Doulas and Caesarean birth

Stereotypes and assumptions mean that a lot of people associate doulas with home birth. They see doulas as the choice of people who are hypnobirthing or planning to birth as undisturbed as possible. We do absolutely support those births and love doing so but support and information is not reserved only for those women.  In fact those that have more complex pregnancies and are planning a more medical birth such as an elective caesarean or induction maybe need that support and information even more. Trying to negotiate your way through the maternity services and make informed choices in complex situations can be scary and overwhelming, a doula can accompany you on that journey, signposting to information and evidence, holding your hand during appointments, holding space, listening with open ears, facilitating conversations and ensuring your choices are respected. 

So let's break this down,
Before birth 
If you book my birth support package you get up to 5 antenatal sessions during your pregnancy, these can be at your home or support at medical appointments. What can I offer you during these sessions if you already know you will be planning an elective caesarean? 
Information and evidence- If your pregnancy is complex or you have multiple considerations there may be lots of complicated evidence and information, a doula can help you understand this and signpost you to places where you can access more specialised support. A doula can also help you understand your rights. What are you "allowed" to request? Understanding how important consent is in every birth situation. Ever heard of a gentle caesarean? A doula can help explain what this means and explore the evidence behind it, support you to understand the evidence for skin to skin and the microbiome. 
Support at medical appointments. Whether you are planning a maternal request caesarean birth and need support ensuring your choices are respected or you are advised to have an elective by your medical caregivers, there will be appointments to discuss your care and options. As your doula I can accompany you to these and support you, help facilitate conversations in a multidisciplinary meeting, ensure you and your partner fully understand what is being discussed and that you are at the centre of decisions made about your care. 
Having someone that you can call and know they will be there to listen can be a great comfort. 

" ​Nicki helped us through consultant appointments and was always on hand to support us on the phone, or by text messages and email before and after midwife appointments and growth scans. We always felt like we were fully informed as Nicki made sure we had all the information we needed and was always on-hand if we had any questions. 

Knowing that we had someone to ask and who was there to support us gave us the confidence we needed to navigate our way through tough times when the news was not good. As the pregnancy progressed we experienced more of these tough times, potential low lying placenta, questions around whether I had Gestational Diabetes again and then concerns over the baby’s size being large for gestational age. Nicki helped us to understand the implications of all of the scan results and prepared us for the impact they might have on our birth plans with lots of evidence based information. " 

On the day of caesarean- You will likely be asked to come to hospital at a set time, having not eaten for hours and then have to wait on a ward until your time in theatre comes. This may be delayed due to emergencies. As a doula I can meet you at the hospital and accompany you to the ward, get you settled, ensure your comfortable in your surroundings, help you stay relaxed as you wait and support you to ask any questions you have and communicate your choices and birth plan. Things such as ensuring your cannula goes in your non dominant hand or ecg dots go on your back. I can also make sure there is a clear note that you want to keep your placenta before going into theatre and support your partner at this anxious time. 

" Planning our gentle section out with Nicki and our consultant ahead of the day meant that when the time came we could be confident of achieving the positive birth we needed after the experience of our first birth. "

During the birth  Having a doula in theatre with you gives you the continuity of having a familiar friendly face at all times, for you and your partner. Your doula can support you while you are getting the anaesthesia, hold your hand, set the scene with music, explain to you and your partner what is happening, take pictures, protect your immediate space once baby is born to allow you skin to skin and bonding by having conversations with staff in theatre so they do not need to interrupt you with questions. Many hospitals have 1 birth partner rule in theatre but it is important to understand this is only a guideline not the law and every hospital should be willing to have a discussion and do their best to facilitate your choices. I know many doulas who have supported births in theatre including myself.

"  ​It was important to us that Nicki attended theatre with us but we knew beforehand that hospital policy meant that normally only one person would be able to accompany me in the operating room. My husband had struggled with some of the things that happened during my previous Caesarean section and it was because of this that we needed Nicki there to support us and act as an intermediary explaining the process and reassuring us both. Through the grace of the clinicians attending and prior discussion of the importance of Nicki’s attendance with our consultant, this was something we managed to achieve.

Nicki made a huge difference to our experience in theatre. She supported me when it was difficult for my husband to, she helped him to relax and above all she gave us both the space we needed mentally to cope with the situation. "

In Recovery Immediately after theatre you will be transferred to a recovery room. You will still be under the effects of the anaesthesia so wont be able to move your legs for a while, You will be having very regular monitoring and be hooked up to BP machines, drips and an ecg etc. A theatre nurse and midwife will be there to look after you and your baby and ensure you are medically recovering form the surgery. A doula can help look after you emotionally at this point, the staff will be very busy and concentrating on notes and observations. A doula can support you to feed your baby and protect your space while you and your partner continue to bond. 
If your baby has had to be transferred to NICU a doula can stay with you while your partner goes with your baby or vice versa. A doula will support you to express if needed and ensure your wishes for your baby are respected. 

" Nicki knew from all of our conversations how important it was to me that breastfeeding was established as soon as possible and so as soon as we were settled in recovery she helped me to latch our baby on for the first feed. Despite it being a very long day Nicki stayed with us in recovery as long as we needed and only left after we were all comfortable and content. "

Postnatally -   In the days and weeks after birth things can be a little crazy, in the short term staying on the postnatal ward after major surgery can be tough, a doula can visit you or stay with you if your partner needs to go home. In the longer term a doula can be a friendly face and source of encouragement when needed, your doula can support you at home as much or as little as you need. Offering feeding support and signposting to services or information. Talking to you about what is normal and realistic expectations of recovery. Reminding you to take your time and enjoy these early moments as much as possible. Some doulas also offer more practical support such as cooking or cleaning. Emotionally having someone there that you know you can call or ask any quesitons can be very reassuring especially once discharged form midwifery care. 

"  After a five day stay in hospital and all the normal checks I found myself discharged from midwifery care within two weeks. It was very hard to sever the link with my care team and I was anxious about it as I was still recovering from my surgery. Nicki however remained on hand through out everything and the friendship and advice she gave us during the postnatal period made us feel secure and confident about facing the next stage. "

" We are so glad that we hired Nicki as our doula. She has been an invaluable source of comfort, information and support. Nicki helped us to form the relationships with our clinicians that led us to have the positive birth experience we wanted. Had we not had Nicki’s help to find our way through the appointments and clinical guidelines we could easily have faced a traumatic birth similar to our first experience. Nicki’s quiet and unassuming guidance through everything gave us what we needed to feel informed and empowered to ask the right questions and make the right choice for us. So now when people say to me that a doula is not for them because they are having a hospital birth or a Caesarean section I respond with that’s exactly the reason why you need a doula all the more."
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If you are thinking about hiring a doula and want to find out more about what we do you can check out Doula uk 
​If you are interested in hiring me you can find out more on my services page. I have lots of experience working with more complex pregnancies and am confident working in multi-disciplinary teams alongside specialist midwives and consultants. 

I want to say a huge thank you to Bridie and Steven for letting me use their pictures in this blog an for Bridie's amazing words that are quoted throughout.