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Q: Can a doula help me if I am planning a cesarean birth?

Skylar VanSteemburg

Some of the questions that we receive most often during consultations involve doulas and an upcoming planned cesarean birth: Can a doula actually help me if I am planning a cesarean birth? Will I benefit from doula support when my birth is so straightforward? Is it really worth it to have my doula there?

The short answer: We sure think so! We believe that no matter which way your baby arrives into this world, you deserve compassionate support, full bodily autonomy, and informed consent -- even when there are a few more “knowns” in terms of the actual birth plan.

Here are three reasons why doulas can be vitally helpful in the event of a planned cesarean birth:

1. Sometimes cesarean wasn’t always the plan. 

Some folks have always known that they would need to birth a baby by cesarean due to a pre-existing medical condition, or simply a preference to birth by this method. For folks who have been planning a vaginal birth, it can be a huge change of plans during pregnancy when a cesarean birth becomes medically necessary. Whether you've always known, or this is the new plan, cesarean birth can bring up a lot of feelings like fear, anxiety and shame, as well as joy, excitement and anticipation. As doulas, one of our most important jobs is to walk through that emotional journey with you. We are here to listen to your fears, we are here to comfort you and validate you, and we are here to make sure that you have as much information as you need to make the decisions that are right for you, your body, and your baby. 

2. You still have options.

Did you know that you can still create a birth “plan” for your planned cesarean birth? Depending on where you live and at which hospital you are birthing, you can still make decisions about how you want your birth to be. Many hospitals offer Gentle or Family-Centered cesarean birth, which can sometimes include delayed cord clamping, immediate skin-to-skin and initiation of breastfeeding while you are still in the OR. Would you like to watch the birth of your baby? You may ask if the surgeon uses a clear drape, a drape with a window in it, or if they are able to lower the drape so you may see your baby be born. You may also request that they angle a mirror so you can watch! You may be able to bring your doula and/or birth photographer into the OR with the permission of the team administering your care. These are all questions and considerations that you may discuss with your doctor and your hospital before the birth of your baby. Check out your options! Luna Doulas offers a prenatal planning session that can be tailored to exploring these questions and choices.  

3. Postpartum recovery and healing can be challenging after cesarean.

One of the most significant challenges to cesarean birth is the postpartum recovery and healing period. There are many physical and mental needs to be considered at this time, including the healing if your incision site, the limit on how much weight you can lift or carry, an extended hospital stay, managing pain and discomfort as you heal from the surgery, finding a comfortable position for feeding, and ensuring that you rest as much as possible. This can be very challenging alongside caring for your newborn. With Luna Doulas, not only will we be there, at the hospital, before the birth of your child by cesarean, but we can stay as long as you need us after the birth so as to address these questions and concerns. We also offer comprehensive in-home postpartum support as you transition back home after the birth. We act as another set of hands to help around the house, and as an open set of ears to provide you with compassionate, considerate postpartum support.


Luna Doulas believes that cesarean birth is birth, after all! Just because you are planning a cesarean birth does not mean that you automatically lose your rights to informed consent and a happy, satisfying experience. We will be with you every step of the way, no matter what type of birth you are planning!

 

What's the Evidence for Doulas?

Skylar VanSteemburg

At Luna Doulas, we often talk about how we as doulas are there to help you make informed choices for your pregnancy and birth; to be a compassionate, non-judgmental sounding board for your concerns; to assist you in preparing for labor and creating personalized birth plans and intentions; and to offer hands-on comfort measures and support during labor.

But those aren’t the only benefits to having a doula. In fact, studies have shown that doula care can have a significant positive impact on birth outcomes! According to the American College of Obstetricians and Gynecologists, “one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula.”[i]

In honor of World Doula Week, here is some of the evidence for doulas.

Lower Rates of Cesarean Births

·       A 2012 Chochrane review of 22 trials involving over 15,000 women* found that, when they had doula support, women experienced a 28% decrease in the risk of cesarean birth.[ii]

·       Another 2014 study showed that the odds of non-indicated cesarean births were 80-90% lower among women who had doulas, and were 60% lower overall.[iii]

·       Doulas can also increase the chances of a successful VBAC.[iv]

Fewer Interventions

·       Overall, women who have doulas have fewer interventions throughout labor and birth. For example, the Cochrane review showed that women with doula support experienced a 31% decrease in the use of Pitocin and a 12% increase in the chances of a spontaneous vaginal birth. [v]

Decreased Use of Pain Medication

·       Doula support can be especially helpful for those who hope to have an unmedicated birth. The Cochrane review found that, with the support of a doula, women were 9% less likely to choose medications for pain relief.[vi] Rebecca Decker of EvidenceBasedBirth.com goes so far as to say that “doulas are a form of pain relief.”[vii]

Shorter Labors

·       Most people would prefer to have a shorter labor rather than a longer one! Interestingly, studies have found that doulas are beneficial here as well – one study showed that, with doula support, labors are as much as 21% shorter.[viii]

Greater Birth Satisfaction

·       As doulas, we do everything we can to support our clients’ goals and ensure that they have a positive birth experience. The evidence shows that we’re on to something! Based on a study of almost 10,000 women, those who had doula care were 27% less likely to be dissatisfied with their births compared to those who didn’t work with a doula.[ix]

Dr. John Kennell famously remarked, “If a doula were a drug, it would be unethical not to use it” – and after reviewing the evidence, we agree! However, it is important to note that we as doulas can neither guarantee certain results, nor are we responsible for the outcome of any labor and birth that we support. In addition, it’s vital to have a knowledgeable and reliable health care provider(s), such as a midwife or an OB, who is aligned with your goals for pregnancy, birth, and postpartum. Still, it’s exciting to see how the simple act of including doulas in your care team can transform your birth experience.

To learn more about how Luna Doulas can support your vision for your birth, contact us today to set up a complimentary consultation!

 *Please note that we exclusively use the term “women” here because this is the terminology used in the studies we’re citing. However, any birthing person can benefit from this information and from doula support, regardless of gender identity, and Luna Doulas remains committed to inclusivity.

References

[i] American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. “Safe Prevention of the Primary Cesarean Delivery.” American Journal of Obstetrics and Gynecology, March 2014. Web. 

[ii] Hodnett, Gates, Hofmeyr, and Sakala. “Continuous Support for Women During Childbirth.” Cochrane Database Syst Rev, October 2012. Web.

[iii] Kozhimannil,Attanasio, Jou, Joarnt, Johnson, and Gjerdingen MD. “Potential Benefits of Increased Access to Doula Support During Childbirth.” American Journal of Managed Care, August 2014. Web. 

[iv] Jukelevic. “Increasing Your Odds for a VBAC Before and During Labor.” VBAC.com. January 2014. Web. 

[v] Decker. “The Evidence for Doulas.” Evidence-Based Birth. Web.  

[vi] Hodnett, Gates, Hofmeyr, and Sakala. “Continuous Support for Women During Childbirth.” Cochrane Database Syst Rev, October 2012. Web. 

[vii] Decker. “The Evidence for Doulas.” Evidence-Based Birth. Web. 

[viii] Klaus, Kennell, and Klaus. The Doula Book, Third Edition. Boston: Del Capo, 2012. Print.

[ix] Lythgoe. “Playing the Doula Numbers Game.” UnderstandingResearch.com. Web.

 

Meet Sierra: Birth, Beer, and Bad TV

Skylar VanSteemburg

What is your hope for the future of doula work?

At the Colorado Doulas Association conference last year, I attended a presentation by Cristen Pascucci of ImprovingBirth.org where I learned that over 90% of people giving birth do not work with a doula. When I think about that number, I think about how there are A LOT of people that we’re not reaching – people who don’t have access to a doula, people who think that a doula isn’t for them, and people who haven’t even heard of doulas! I would like to see doulas more fully integrated into the maternal health care system so that everyone who wants a doula can have one and so that more people are aware of the evidence for doulas and how doula support can be beneficial for every type of birth. I envision: more in-house doulas at hospitals and birth centers; insurance and Medicaid coverage for doulas so that doula care is more affordable; more avenues for doulas to make a living wage and support ourselves and our families; and community doula programs specifically for underserved populations aimed at addressing health disparities.

A moment when you knew you wanted to be a doula:

When I signed up for my CAPPA doula training, I didn’t think that I was actually going to become a doula. At the time, I was pursuing a career supporting women’s human rights and women’s health through the nonprofit sector, and I thought that taking the training would add to my knowledge base about pregnancy and birth and teach me some interesting skills. But at the training, I felt a spark that I couldn’t ignore, and I also met my future business partner, Skylar – it was fate! After attending my first couple of births and experiencing how birth work challenges me, allows me to use critical thinking, intuition, and creativity, and provides an avenue for making a positive difference for my clients and my community, I knew that this was the path for me.

A challenging moment as a doula:

Some of the most challenging times I’ve had as a doula are when unforeseen obstacles emerge during a labor or birth. Things can sometimes change rapidly, which requires me to think on my feet and quickly absorb and communicate information, while also remaining deeply attuned to my client’s needs and goals. I’m confident in my ability to do this and to be calm, thoughtful, and organized under pressure, but it’s still tough!

What keeps you going/what motivates you?

Just as birth has its challenging moments, each birth also has transcendent moments. For me, that’s witnessing women and birthing people tap into their power and strength during labor and birth – making and owning the choices that are right for them and deepening their connection to their body. I believe that if you are supported, empowered, informed, and cared for during the birth process, it can be a time where you discover the fullest expression of yourself, and that can radiate into other areas of your life as well. Seeing that unfold for my clients fuels my energy and passion for this work. In addition, being there when a new life comes into the world, in all its beautiful, messy, mysterious, earthy glory never ceases to amaze and humble me, and it’s something I want to come back to again and again.

What is some advice from another doula that has helped you?

As part of my labor doula certification, I took an incredibly informative childbirth education class with Carole Robison-Brass and Julie Guarino of Macushla Birth. While we were discussing informed consent, Carole and Julie also emphasized the importance of conscious agreement and intuition in the decision-making process. After learning about this, I incorporated it into my own practice and began to take more opportunities to encourage my clients to check in with their intuition when they are weighing the many options they have to consider during pregnancy, birth, and the postpartum period. I’ve seen that it makes a dramatic difference in how my clients approach decisions, how confident they are in their choices, and how they feel when they reflect on those choices later. I’m so grateful to Carole and Julie for this great advice!

What’s your favorite part about working as a team?

I love working in a partnership because I know that we are stronger together (if you haven’t noticed, we’re really into shine theory)! Skylar and I support one another so that we can best support our clients through our unique team approach.  For me, that support means having a life outside of work, benefiting from our combined professional skills and experience, knowing that she’s there to share the joys and challenges that come with being a doula, and just enjoying her friendship!

Why Denver?

Other than a couple of years spent in New York City in my twenties, Colorado has always been my home. I grew up and went to college in Boulder and I have lived in Denver since 2010. I love the mountains, the small-town feel that Denver has retained even as it has grown, the fun arts and music scene (which I get to participate in via my boyfriend, Tom, who is in an awesome band), and being near my family and long-time friends.

What do you do for self-care?

I’m an introvert, so in order to have the energy to be a doula, I always need to make sure that I have solo time to rest and rejuvenate. For me, that usually looks like kicking back on the couch with my cat on my lap, a cup of tea or glass of wine in my hand, and my nose in a book. Other self-care measures for me include being in nature, moving my body, doing something creative, and making sure I have opportunities to unplug.

What’s something on your bucket list?

I would love to hike the Camino de Santiago, an ancient pilgrimage route through France and Spain.

If you could have a superpower what would it be?

This is a pretty superficial superpower, but I would love to be able to do something to alter my appearance (like dye/cut my hair or get a tattoo) and then have it instantaneously go back to its original state whenever I wanted.

 Favorite local brewery? 

I decided to alter this question, since my answer to the original ice cream question would be the same as Skylar’s. Luckily, in addition to delicious ice cream spots, we have tons of great local craft breweries! It seems like a new one pops up every day, but some of my current favorites are Ratio Beerworks in Denver and Sanitas Brewing Co. in Boulder.

What’s the last TV show you binge-watched?

Some of my girlfriends decided that we should watch “The Bachelor” together as a group and, while I was initially resistant, I ended up getting deeply, embarrassingly into it. It’s full of awful gender stereotypes and messed-up messages about relationships, but I’ve fallen for it just like (spoiler!) Ben fell for Lauren B.