Supporting Families through Cesarean Birth and Recovery

It’s International Cesarean Awareness Month, and given the current cesarean rate, I think it’s a pretty safe bet that pretty much all doulas will support someone having or recovering from a cesarean birth at some point in their career. I’ve assembled some helpful tips for birth doulas and postpartum doulas who are supporting families through a cesarean experience.

Tips for birth doulas supporting parents through an expected cesarean birth:

  • Don’t be judgemental of the choice for a cesarean – I don’t mean don’t let your judgement show, I mean truly don’t BE judgemental. That’s harder than it looks, and important for the family. Remember that you may not know everything the care provider knows about the situation, and families may not disclose everything to you, either. And that’s okay. They don’t have to. Trust the families you work with to make good decisions, and don’t expect them to justify those choices to you.
  • Talk to them about options – You don’t want to make promises, because things can change on a dime at the hospital, but talk to them about things like being able to play their own music, having a drape they can see through, doing skin to skin in the OR or recovery room, and having you present.
  • Supporting them is not about “getting in” – Yes, the family could benefit from your presence in the operating room, but it’s not all about that, and if you fight to get in it could make things harder for them with the staff. You can successfully support someone through a cesarean birth without being in the operating room. If your client wants you to be there, it’s up to them to advocate for it, as they are the customer.
  • Take your cue from the parents – They may be angry and upset about the cesarean birth, but they might not be! Don’t treat a change in birth plan as a tragedy or jump to the conclusion that it is going to be traumatic. Parents might be at peace with the change, and not all cesareans are trauma.
  • Help them know what to expect – If they have questions about the surgery, the recover, etc. help them understand. If you don’t know, help them develop questions to ask their care provider or hospital so that they have as much information as they want.
  • Plan to be with them at the hospital from admission to postpartum – This will be likely be much longer than you think. I’ve spent over 8 hours with a family for a planned cesarean. The surgery might only be an hour or so, but the entire process is much, much longer. Planned cesareans often get bumped back for emergent situations. This is one reason I don’t charge less for planned cesareans.

If your client has an unexpected cesarean:

  • There may or may not be time to talk about options. – If the staff is rushing around trying to make it happen fast, let it go. If there isn’t a sense of urgency, ask if there’s time to talk about options.
  • Ask ONCE about coming back to the OR – Again, it’s not about you. Don’t delay or distract what needs to be done debating with staff. If you’re not in the OR with your client, here are some other things you can do:
  • Stick around to support postpartum – Depending on the hospitals in your area, you may be able to be with your client in immediate recovery. Even if you are not at your client’s side, knowing you are there for them can be vital. You do not want your client to feel abandoned because the birth plan changed.
  • Support any other family members who may be waiting – You can help grandparents or other family members who are nearby while you wait. They may need help understanding what’s happened and why, and might need help processing their own fears. You can also recommend things they can do to help during recovery.
  • Be prepared for processing the experience after birth – Listen, listen, listen. Take your cues from the client. Process when they are ready. I’ve had clients reach out to me YEARS later to process emergency cesarean births.

If you do get into the OR:

  • The hospital will bring you something to wear in the OR. This usually includes either a paper gown that goes over your clothes or cloth scrubs to wear instead of your clothes. Also a hair-catching hat, booties to cover your shoes and a mask to cover your face. The mask may or may not have a clear plastic splash guard to cover your eyes.
  • Their arms may or may not be strapped down. In my experience, that was a lot more common 10 years ago than it is now.
  • There will be a blue or green drape placed between their face and belly. This drape may be placed above the arms or below the arms, I find it varies by hospital. Some drapes are solid and prevent a view of the surgery. Some drapes are clear or have a clear window so that they can see. Ask your client what they want.
  • Don’t be surprised if the doctors doing the surgery have to do a surprising amount of tugging and pulling to get the baby out of the small incision. Did you know there are two? One main surgeon and an assisting surgeon. Usually a second OB, but I have seen two CNMs assist as well.
  • Stay where you’re told. Generally the anesthesiologist is sitting next to your client’s head, and her job is to monitor vital signs, pain levels, and take care of any needs your client has during the surgery. There is usually a round stool or chair on the other side of the operating table where the partner will be. There may or may not be a second chair for you to sit on.
  • A good rule of thumb is to never touch anything that is blue or green, or is resting on a blue or green cloth or paper. These colors in a hospital designate sterile fields, and you are not sterile.
  • Ask before taking any pictures – In some places and situations this would be okay. In others, very much not. Ask and respect the answer.
  • Stay focused on support – It’s easy to get fascinated with what’s happening. To watch the surgery instead of paying attention to the person giving birth. This is especially true if the surgeon likes to explain things to doulas!
  • What if I am squeamish? There are two options. One is to decline going back to the OR. The other is to do your best. Before you go back, eat something with complex carbs and protein (like a granola bar or some yogurt) so your blood sugar remains steady and doesn’t compound the issue. The average blood loss with a cesarean birth is twice what you’ll see with a vaginal birth, and the incision itself may be tough to see. Some hospitals use a scalpel that uses heat to make the incision, so there may be a smell of burning on top of the smells of blood and amniotic fluid. If smells tend to bother you, rub a little mustache of Vicks VapoRub under your nose right before you go back, and that’s all you will smell!

Tips for supporting parents through recovering from a cesarean birth

  • Be familiar with the discharge instructions from the hospital and encourage your client to follow them.
  • If your client is breastfeeding, teach the sidelying and football holds to keep pressure off the incision.
  • Help your client to get as much rest as they need – keep older children quiet, anticipate needs and create space for rest. Set up a safe space for the baby within arm’s reach, and make sure diapers and other supplies are close at hand.
  • Also, help your client move as much as they need. If you client needs an arm to lean on to walk to the restroom or come to the table for a meal, be there for them.
  • Watch out for red flags and encourage your client to get help if something comes up.
  • Have a good working knowledge of community resources in case they become necessary. Physical therapists, lactation specialists, counselors, parenting support groups, anything that can help with recovery.
  • Don’t push VBAC unless your client asks about it. It’s too soon.

Above all, remember that cesarean birth IS birth. Parents experiencing a wanted or unwanted cesarean get plenty of criticism and judgement and it’s important to be aware and careful you don’t unintentionally add to that or give credence to their own inner doubting voice. Support the parents and build confidence in their abilities.

Doulas can make such a positive difference for families birthing by cesarean, and given how common it is, it’s a good idea to be prepared.

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