I originally wrote this as a presentation to a Doula group, but I missed that meeting to (ironically) support a cesarean birth! So, a blog post it shall be!
Here are some steps to successfully supporting cesarean births:
First, Educate Yourself on Cesareans.
1. The Rates of Cesareans
The cesarean rate in America was 32.4% in 2023, or about 1 in 3 Moms. One-third of all Moms is a pretty significant number!
What should the rate be?
WHO considers a 10-15% cesarean rate to be ideal.
In 1970, the US had a 5% cesarean rate.
The Farm in Tennessee (made well known by Ina May Gaskin) has a slightly less than 5% cesarean rate even today!
2. The Risks of Cesareans
Infection: 5-15% (less with sutures instead of staples)
Transfusion risk is higher than with a vaginal delivery.
Blood clot risk is higher than with a vaginal delivery.
Side affects of medication:
-Antibiotics- affects gut flora
-Pictocin- increases risk of PPD and PPA https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310833/
-Anesthesia- disconnect from birth, difficulty breastfeeding
Injuries to Mother: bowel and bladder- increases with subsequent pregnancies, along with risk of uterine rupture, and placenta accreta (40% of Moms with 3 cesareans or more will experience hemorrhage or accreta).
Injuries to Baby: scalpel nicks, brachial plexus, neck injuries, broken clavicles, broken bones (In the study Term Breech Trial, injuries happened more often during breech cesarean births than in vaginal breech deliveries.) https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)71319-2/fulltext
Post-Surgical Pain- immediate and chronic pain from adhesions and scarring. Scarring could also affect fertility in the future.
Difficulty finding a VBAC supportive provider in future pregnancies.
Increased possibility of breathing issues, and baby needing respiratory assistance (baby isn't squeezed through the birth canal).
Higher Maternal Mortality Rate- 5× greater than vaginal delivery.
Second, Educate Your Client. (On birth in general!)
1. Childbirth Education may decrease the risk of cesareans by 20% for First-Time, Low-Risk Moms.
Learning about the birthing process prepares Moms, demystifies birth and leads to greater confidence. It can also decrease the incidence of requested cesareans by reducing anxiety, and providing important knowledge about the risks. So many times, when cesareans are discussed among peers, it is implied as being the risk-free choice, when in reality it may be the higher-risk choice in many situations.
If you don't offer birth education, refer it out! Birth education can also help Mothers discern the difference between necessary and unnecessary reasons for induction or other interventions that could lead to a greater risk of cesarean.
Never be afraid to refer your clients to other birth experts such as pelvic floor therapists, maternal mental health therapists, IBCLCs/ CLCs, or birth educators! We work as a team for the same end goal!
2. How To Discuss Cesarean Birth Choices With Your Client:
Don't have a set idea of how support will look! Even without the perspective of cesarean birth, make sure that you're supporting your clients as the unique individual that they are, and not just trying to do things in the most comfortable way for you.
Ask questions to see where a client is at when they decide on a cesarean (or any other major decision) instead of making statements/stating facts. Don't just try to educate them into what you feel is a better decision. Work towards understanding their decision for themselves so that you can serve them in that capacity.
Offer support outside of the OR. A lot of hospitals will not allow an additional support person besides Dad into the OR. Remember: Cesareans are births, but they're also surgeries requiring a sterile field.
Some tips for advocating to be in the OR:
Client has to personally express a desire for your presence. (suggest that they request you) The anesthesiologist typically determines who is present.
Help Mom and Partner process their emotions before the surgery. This may be especially useful if cesarean delivery is a new development. Mothers may need someone to talk to, and to grieve the loss of their original birth plan. Although permission to grieve isn't necessary, validation that grieving isn't petty or selfish can impact a mother's thought process greatly.
Offer to help Mom form a gentle/family- centered cesarean birth plan if there is time and one isn't created yet. I have started the practice of going over gentle cesarean birth plans briefly in prenatals, and helping all Moms create one as a "just in case" before birth with my doula clients.
Gentle Cesarean Birth Plans can include:
• No students in the OR. • No monitoring equipment blocking Mom's view of birth or baby. • Not strapping Mom's arms. • Music of Mom's choice playing in the background (can be especially beneficial for spinal anesthesia placement). • Requesting staff only speak about the birth. • Requesting step-by-step explanation throughout procedure. • Clear or lowered drape so parents can witness birth. • Most VBAC-friendly incision requested (called a low, transverse incision or horizontal incision).
• Requesting no additional relaxation medication. • Requesting sutures instead of staples (this can cut the risk of infection in half). • Delayed cord clamping. • Dad cut cord through drape. • Only wiping vernix from face for breathing purposes. • Immediate skin to skin with Mom or Dad in the OR. • Keeping the placenta. • Delaying newborn procedures like weight and length until recovery so that Mom can be involved more. • Photos/videos taken by the additional support person or a nurse. • Breastfeeding as soon as possible. • Baby carried to recovery skin-to-skin by Mom on bed. • Opting out of any newborn procedures (just like any other birth process) such as erythromycin, Hepatitis B vaccine, Vitamin K shot, circumcision, or bath. • Baby staying with parent at all times.
One resource that I feel is beneficial to parents and doulas is Penny Simpkin's paper called "Ideas For The Best Planned Cesarean Possible".
Offer to arrive at the hospital and stay with the parents before and after the cesarean, even if you are not allowed in the OR. You can take this time to help ease nerves, walk them through the process of the day, and move belongings to recovery if needed. You can also be with mom in recovery if Dad needs to accompany baby to the NICU.
A cesarean birth can be empowering with the proper preparation and support!
If you need help supporting your client, don't be afraid to lean on the medical staff. They most likely have a lot more experience than you in this area, and would probably be happy to help.
Lastly, offer to make yourself available for extra postpartum support. Recovery from a major abdominal surgery is hard, and Moms need time to heal.
More Resources For Cesarean Information:
Podcasts:
Websites:
I hope this blog post empowers doulas to support cesarean births well, and encourages any Mom that my read it as well, in knowing that you do have choices, even with a cesarean birth.
Until next time! ♡ Bethany
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