Many assume that doulas only support natural birth or that you only need a doula if you want to have a natural birth. Doulas— especially the good ones— support all types of birth. Having attended natural, epidural, and cesarean births, I can tell you that each and every type of birth can benefit from doula support. In fact, my clients who have had births that have resulted in a c-section have needed even more support than my clients who have had natural births.

Here’s Why You’d Want for Doula for a C-Section:

Preparation & Anticipation: With a national cesarean rate of 33% (that’s 1 in 3 US births!), there’s a real chance that you may be faced with a cesarean (side-note: that number is *way* to high— the World Health Organization states that any national average should be between 10-12%, but that’s a topic for another blog post, stay tuned). For most women, cesareans are not planned or scheduled in advance, but arise due to special circumstances during labor. What would this mean for you? How would you respond to a turn in your labor that meant a cesarean was necessary? This can be an overwhelming, emotional time. With a doula present, she can help you understand what to expect, walking you through exactly what will happen in the next hour or so and prepare you for the environment of the O.R. and the physical sensations of a c-section (remember, women are fully awake and conscious during surgery); she can help you to process the dramatic change your labor has taken by answering your questions and grieving the loss of the vaginal delivery that you most likely hoped for; and, finally, she can offer a variety of techniques, including massage, relaxation, breathing, and rebozo tenting to help bring about a sense of calm, safety, and reassurance as you prepare for the cesarean.

Someone By Your Side in the O.R.: The O.R. can be a scary place: bright lights, cold air, wires, sterile drapes, noises from machines, several doctors (two OBs, an anesthesiologist, and a pediatrician), a nurse, scrub tech, and sometimes residents (everyone wears a cap and a mask so there is no way to read facial expressions— all you can see are eyes). For most women, this is not the peaceful birthing environment they had envisioned. While your partner will most likely be in the O.R. with you, he/she is often as overwhelmed as the mother, left feeling powerless on how to best support you through the experience. With a doula present, she can also prepare the partner for what to expect and can encourage the partner to get involved by offering touch, eye contact, and comforting words Because the medical staff is entirely focused on the physical well-being of the mother and baby, women are often left lying on the table without support. This can be very scary. A doula by your side can bring a sense of calm to an otherwise scary environment. She can talk you through what’s happening, help you focus on breathing, offer relaxation prompts and techniques, ensure that you feel safe and secure throughout the process, and offer ear buds to listen to soothing music (instead of the noises of the surgery and machines). Hopefully baby can immediately be skin-to-skin with the mother (this is becoming a more common practice, as many practitioners are recognizing the benefits of to both mom and baby of immediate skin-to-skin), but sometimes the baby will need to go to the NICU (and the partner often follows). When this happens, the mother is left alone, without the support of her partner, as the medical staff works to complete the surgery. If a doula is present, she stays as the mother is sewn up (a process that can take up to 30 minutes), offering reassurance and guidance.

Recovery & Bonding with Baby: Most women will move from the post-op area to the postpartum floor within a few hours of the surgery. A doula’s presence during this time can help the mother know what to expect next and, if the baby is present and well, the doula can help to facilitate bonding with skin-to-skin time. Unfortunately, due to all of the medications dispensed throughout the surgery, women often feel nauseas and a bit out of it for a few hours post-op. Having a doula present to help you understand why you’re feeling the way you are, to provide natural means of relief (peppermint essential oil, for example, can be a great way to reduce the nausea), and to encourage bonding and initiate breastfeeding can be immensely helpful.

If you decide that in the event of a cesarean, you would like doula support, it is imperative that you and your partner take the necessary steps to ensure that the doula is allowed into the O.R. (the anesthesiologist on-call is the person who makes this decision—most love doulas in their O.R. because patients are so much more relaxed and confident, but some are not familiar with doula support and resist or even refuse it (you can kindly remind them that doulas go into O.R.s all the time— there are some doulas who only attend cesarean birth). Include the preference for doula support in the O.R. in your Birth Wish-List (see previous blog post) should a need for a c-section arise and talk with your care providers about this preference in advance and at the time of labor so that everyone is on the same page. If you find yourself in a situation where you need a c-section and you are told that the doula is not allowed into the O.R., remember that a doula cannot speak on your behalf, so you must advocate for yourself and insist that she be allowed in with you. Here are some statements that work very well in getting a doula into an O.R. with a hesitant or resistant anesthesiologist (remember, *YOU* are in charge— be adamant, insistent, and emotional, if necessary): “This is my support person, and I NEED her in the OR with me” or “I cannot do this without her. She must be in there to ensure continuity of my care.”

I truly believe that every birth is beautiful, including caesarean birth. Though uncommon, it is possible to have an empowering, satisfying cesarean delivery, but this requires preparation and adequate support. When it comes to birth, prepare for the best (envision your dream birth all the time), but also be prepared for unanticipated circumstances and turns— and, as always, hire a doula who supports all types of birth.

**Ellie Lindenmayer provides birth doula services to the north shore of Boston, the greater Boston area, and seacoast New Hampshire.