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Thursday
Mar032011

Doulas... LISTEN UP!

I received this letter last night from a woman who doesn't live in my area, but who found something on my Navelgazing Midwife (Monitrice-Doula) site that she had to tell me about. Here is her letter:

I just wanted to let you know how rare it is to see a doula advertise her services to a scheduled c/s mom.

I am looking for a doula for my to-be-scheduled-at-some-point c/s and haven't been able to find ONE in my area that mentions anything about c/s on their websites other than how to avoid them. Not a single one discusses how they can help mothers birthing by planned c/s.

I've seen plenty of judgment on sections and discussion on how they can help you not have another.

I've seen lots of support for VBAC moms, but not a peep for repeat c/s moms.

I've honestly given up on having a doula because I am a) completely comfortable with my repeat section and don't feel any need to justify it to the doula's satisfaction that I really NEED one and b) I don't want anyone there at my birth who doesn't want to be there because they think I should be VBACing.

I don't have a single problem explaining what happened at my first birth and why my very complicated obstetric history leads to another section, but I don't want to justify it, if that makes sense. When I saw that you actually describe the services you provide to C/S moms, I was very moved, especially after not finding a single one here that does that. I live in <another state>, or I would have already booked you.

After I read her letter, I had to go to my own site to see what I had said that touched her. I honestly couldn't remember saying anything terribly detailed or focused on this topic. What I found was a simple blurb that reads:

Cesarean - If you're having a scheduled cesarean, I come with you in the morning and won't leave until you're successfully nursing or, if your baby is in the NICU, make sure you've at least seen pictures of your new baby and are comfortable and resting.

That's it. That one sentence made a huge difference in one woman's upcoming birth experience -and she doesn't even live here!

I'm not sure if it's a side effect of years of experience or a glitch in the doula training system that helps me see that much larger picture than many (most!) doulas are blind to. Why are doulas so hell-bent on having only clients that want a natural birth? Why can't they be cool with a woman who wants someone with her even if she knows she wants an epidural? Doesn't this smack of pushing one's own agenda?

How do we fix this?

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Reader Comments (36)

The doulas in my area of Iowa support women through c-sections.
I'm glad to know them.

How do we encourage doulas to be fully supportive of women in the hospital setting, cesareans and all? I don't know.

You are taking the first step by bringing awareness to it though.

March 3, 2011 | Unregistered CommenterLeslie

Valuable input for a doula to be! Something I've touched on
In my own ponderings lately and I'll definitely raise it when I go on my course. Thank you.

March 3, 2011 | Unregistered CommenterSam

Wow. Thanks for that. I have often thought of the different birthing situations that arise and how it's not my job to judge or decide. You're always pushing us birth folk to dig a little deeper and think a little harder, thanks!

March 3, 2011 | Unregistered CommenterSummer

My doula was so terrific during my cesarean - my husband called her when I was in the ambulance (for a footling breech) and said that I was going to be rushed in for a section, and she didn't need to be there. She showed up anyway, babysat our toddler so my husband could be in the theater with me, and then came in the next day to talk the whole thing over and help me gently take that first painful walk to the shower.

It wasn't at all what I'd hoped she'd be doing (ie. helping me through a natural delivery) but it was just invaluable at the time.

March 3, 2011 | Unregistered CommenterT

There is *so much* a doula can do for a cesarean birth! I have supported several in the OR, though I realize that is not the norm for most areas. Birthing From Within classes do a "how to birth your baby by cesarean" section - I would encourage this mom to seek out a BFW trained doula in her area.

March 3, 2011 | Unregistered CommenterKristina

I wonder if it's not so much that doulas are trying to stay away from cesarean clients and more that they think they're not wanted/needed. This post from Gina @ TFB is what I'm talking about: http://thefeministbreeder.com/my-first-cesarean%E2%80%A6-as-a-doula/ Another thing that's in the mix for me is that I know I would not be a good fit for a woman that schedules a truly elective cesarean (as in, absolutely no medical indications, and "why don't we throw in that tummy tuck at the same time?" kind of situation). I have my motivations and reasoning for becoming a doula and I need to be true to myself as well. That said, you are right - when I think of marketing myself to potential clients, women having cesareans doesn't immediately fit into my target demographic.

March 3, 2011 | Unregistered Commenterkateisfun

As a doula, I've supported one mother who ended up needing a c/s, but I was sent home by another mom as she headed into the OR for a c/s. Honestly, I felt mildly useful for the first birth (except for getting fussed at by the RNs for photographing the brand-new twins). The second birth left me so sad. In the mom's mind, as soon as they decided to have a c/s, I was no longer needed. I wanted to stay to offer support. I had been helping the parents for hours, only to be sent home without finishing. The hospital staff assured these parents that a doula was no longer necessary in the OR.

I would love to hear of more parents, hospital staff and doulas seeing the value of doulas for c/s moms.

March 3, 2011 | Unregistered CommenterNana V

I think it's because many women become doulas because they are on a crusade to save women from the system. If you perceive the system as an evil you are saving clients from then the biggest evil of all would be a scheduled c-section.

I confess I felt this way when I started out, but the more I talked and listened with women the more I began to see the role of the doula as one of unconditional support.

Personally as a fairly well educated (on birth any way) woman looking for a doula the one I interviewed that wanted me to change my choices and was hell bent on educating me was NOT the one I hired. I hired the one that listened to me and said she worked hard to create a good birth environment no matter the birth.

The crusade turns women off-what they want is SUPPORT. Just ONE person that unconditionally supports them and their wishes with no outside agenda. In my opinion as a doula THAT is what you are providing (or that should be your goal anyway).

March 3, 2011 | Unregistered CommenterKimberly

You raise an important question since mothers choosing c/s often follow their verbal decision with a rationalization for choosing a c/s...as if they will automatically receive disapproving looks, comments and questions (they usually do) as to why they don't attempt a vaginal birth. These women deserve the same support and respect as a woman planning on a vaginal birth. My only suggestion is that the patient make sure the L&D unit actually allows a doula in the OR along with the support person/partner. Most OR's have a strict "1 person only" policy for OR safety.

March 3, 2011 | Unregistered Commentersupportive guest

I haven't been in the OR as a doula in a very long time, so I didn't mean as an OR doula for a cesarean... should have clarified.

Of course, this post begs the question:

What CAN a doula do for a mom who's sceduling a cesarean? Anyone want to write a post with me?

March 3, 2011 | Registered CommenterNavelgazing Midwife

I do I do!

March 3, 2011 | Unregistered CommenterKristina

My contract states that I will attend c-sections. While I've talked to many women about the benefits of a doula for surgical births, many times I have been turned down. My contract also states that should a woman end up with a c-section that I will visit her again while she is still in the hospital.

Thanks for blogging about it... another area where families could definitely use more support.

March 3, 2011 | Unregistered CommenterKimberly

Kristina: You start... Email me an outline and we can go from there... each fleshing the other out.

And it doesn't have to be enormously long or anything. But I would love to do a piece with you! :)

March 3, 2011 | Registered CommenterNavelgazing Midwife

A doula can "doula" anyone through any life event, but in the elective c/s context I have never seen it addressed with any great insight or success. If a woman wants a cesarean it is her choice, if a doula cannot support that with her whole heart she shouldn't be involved. So...do not judge a woman for wanting this type of birth and don't judge the doula for not wanting to attend this type of birth. Both are choices and both are equally entitled to it.

March 3, 2011 | Unregistered CommenterTracey

(If I had actually started practicing as a doula) I don't think I ever realized a doula could be useful at a c/s.

At my doula training, I think I was the only one who wasn't vociferously all-natural. I mean, I think in a large majority of births natural is probably better, but since I went to med school for 2 years, I don't see epidurals / c/s / doctors as the ultimate enemy. I understand that it's a contentious relationship between doulas/midwives and doctors, but being on both sides let me realize there's good in both.

March 3, 2011 | Unregistered CommenterChe

I don't think the issue is condemning doulas who don't want to work with women scheduling cesareans, it is that women who want a doula when they are scheduling a cesarean are left feeling like crap as they try to find someone.

*I* don't work with every woman who comes a'callin'. Besides the "connection" issue, I don't work with families that see my lesbianism as a sin or as evil. I don't do well with Right-Wing Republicans, either.

So, I know "A Doula for Every Woman" doesn't mean "Every Doula for Every Woman," but it would be nice if there were at least *some* doulas for the "alternative" communities (epidurals, scheduled c/s, inductions, etc.).

March 3, 2011 | Registered CommenterNavelgazing Midwife

We posted a story on our doula network website from a local mother who had a doula at her Cesarean birth. Although we do encounter some resistance about having an additional support person in the OR, I'd say that I've been fortunate to be able to be in the OR with about 75% of my doula clients who've had Cesareans. See the link below for the article.

http://www.fortwaynedoula.com/fort_wayne_doulas/2009/09/doulas-cesarean-birth.html

March 3, 2011 | Unregistered CommenterKat

My contract says that I would be happy to attend a cesarean, but only one person is allowed in the OR, so I don't see it happening any time soon.

March 3, 2011 | Unregistered Commentersara

Again, it isn't just going IN to the cesarean that a doula is needed, but before and after... including processing the birth (which is done no matter how "perfect" the birth is for the mom) postpartum.

March 3, 2011 | Registered CommenterNavelgazing Midwife

I've offered to be there for moms having c-sections, but so far no takers. I know that it would be very helpful, but it's hard to convince moms of that sometimes. I have even been offering my services for free, and still haven't had any c-section moms take me up on it.

March 4, 2011 | Unregistered Commentersara

Thank you for posting this! When I was in doula training, and my more recent Childbirth Educator Training, I heard and felt a lot of negativity and *presumption* on behalf of many students (but not the trainers!) regarding all things medical-birth. I find that very upsetting, because what matters most to me is that families have choices in childbirth, and that women feel and honor their power as they navigate the many decisions that must be made. It is not the doula's job to steer a client in a direction of which the doula approves, nor to presume that because the client want's something that the doula perceives as "bad/unnatural/medicalized" the client must be re-educated. Sometimes we walk a fine line between educating and prosthelytizing.

Thank you for the reminder that all women deserve the support of an objective professional, no matter the manner in which they choose to welcome their baby into the world.

March 4, 2011 | Unregistered CommenterArya

"What CAN a doula do for a mom who's sceduling a cesarean? Anyone want to write a post with me?"

I wrote this one a while back, hope you like! :O)

http://dou-la-la.blogspot.com/2010/02/mothering-mother-in-all-circumstances.html

(It links to the Fort Wayne Doula post as well!)

March 4, 2011 | Unregistered CommenterDou-la-la

@NgM: Working on the outline right now! I'm pretty wordy; we will have to decide together what is the most important - feel free to slash and burn.

March 4, 2011 | Unregistered CommenterKristina

I have been invited into every cesarean section my families have encountered. BUT, that is pure luck. I tell the parents ahead of time that they will have to be the ones to insist on my presence. I think, too, there is a vast difference between the midwest and the west coast. Either way, being there for the actual surgery is a small part of the process; in the same way that catching a baby is a small part of midwifery. The value is in continuity of care, no matter how it happens.

March 4, 2011 | Unregistered CommenterErika

I've done a few scheduled cesarean births - and I find that not only is it soo helpful to the mom, but the extended family as well. Surgery seems to scare them far more than a vaginal delivery and they need much support and accurate information!

Our hospital still refuses to let doula and dad attend, so usually I'm with the family and I give them relaxing hand massages and find coffee and answer questions and sometimes just distract. One time I just kept "miss doom and gloom" talking about something other than all the horror stories she kept trying to tell!

Thanks for posting this reminder - since our job is to help moms have the birth THEY desire, this absolutely does include planned cesarean births!! (and yes, I'm going to scan my site to be sure I actually SAY that on there!!!)

March 6, 2011 | Unregistered CommenterShannon

Until hospitals offer "family-centered" cesareans with immediate skin to skin, fewer people in the room, calming music and lighting and allow doulas in the room, I don't see how a doula can do much for a mom during the surgery, or even after, since many hospitals separate mom and baby by policy.

I don't think the issue that doulas do not want to support moms through ECs, more that there is little we can do to improve the experience. Even at the best maternity hospital where I live, the experience is pretty rough for moms and babies. There is quite a bit of separation and too many people in the room saying things that could upset the mom.

So moms need to start pushing the hospitals to change their CS policies and stop accepting the stand protocols which interfere with breastfeeding and bonding and isolate the mom.

March 7, 2011 | Unregistered CommenterVanessa

Wow, Vanessa, sad the situation is so lame there. Even at the worst hospitals here, mom gets baby in the Recovery Room unless there's something wrong with hir. And we are also blessed to have *3* Baby-Friendly Hospitals here now (Kaiser just got their status last month I think it was.), so there's probably economic pressure for the others to be somewhat civil with moms and babies postpartum.

Even when I don't go into the surgery itself, I *am* able to switch off with dad in Recovery so I can help mom nurse. It isn't uncommon for me to hold a mom's breast *and* the baby so s/he can latch while mom dozes (with her request, usually during pregnancy, of course). This gives dad some time to go eat and pee.

Kristina French is writing an amazing "What Doulas Can Do for Cesarean Moms" post that I'll put up as soon as she's finished. We were going to write it together, but goodness, her outline was FABulous, so I passed it off to her. :)

March 7, 2011 | Registered CommenterNavelgazing Midwife

I am a doula in the Midwest, and so far, knock on wood, I have almost always been allowed in the OR with my clients for a cesarean, emergency or planned. Moms and dads/partners both seem soothed by the extra presence, and mom has someone to stay focused on her needs when her partner goes to the baby immediately after birth. We have been able to advocate for skin-to-skin on the operating table, eliminate or greatly reduce separation, etc. Many strides in our hospitals in the past few years! As others have said, though, it is always a decision made in the moment by the surgeon and the anesthesiologist. Both must agree to allow the doula to be present.

We have a repeat client due with twins in April, and she is scheduled for an ERC at the end of this month. I am sharing call time with one of my doula partners, one of us will absolutely be with her! When it became clear that it would be an ERC and not a VBAC, she rather sheepishly asked if we could please still come. We said OF COURSE! A mom having a cesarean birth has no less need for a doula, she still needs all the same love, support, information and advocacy as a woman having a vaginal birth.

March 8, 2011 | Unregistered CommenterJessicaE

As a doula, I have supported several c-sections in the OR. The anesthesiologist is usually the one who gets to make the decision, and I've found that meeting the both the OB and the anesthesiologist ahead of time to discuss it (if it is a planned section) goes a long way in getting this done. It's especially helpful if they take the baby over to the warmer -- the dad can go with baby and doula can stay with mom. I'll take some pictures on a digital camera and then can show them to her if she can't see what's going on.

I think these mamas need lots of support!! I just wrote a blog post about the different ways you can have a pleasant and family-centered c-section, if anyone wants to check it out!

March 8, 2011 | Unregistered CommenterNurtured Moms

I am a doula, and I have never even thought about it! I have had mom's plan to get an epi and still want me there (which I am fine with), but never once thought about the needs of woman planning a c-section. I hope you don't mind... I am going to borrow your idea!

March 8, 2011 | Unregistered CommenterAbbey Lake

"Until hospitals offer "family-centered" cesareans with immediate skin to skin, fewer people in the room, calming music and lighting and allow doulas in the room, I don't see how a doula can do much for a mom during the surgery, or even after, since many hospitals separate mom and baby by policy.
So moms need to start pushing the hospitals to change their CS policies and stop accepting the stand protocols which interfere with breastfeeding and bonding and isolate the mom." (Vanessa March 7)

I'm assuming the above statement was meant to be sarcastic and not serious. The key word is "surgery" soft music and quiet environment are realistic however, the last thing you want is dim lighting and only a couple/few people in the OR...A c/s is major surgery, elective or not and requires specific participants as well as bright lighting so the surgeons can see what they are doing. I am happy to say that the hospital I work in keeps mom and baby together and we get baby to breast ASAP in recovery (within first 15 min of recovery...not realistic while on the OR table)...yes, the RN does most of the work holding baby to breast since mom is rather limited in her abilities at that point.

March 10, 2011 | Unregistered Commentersupportive guest

The doulas that work in my area are very open and non judgmental. I haven't heard one yet say they wouldn't take a client because she wanted an epi or a planned c/s. It's a bit surprising to me to read your post. I also mention c/s births on my website and in my brochure because every woman deserves support during such a momentus point in her life.

doulasteph CD(DONA)

March 28, 2011 | Unregistered Commenterdoulasteph

I am a doula and I totally uphold a woman's right to an epi or an elective c-section. I welcome these mamas in my birth classes, and i hope I include information that will be particularly helpful to them. However, I do not like taking clients who plan on getting their epidural as soon as the first contraction hits. I usually give these moms a list of names and numbers of other doulas in the area, then wish them well. I am not pushing an agenda, but because as a woman and mother, I can not stand to be a part of this kind of birth. Once the mom is drugged and immobile, she is subject to 50 million other interventions, and the whole thing is hard to watch PLUS my presence is not doing anything to help her at that point. I go home at the end of the birth feeling like my presence was condoning the episiotomy she was given without consent, or whatever else was done to her because she was too numb to birth effectively. But that's just me. Again, I support a mother's right to choose whatever kind of birth she wants, but in some cases I'm going to have to bow out and let her find someone else to support her in that journey.

As far as planned c/s, I would be much more willing to than your standard drug-em and cut-em birth. IMO those are the moms who need support - especially in the hours immediately beforehand when many moms are incredibly nervous and anxious about the surgery.

April 6, 2011 | Unregistered Commenterstarry-eyes

If I were in your situation, NG, I would encourage the mother who wrote the letter to become a trained and certified doula who specializes in supporting cesarean mothers.

August 18, 2011 | Unregistered CommenterDonna

As I have stated in another comment, I am a new doula. I am saddened that any mom would be unable to find support that she wanted. I would love to be available to ANY laboring mother. I say laboring because I see a c/s as just as much work as a vaginal delivery, just in a different way. I would welcome c/s clients with open arms. I think that, maybe, just maybe, a mom would feel less judged and more loved by simply having a supportive doula by her side. I truly hope that I am not alone in feeling that our job is to support...not exclude.

May 3, 2012 | Unregistered CommenterPennie

Pennie: Your attitude is wonderful. Keep going, hon.

May 4, 2012 | Registered CommenterNavelgazing Midwife

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