Doulas and C-sections: can they go together?

A question I get asked a lot is “I’m planning a c-section, how can a doula help me? Why should I hire one?”  There is a common misconception that Doulas are only for women who are planning drug and intervention free births. I’m here to break that stereotype, and to tell you that Doulas are for EVERY birth. A Doula is meant to provide unbiased support and education, and to help her client achieve their dream birth. This includes C-sections. The rate of C-section birth in the U.S. is high, around 33%, which is 2x higher than the WHO recommends. This means that on average, 1 in 3 babies in the United States are born via C-section. Most of these are for emergent or medical reasons, while some are elective (in cases of RCS, birth of multiples, etc). Regardless of the reason for the C-section, it is a valid birth choice, and the birthing mother should be able to feel confident and in control.

A Doula is a wonderful resource to use, even if you are planning a cesarean birth. Many people don’t realize the benefits a Doula brings to a C-section, whether planned or emergent. Yes, one of the main “bragging points” of a Doula is that we reduce the risk of needing a C-section by about 30%. However, that fact doesn’t mean we become useless if a C-section is wanted or needed.

 

I've made a handy chart here that highlights key benefits

Before the Birth

Prior to your surgery, your Doula will provide you with any information you desire. She will go over the pros and cons of elective Cesarean surgery, various anesthesia options, the possibility of a “family” or “gentle” C-section, the various stages of the surgery itself, and the recovery. Having an extra pair of eyes, ears, and hands never hurts when it comes to planning the birth of your baby. She will make sure you are feeling confident and empowered in your choice to birth via Cesarean. She will talk with you in depth about any fears you may have, and can help you create a birth plan to cover your desires for your birth. Even if you are planning a vaginal birth, it’s worth discussing the possibility of C-section with your Doula, and creating a plan in the event of an emergency. Some Doulas may even be able to offer you access to a class that covers childbirth by C-section. 

Upon arriving at the hospital, your Doula will be with you during admissions and pre-op prep, and can help keep you calm. She can read to you, massage your feet, and keep the atmosphere of the room light. She can help you stay relaxed during IV insertion, and will remain by your side for as long as possible.

During the Birth

Some hospitals have a policy that only one support person is allowed in the OR in the event of a Cesarean. Speak with your doctor prior to delivery day about your desire to have your Doula present if possible. As an active and supportive member of your birth team, it is your Doula's desire to be with you if it is feasible.

If your Doula is able to be present in the OR, she will explain any procedures as they happen. The doctors and nurses are focused on their jobs- getting baby out and putting you back together. Your doula can explain what’s happening. She will hold your hand and be an extra voice of comfort and reassurance.  She can snap a few photos, especially of your brand new baby’s first few minutes of life. Those moments happen so quickly, and often memories of the surgery become blurred. A Doula will make sure you have details to remember this special day by. Typically, baby will be born in the first few minutes of the C-section. The rest of the hour-long procedure is the repair, during which time the baby is usually taken out of the room. During this time, your Doula will stay by your side while your partner accompanies baby to the recovery room to wait for you.

After the Birth

During the post-op time, things can be a bit fuzzy. As the anesthesia from surgery wears off, there is often discomfort, and sometimes some side effects. Your Doula can help you manage this discomfort, and can help get you up and moving. Walking is a critical component to recovery after a C-section, and your Doula will help you move. She can also help you to and from the restroom, and can help get you into more comfortable clothes once you are moved out of the recovery room. She will be an extra pair of hands for you during this awkward phase of recovery. Your Doula can help with initial breastfeeding attempts if you desire, and can update your family and friends. She will often return to spend time with you in the hospital during your stay there, and to help in your recovery. If you have hired her as a Postpartum Doula as well, you can expect full support once you return home. C-section recovery is lengthy and painful, and a Doula can help you manage and accomplish everyday tasks.  

A Doula can be useful in these ways in both planned and emergency C-sections. It’s best to talk with your care provider about your wishes for your birth, and for your desire for your Doula to be an active, present member of your birth team. Your Doula is there to help you feel validated and empowered, and to feel calm during the birth of your baby. Cesarean birth IS birth, and a Doula can help. 

Mother vs Doula: Childcare

Welcome to the second installment of Mother vs Doula! Last week I talked about how I make breastfeeding work for us, despite the crazy long hours and being on-call 24/7. If you missed it, you can read about it here: Mother vs Doula: Breastfeeding. Today's topic is, in my opinion, my biggest "hurdle" when it comes to working as a full time Doula with young children- Childcare.

Due to the unpredictable nature of labor, I need to have childcare options available at the drop of a hat. In my contract, I have it listed (several times!) that a client is responsible to call me the minute she believes labor is starting. This gives me at least 2-3 hours to alert my support team that I may be leaving to attend a birth within a few hours if it does turn out to be baby time. I am always able to tell my clients to relax, take a shower, drink some water, lay down, and time the contractions for at least an hour and a half and call me with the results. During this time, I'm figuring out my childcare options for that day/night.

I'm lucky, in the sense that I'm married to a guy who is home by 7-8 pm on the average night. He's home all night, and typically doesn't leave the house until 9-10 am for work. So if my client goes into labor at 10 pm, I can call my childcare options and tell them I'm headed to a birth and will probably need them for a few hours the next morning. If it's my husband's day off the next day, I don't even have to worry, I can just kiss everyone goodbye and head out the door. Otherwise, I tell my sitters that he or I will call them around 7:30 am to confirm that we need them, and what time to be at my house. If a client goes into labor around 2 in the afternoon, I start calling my childcare as soon as she tells me she thinks it's time. I find out who is available and who isn't. By the time my client calls me back 2 hours later with a progress report, I've got a game plan in place.

As I stated before, my clients are responsible for calling me the minute they suspect they are in labor, no matter what time it is. This is to give me time to set up. They are to call me back 2 hours later with an update on the contractions. The follow up from my client will be one of three things:

1. "My contractions are coming every 8 minutes apart, and have been for the last hour and a half!"
2. "I'm still having contractions, but they are still very mild and only every 10-15 minutes, not super consistent yet."
3. "Everything stopped, false alarm. Sorry!"

Occasionally, before the two hours are up, I'll get this fourth option:
4. "I know you said to time the contractions for two hours but my water just broke and the contractions are getting intense!"

Depending on the nature of the update, I will have different plans.

1. "Alright, I'll let my sitter know. Hang tight, I'll be there in about an hour. You're having a baby today!"
2. Ok, sounds like it could be early labor, but you also could just be dehydrated. Go drink 16 oz of water and try to take a nap. Call me if anything changes." I then let my sitter know that I'll update her when there's a change, but she is not needed immediately.
3."No problem! Call me if anything changes, get some rest." I will then call my sitter and tell her it was a false alarm, but I'll call her back if anything changes.

And of course,

4. "Alright, my sitter will be here soon, I'll be to you as quick as I can. You are having a baby today!" Then I call my sitter and tell her to get here ASAP.

As far as finding sitters available on short notice, knowing other Doulas in the community is a bonus in that aspect. Often they will watch your kids if you agree to watch theirs when the time is needed, or they will know a good reliable last-minute sitter. It also pays off to have family in the area who is always bugging you about spending time with your kids (hey mom!) and has a flexible schedule. Those options, plus a family friend or two who doesn't have kids of their own make a nice selection for last-minute childcare options. Just like I don't put my life on hold just because I'm a Doula, I don't expect my childcare options to just be chilling at home waiting for me to call. That's one of the reasons I have my contract written the way it is, with a clause that says to allow up to 90 minutes from the time we determine it's really go time for me to get to you. That's also why it is absolutely vital that a client let me know the minute they suspect labor. It gives me time to prepare without feeling rushed or panicked. I always tell my clients not to worry about waking me, or about "bothering" me by having a lot of false alarms. I would rather be very in the loop about what's going on than to get a call that says "my water broke 2 hours ago and the contractions are really picking up, I need you now!" That is so inconvenient for me, and with my responsibility as a mother to make sure my children are cared for in my absence, I may miss the birth of your baby. Yes, I have a responsibility to my client to be there. But my client has a responsibility to me, to keep me informed.

I find that by being completely transparent with my clients about WHY I want them to keep me in the loop, and call me with any changes, it makes all of our lives so much easier. They know I'm able to get to them when they truly need me, and I don't feel stressed or rushed. At this point, my kids are used to me going to births and being gone for 12-24 hours, so it's not a big deal in that aspect.

Childcare was my biggest fear when I first started working as a Doula, because it is such an unpredictable job. But once you get a solid network of options in place and have a system that your clients follow, it takes all the stress out of it, and you can pour your focus into your love for the job.

Mother vs Doula: Breastfeeding

It's no secret that a lot of Doulas have children of their own. How does one balance family life and a Doula business at the same time? Being a Doula isn't like having a normal 9-5 job; I'm on call 24/7 pretty much year round, depending on how many clients per month I have. I can be sound asleep one minute, and off to attend a woman in labor the next. I do have scheduled "office hours", during which I schedule prenatals, postnatals, consultations, file paperwork, and offer my Postpartum Services. But labor is unpredictable.

So knowing that, how does one balance having small children at home while being on call? In this mini-series, Mother vs Doula, I intend to cover the various aspects of Motherhood, and how I work around them as a full time Doula.

So, item one on the docket: Breastfeeding.

My youngest was exclusively breastfed until nearly 7 months old, when we started Baby Led Weaning. She is now 9 months old and her diet is 80% breast milk, 20% solid foods. I nurse her exclusively when I am home, and pump once per day, usually at night once she has gone to sleep. The milk I pump goes straight into the freezer (frozen flat, in 3 oz increments) for when I am gone. I currently have about 120 oz in our freezer, give or take a few. I am fully at ease knowing that even if I'm at an incredibly long labor (like the 45+ hour labor I attended back in June), my daughter still has more than enough milk in the freezer to cover the time I'm away. All of my childcare providers (aka my husband, my mother, and my backup Doula) are informed on paced feeding and know how to prepare the frozen breast milk.

When I am away from her at a birth, I do need to remove myself every 4-5 hours or so to pump. I bring a little cooler filled with ice and either leave it in my car or bring it to the nurses station. I am usually able to use the nurses lounge or an on-call room if I'm at a hospital, and I take 15-20 minutes and quickly pump. If a birth is intense and I am unable to pull away, so be it. It can certainly be uncomfortable at times, but that's a sacrifice I'm willing to make. I will not leave the room once transition (8cm+) is in full swing, so sometimes I have to wait 6+ hours between pumping sessions. I always wear a cloth diaper insert inside of my bra for these occasions, just in case. It doesn't look very professional to start leaking all over your clients as they are welcoming their brand new baby into the world!

Once I arrive home, depending on what time it is, I'll either pump and then fall asleep, or I'll immediately latch my daughter to the breast and relax. When I first began taking clients after my daughter's birth, I was worried about the breastfeeding aspect. Would I be able to juggle it and not have to resort to formula? My fears were valid, but I find that most mothers are totally understanding about needing to briefly step away to pump, and as long as you have some stored in your freezer at home, you are golden.

Most breastfed babies will drink 1-1.5 oz per hour, so that's a good base calculation to start with. If you anticipate a long labor and delivery for each client, say 30 hours, it's a good idea to consistently have at least 45-60 oz in your freezer stash. Some births will be quick, 8-12 hours, and you will be home before you know it. Others will be seemingly endless and may deplete your freezer stash down to the bones. If that happens, don't panic. Pump a little after each nursing session to slowly build your stash again. The odds of having two intense 30+ labors back to back isn't too likely, unless you take 5+ clients per month. If you are averaging 3-4 clients per month or less, you should have a bit of time between births to refresh your freezer stash. If you are able to pump during the labors, then you will be returning home with some liquid gold to replenish your stash anyway, so the rebuilding won't be from the ground.

Breastfeeding while being an on-call Doula can be challenging and at times uncomfortable, but it is by no means impossible. As with any job, it requires some time and dedication to pull it off, but if you have a game plan set in advance, it's not nearly such a daunting task.

On that note, goodbye until next time, and Happy World Breastfeeding Week!