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!

It's Not About Me

When clients discover I have two children of my own, the topic immediately turns to my own labor and delivery experiences. I would love to be able to answer that the births of my children were beautiful experiences that were the best times of my life. But that would be a lie. So what do I say instead?  How can I share about my experience appropriately without absolutely terrifying my clients in the process? Simple answer- I really can't.

So instead, I usually reply with something along the lines of "Your birth is not about me or my experiences, every woman and every labor is different". Which is the truth. Occasionally, I am able to use my personal experiences as a teaching moment when we are designing the client's birth preferences, which is usually when the question about my own experience is posed. My own experiences are a great reminder that things rarely go exactly according to plan. I don't like to give details to my clients, but I usually am able to say "I had two births, neither went according to my plans, one varied slightly and one was totally different. However, my kids and I are all ok, and having a deviation from the plan isn't the end of the world. Birth is fluid and we must adapt."

I'll share my experiences here, but as a disclaimer, do NOT let this discourage you from preparing for your desired birth. I'm still holding out hope that when it's time for the next baby, I'll get the beautiful birth I've been dreaming of for years.


 I had my birth preferences (birth plan) ready to go each time. I had in my mind a beautiful picture of
how the labor and delivery would go. With my son, I wanted a quick, natural hospital delivery. What I got was weeks of prodromal labor, and horrible SPD. When active labor finally arrived, I was exhausted but hoped it would be over soon. 84 hours later, he arrived. During my time in the hospital, I was bullied, given pitocin to "speed things up" when I stalled at 5 cm for over 20 hours, threatened with a c-section, and given an episiotomy against my will. They whisked him away to the nursery and gave him formula without my consent, and that was the beginning of the destruction of our breastfeeding relationship. The whole experience felt rushed and like I was out of control.

With my daughter, I didn't want a repeat of my last experience, so I chose to have a home birth. I planned and prepared, and had the picture perfect pregnancy. My due date came and went, no worries from me. Then, I woke up in the middle of the night to my water breaking. I was so excited, it was finally time! I grabbed my phone to call my midwife, and I flipped on the bedroom light. All my joy turned to terror as I realized I was standing in a puddle of blood, with more rushing down my legs. I knew what bloody show looked like, and I knew what a placental abruption looked like. This was the latter. I sent a photo of the blood to my midwife and she immediately responded with what I already knew in my heart: go to the hospital ASAP, don't wait. So we grabbed a few things and flew out the door. Labor started in the car, hard and fast, and with every contraction more blood came running out. We got to the hospital about an hour after my water broke, and they took me upstairs. They took one look at me, and tried to get my daughter's heart on the monitor. It was there, but it was all over the place. My contractions were coming every 2 minutes, and I was already 8 1/2 cm, but I had lost too much blood and they couldn't wait. They rushed me back for a c-section and a blood transfusion. It all happened so fast, I felt completely out of control and for a minute there I actually thought I was going to die. It was without a doubt the worst experience of my life. Thankfully, both my daughter and I survived with minimal physical scarring, though emotionally it certainly took its toll on me.

So why am I sharing this here? What purpose does it serve? The point is, it's not about me. Yes, I have had birth experiences that were far from ideal. But that doesn't mean that happens to everyone. Especially what happened with my daughter, I'm in the minority. So when you ask about my birth experiences and I simply say "neither really went according to my plans, but we are all ok, but this isn't about me", now you know why. I don't want to scare you, or dissuade you from following your dreams for your birth. I don't want you to take my experience as the end all, be all. I don't want you to compare our experiences. I don't ever want you to doubt your ability, to doubt your body.

Your birth is about you and your baby. It's not about me.

The Benefits of Consuming Your Placenta

Once you’ve finally given birth, you’d hope that the rollercoaster of hormones and emotions is over. Unfortunately, postnatal hormones can be even more intense than those encountered during pregnancy. Around 80% of women develop some kind of postpartum mood disorder, from the more common mild “baby blues” to the rare case of postpartum psychosis. One of the best ways to help combat the hormonal surges is to ingest the placenta.

Yes, I said it. Ingest your placenta.

Now, you may be thinking, “ew, that’s gross!”, or even “what on earth is a placenta!?”. Well, luckily, I can answer that question, and hopefully change your mind on the ‘gross’ part.

The placenta is the organ that attaches to the wall of the uterus and is connected to your baby via the umbilical cord. All nutrients for your baby pass through the placenta, as well as oxygen and hormones. The placenta is often called the ‘tree of life’, both for its life-sustaining properties and the tree-like vein patterns that course through it.

Your placenta contains a variety of ingredients: your own natural hormones, vitamins, minerals, protein, iron, etc. By re-introducing small amounts of your placenta back into your body over a gradual period, you help to combat the sudden hormonal shift that happens after childbirth.

Some benefits of ingesting your placenta are
  It is perfectly made for YOU
  It helps to balance your system
  It replenishes depleted iron
  It gives you more energy
  It can lessen postnatal bleeding, both immediately after birth and for the month that follows
  It has been shown to increase breastmilk production
  It helps the uterus return to its pre-pregnancy state more quickly
  It can be helpful during menopause
  It can help you reduce depression and negative feelings in the postnatal time
  It can decrease the likelihood of postnatal insomnia

Your placenta is tailor made for you, and women around the globe have been ingesting placenta for generations. It can be taken in capsule form, raw, cooked, grilled, blended… you name it. Capsules are the most popular modern option for placenta ingestion, and are taken much like a vitamin. In some cultures, women take bites of the raw placenta immediately following birth in order to prevent postpartum hemorrhage and to help the uterus contract back down, and then the rest of the placenta is saved to be consumed later.

Of course, before attempting to do ANYTHING with your placenta, it is important to verify that you and your placenta are in good health. Asking your caregiver immediately following the birth if your placenta is healthy is the first step. If you are delivering in a hospital setting, there may be paperwork to fill out before your placenta is released into your care or the care of your Placenta Specialist.

For more information on the benefits of ingesting your placenta, visit PlacentaBenefits.info.

Labor is a Thunder Storm

Watching a woman in labor is like watching a thunderstorm. To an outside observer, labor can seem wild, fierce, frightening even. But to one who holds the act of childbirth in reverence, it is beautiful, rhythmic, and glorious. The rain will pour and the thunder will roll, but the raw, untamed beauty takes my breath away.

Contrary to what television and movies show us, labor doesn’t usually start with a bang and take mere minutes. First, the clouds begin rolling in on the horizon. The mother-to-be notices some mild discomfort, perhaps some pressure. She has a subconscious feeling that labor is soon, but maybe she doesn’t vocalize that thought. Instinctually, she prepares. She begins to ‘nest’: cleaning, organizing, and stocking up on necessities. Then, the calm. That eerie, quiet calm, just before the rainfall. The clouds are so close you can practically taste them, and the air hangs heavy. The waiting takes both forever and no time at all.

Then comes the first wave of rain. It starts out light, and everyone wonders if this is the real thing, or perhaps just a sun shower. Gradually, the rainfall increases its intensity, and the birth team circles the wagons and hunkers down to rejoice in the storm. It is time.

Low thunder rolls through the falling rain, the mother gently sways, held up by the arms of her doula. The rocking is like a rhythm, the thunder is still coming closer. The rain is heavy now, cooling the earth and encouraging new life. The thunder rolls, and mother moans. It is time. It is time.

The rain is pouring now, coming down in driving sheets. A crack of lightning splits the sky, white hot and so close. The thunder follows right behind, shaking every living thing down to their core. This is it. The heart of the storm. The flashes come one on top of another, each one as intense as the last. Mother cries out, grasping tightly to her support team. Her hair has come loose, it tumbles about her face in a wild cascade. Sweat and tears fall like the rain, she gasps for air and soldiers on. The thunder is here.

The storm suddenly changes. The rain eases up a bit, but the thunder continues to roll in a continuous parade. Mother grunts as she bears down with all her might. The rain is clearing, but the thunder still rolls. Rumble after rumble, wave after wave, sweet relief for mother as she bears down with all her strength. Then suddenly, new life. Pink and grey and red, screaming and sputtering. Out out out, into the light and the embrace of mother. The rain is but a drizzle now, and the birds can be heard quietly chirping in the trees. Mother and babe cry in unison, babe for the newness of it all, and mother for the love that is like no other. Thunder can still be heard, but mother pays it no mind. To her, the storm is over. Those distant rumbles of thunder bring forth the afterbirth, and the birth team gently cleans and restores any damage the storm has left behind. The rain is now a fine mist, leaving the world damp and rich, and bursting with new life.

There is nothing like this experience in the whole of the world. The raw beauty of a birth can’t be fully captured in words or images. I can only paint a picture of how it feels to be invited into that sacred space, to be welcomed into the circle as a woman faces her own unique storm. Incredible doesn’t even begin to cover it.

 If I am to learn one thing in my life, it is this: 

 Never fear the storm, for there is beauty and wisdom in its ferocity.

Your Body, Your Baby, Your Birth { informed consent and creating birth preferences }

The birth of a child is a sacred, intimate experience. There is no disputing that fact. For every pregnant person, thoughts of labor and delivery are guaranteed. There is likely to be some uncertainty, fear, doubt, and curiosity in the minds of first-time mothers, and maybe even in repeat births. There is anticipation, there is excitement. Labor is the only blind date where you are sure you will be meeting the love of your life. Labor is incredible.

Labor is also unpredictable.

As much as one can study and prepare for the labor and delivery of their sweet baby, nothing is guaranteed. Rarely does a birth go absolutely perfectly, meeting every single expectation. It could be an incredibly fast labor, or a long, drawn out even that takes days. The OB you've seen your whole pregnancy could be out of town, you may go into labor while on vacation yourself, maybe there's a storm and you can't make it to the hospital. Labor can be tricky, but it's a good idea to set up some birth preferences in advance.

I use the term preferences, rather than 'plan', because as I just stated, labor is unpredictable. Having a set of preferences for how you envision your perfect birth is important, but those preferences need to be flexible as well. I encourage my clients to dream big, and put down what their heart truly desires for the best birth experience they can imagine. I also tell them to have a separate set of preferences labelled "emergency". Those cover the preferences if a true emergency arises and a cesarean is necessary, or an induction of labor is medically warranted. Planning and dreaming of your birth experience is a great thing, but always have back up plans just in case. Be prepared.

When forming your birth plan, it's important to research various aspects of labor and delivery. Depending on where you plan on delivering, parts of your birth plan will vary. It is important that you have a solid idea on important factors of labor, like being free to move about if you choose, pain management options, the type of monitoring you want, etc. Read up on your options, become informed on all procedures you wish to have done. Any consent you give during your labor and afterward should be done so only after you are sure you have all the information needed to make the best decision for yourself and your baby. There are several websites that can help structure a birth preference list to your liking. I provide a basic template for my clients, to show them how one should look. Here are some sources for creating a 'birth plan': 1   2   3   4

Effective birth preferences are typically no longer than one page, front and back. Color coding, bolding the most important options, and laminating your paper are all ways to effectively draw attention to your wishes. Be sure to check the policies at the hospital or birth center if you are delivering in one, to make sure your preferences are within reason. Also check your list with your care provider several weeks before delivery, and again during the last week or two of pregnancy. Having full support from your whole labor team and knowing you are giving informed consent is crucial to achieving an amazing birth.