit, “I think this is going to be a big baby. You should just have a c-section”
    ACOG has very specific guidelines for when it is appropriate to offer a patient an elective C/S for MACROSOMIA (fancy word for large baby). ‘Prophylactic (elective) cesarean delivery may be considered for suspected fetal macrosomia with estimated fetal weights greater than 5,000 gms (5kgs) in women without diabetes and greater than 4,500 gms (4.5kgs) in women with diabetes.
  3. “We should induce at 39 weeks because your baby is getting too big” Did you know that, according to ACOG: ‘Induction of labor at least doubles the risk of cesarean delivery without reducing shoulder dystocia (rare situation where baby’s shoulder can get stuck at delivery) or newborn morbidity(complications). Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes.’
  4. Performs routine ultrasounds at end of pregnancy to see how big your baby is. Did you know that ultrasounds at the end of the pregnancy can be 1-2 pounds off? Ask some VBAC patients who were talked into a C/S for this, then had a vaginal delivery of a bigger baby the next time.
  5.  “You have a positive herpes titer (or history of herpes); the baby will get it if you deliver vaginally.” Try some Valtrex for the last month of the pregnancy that is pretty much standard of care now. It prevents outbreaks and allows for a normal vaginal delivery.
  6. “Your baby is breech. You need to have a C/S” Ever heard of or performed an External Cephalic Version (process by which a breech baby is turned to the proper position)? It really does work.
  7. “You have pushed for 2 hours” (with an epidural that prevents you from feeling anything so you are probably not pushing effectively; this is evident on exam because the baby’s head is still perfectly round, but you do not need to know that) “It’s just not going to come out”
  8. “I scheduled you for an induction at 39 weeks. It is just soooo… much more convenient for you!” (and so much higher risk of ending in a C/S, especially if you are not dilated when you start the induction). At least 80% of my VBAC patients were induced the previous pregnancy. For whose convenience was the induction?
  9. First Visit (7 weeks), “Congratulations you are having twins. I will go ahead and schedule your C/S at 38 weeks, but don’t worry if you go in to labor early I will cut you right away!” Translation, “I am scared out of my mind for you to deliver your babies vaginally because I am not trained on what to do when the second baby is coming, plus it pays more to cut you open. Oh yeah, I don’t have that great a rapport with you because I only spend 2 minutes (fundal height, heart beat and ‘I’ll see you next time’) with you each visit, so I am afraid I will be sued for trying to do the right thing.”
  10. First Pelvic Exam in Office (7 weeks), “Hmm, your pelvis is pretty narrow”.

5 Tips for Coping with your Newborn Baby

This is my personal perspective. I really struggled to cope with the experience and since working as a doula over the last 10 years I have tried to figure out what the difference is between those who find it a breeze and those who, like me, felt like it was hell on earth. So this is what I have discovered…

(these tips are specifically related to the first two weeks post-birth)

1. Give up control

You have a new boss with a closed door policy. In fact, this is more of a Dictator than a boss. The best thing you can do is submit to his or her will. For those of us who like to take charge, be in control and call the shots – this is a monumental task but the rewards for getting it right are many. Once you are at home with your baby, climb into bed with him/her and stay there (for the most part). Just like you may have spent two weeks in bed on your honeymoon making love, this is also time to take two weeks in bed for your babymoon to bask in the love of your new little family. The most important thing on your to-do list should be tuning in to your baby’s natural rhythm of sleeping and eating, while you might find the odd moment to do something like take a shower or grab a bite to eat. Also to point out that “in bed” can also just be on the couch or anywhere else in your house where you can relax. The idea is to have no external pressure to do anything – all you should need to do is look after your baby.

2. Live in the moment

A Newborn Baby will force you to live in the moment, whether you like it or not. They have no conscious understanding of past or future and therefore live completely in the moment themselves. An untidy house, a ringing telephone, an unanswered email and a myriad of other things that you might normally find important now need to be “let go of”. Often when you feel yourself getting frustrated it’s because there is something you want to do and your little dictator has decided that now is not the time! It’s best to take a deep breath, let it out and let go of it all – right now this baby is all that truly matters in this moment.

3. And this too shall pass

All this letting go and living in the moment can become tiresome so it’s good to remember that those first two weeks are temporary and will eventually pass. Things will get better and life will go back to being somewhat normal, eventually, even if you don’t believe it right at that moment. It’s also a reason to try and enjoy the experience if and when you can – it can feel like an eternity in the moment, but they really are only so small for a very, very short time.

4. Make Rules for Visitors

You have a new baby, you are going through a massive adjustment and you might still be recovering from the birth – the least your visitors can do is bring a meal and leave the house more tidy than when they arrived. If you don’t already have family and friends planning to help you out like this – or a housekeeper – then don’t be too polite to make some rules. It’s also okay to not have any visitors at all.

5. Nothing can really prepare you

I have yet to hear from anyone who said that they found a class, book or received a piece of information that made them feel fully prepared for what they experienced. Mothers, myself included, have never found the right words to truly explain to the uninitiated what those first weeks are like. Hard unrelenting work, learning about the unbelievable extent to which you can love another being, sleep deprivation that could break a US Navy Seal or the toughest SAS officer, the steepest and most important learning curve you’ll probably ever have, the crazy level of satisfaction from getting simple things right – feeding a baby, changing a nappy, or taking a shower yourself.