8 Key Ways Doulas can Support Cesarean Births
In my time as a full-spectrum companion (the word I prefer to use “companion” instead of “doula” and here’s why), I’ve supported several families through both planned and unplanned cesareans. Sometimes folks wonder “Why do I need a doula if I’m having a cesarean?”, and I’d like to offer some perspective as a caregiver and space holder who has witnessed folks through this transition.
This blog is for other birth workers, as well as birthing families who are preparing for their birth journey.
8 Key Ways Doulas can Support Cesarean Births
Some cesarean births are scheduled, while others are unplanned. Still others are emergent. The ways the following supports look will vary depending on the nature and circumstances of the cesarean, as well as your unique needs and preferences. Below are several ideas for you to consider:
Help the client create birth preferences and communicate to their birth team. While operating rooms (ORs) definitely have certain protocols and procedures, there are some parts of the experience that can be personalized and accommodated to meet the birthing family’s needs and preferences. You may have heard of gentle cesareans, and these are things birthing families and doulas can advocate for, including walking to the OR, playing music of your choice, lowering the drape or using a clear drape to witness baby as they’re born. If this is a planned cesarean, the family can review their preferences with their provider ahead of time to get clear on what the hospital/provider is comfortable with. If there are elements they are uncomfortable with, the companion may help the client find evidence and work towards advocating for their needs and preferences. For folks who are preparing for a vaginal birth, it’s beneficial to discuss the possibility of a cesarean, as well. This can increase the client’s sense of autonomy, safety, and choice if a surgical birth becomes a recommendation or necessity.
Discuss and describe the steps/parts of a cesarean birth. Clients often tell me that these discussions have been comforting and supportive. They have felt more prepared knowing what to expect. My friend and colleague Carly shared this video with me that is a helpful resource for this conversation. (Note: use of gendered language.) We discuss some things like the following: the sensory elements (it will be cold and bright, for example), potential side effects of the medication + homorone shifts (like shaking or nausea), the people who will be in the room + their roles, a general timeline (folks are pretty surprised about how fast baby is born from the beginning of surgery), navigating skin to skin after birth, and the transition to recovery space + first feed.
Be present in the OR.* I have found this role to be massively valuable to families. If the baby is taken to the warmer and the birthing person has a partner(s), they often want the partner to go with baby. In this case, the companion can stay with the birthing person, narrate what’s happening with baby and partner, facilitate the sharing of a photo or video of baby on a phone, hold their hand, stroke their head, offer words of affirmation, etc. A companion may also help elevate your voice if you are feeling unwell and need the anesthesiologist to offer medical support or to advocate if there’s a preference that’s going unmet. *This is, of course, dependent on the hospital policy, and this is something clients should ask their provider about prenatally.
Support in recovery/postpartum. In some hospitals, the birthing person will be transferred to a specific recovery room, in others they will be transferred back to a L&D room, and in some cases, they may be transferred to postpartum. Regardless of location, the companion can support skin to skin and the first feeding (however the family is choosing to feed). This may also be a time to take some photos of the family. As the birthing person is recovering, they’ll need to resume drinking and eating slowly. Often this means beginning with ice chips, moving on to sips of water, then juice and broth, and eventually easily digestible solids. The companion can help facilitate hydration in recovery, offering sips every several minutes and checking in to see how the birthing person is feeling.
Provide logistical support. This can include moving belongings from one room to another, texting or calling loved ones with updates, picking up food for partner(s) (as the birthing person won’t be able to eat for several hours). If the companion is unable to go to the OR, they may be able to prepare the postpartum room and get the birthing family’s items set up before the family arrives after birth.
Offer space for birth processing. Birth is a big transition! Talking about the birth (as the client is ready), can be a helpful way to honor and remember the parts that felt special, as well as the parts that felt difficult and everything in between. Sometimes birthing families have questions about parts of their birth that a companion can help answer. Additionally, I’ve often noticed that folks who are partnered have not had the time to process the birth together, and I can help facilitate that, such that they each get to hear how their partner(s) experienced the birth.
Make relevant referrals. It is entirely wild to me that in some cases, birthing people don’t see their OB until 6 weeks postpartum. Recently, clients have had 2 week check-ins with their OB after surgical births, but I don’t think this is standard practice yet. That said, depending on the client’s support system, there may be a limited number of folks they’re touching base with during early postpartum. Companions help clients connect the dots between needs they have and other service providers or resources from lactation, to parenting groups, to mental health support, and so much more.
Other circumstances. There are tons of other ways a companion can step in and bridge gaps. If the birth is a surrogate birth or adoption, for example, the companion can offer emotional and informational support to the non-gestational parents throughout the process as well. In the case of a loss, a companion can support the family in creating rituals and honoring the birth in ways that feel supportive to them.
Let’s Stay in Conversation
These are some of the ways I have shown up for clients who have birthed via cesarean. I’d love to know what else has been helpful for birthing people, as well as what other birth workers have noticed about cesarean support. It’s through open dialogue and processing that we can help one another grow and heal and navigate the complexities of life transitions. Feel free to reach out here!
If you’re a birthworker or someone who's interested in training as a full-spectrum doula, check out BADT’s 12-week training here!
Courtney/“Court” (they/them) is a witness, space-holder, supporter, and caregiver for families of all types and in all stages. They have served youth and their families since 2008. Court is passionate about honoring life’s transitions, and they believe that all birthing people deserve compassionate, steady, and informed support throughout their unique reproductive journeys. Court works with a wide range of clients, including folks who identify as highly sensitive, queer, trans, polyam, teens or young parents, and fellow caregivers.
As a full-spectrum companion, Court is proud to elevate the voices and needs of each client they have the honor of serving. They are dedicated to inclusive, anti-oppressive work both in their personal and professional relationships and in the systems they live and work in.
Outside of birth and coaching work, Court loves spending time with family, friends, and their cats. They can often be found swimming or walking, scrolling TikTok, or writing.