What to Expect with a Doula-Supported C-section (In the OR)

Photo by Liz Foster Doula *Photo used with permission*

Intro

Cesarean section births can be beautiful and empowering, regardless of how we got to that decision. Not everyone wants a c-section, but for one reason or another, it is a possible option to ensure mom and baby are both healthy and safe for delivery.

Here is the rundown of what you can expect in a c-section WITH doula support!

Pre-Surgery

​So, if it is planned, there is about 2 hours of prep time before surgery, unless it is an emergency situation. During that time, your doula can support you in many ways and keep the mood light (massage your feet, play music, keep you distracted, celebrate!). The staff will come in separately at different times to introduce themselves and explain what their role is (baby nurses, anesthesiologist, OB obviously, charge nurse, etc). Any Hypnobirthing/Hypnobabies training can come in handy throughout all of this! As a birth doula, I have some great meditations on an app on my phone to combat pre-surgery jitters and we can use any meditations/relaxing music before, during and after surgery.

Your birth doula will try to ensure that they can go back there with you, but it's down to if all staff agree that it's ok for a doula to go back. Usually it comes down to the anesthesiologist. Mom and dad can help advocate in that pre-surgery space for your doula. She would greatly appreciate it! You can say, "We're not going back without our doula." If any staff also knows that they are a seasoned doula (they have worked together before), and they know where to be/not to be for a cesarean, it would be helpful. Some hospitals are just miseducated about the value of a birth doula back in the OR.

Surgery Time

Mom will go back first to have a spinal placed and staff will get the OR set up. During that time, dad and your doula will get ready in our "white bunny" suits, booties, caps and masks. A nurse come grab them when the staff is ready to begin. They move quickly, like a pit crew, once dad and your doula join mom in the OR. They will likely do a timeout, stating everyone's name and job in the room, including us. A blue drape will be up to establish a sterile surgical station at about mom's sternum.

​Once they begin the surgery, it takes roughly 5 minutes to birth the baby. There may be some uncomfortable pressure while delivering the baby, as they push on the top of mom's belly to "push" the baby out, similar to someone sitting on your chest. That's where the baby gets the squeeze to get amniotic fluid out. There may be some smells and sounds that are not delightful, so your doula can bring essential oils on Kleenex for both mom and dad. Your doula can play quiet music on anyone's phone or speaker. Sometimes, mom will experience some nausea, which can be helped with medication. I usually give dad peppermint in a Kleenex taped to his bunny suit and that seems to help.

Baby is born!

Once baby is born, there is an option to lower the drape to see baby immediately after the cord is cut, which is very exciting! One-minute delayed cord clamping is the standard in most hospitals now, but you may advocate until the cord is white and/or stops pulsating. Then, he/she will go to the warmer to be assessed. You may advocate for immediate skin-to-skin beforehand, so long as baby looks ok and doesn't need extra support. Dad can go to the warmer while your doula stays with mom. Dad and your doula can trade spots at the warmer, take photos/videos and bring them back to show mom (or a birth photographer can as well). They keep trading spots until you are all reunited behind the curtain, as mom gets put back together. Some ORs have the warmer within eyeshot of mom being able to see baby.

Postpartum Recovery

It takes about 45 minutes from delivery of baby for surgery to be completed. Baby and dad usually go to PACU before mom does, so it's nice to have your doula with mom for the remainder of the surgery. You may advocate to wait and go together, even having mom hold baby as you go to recovery. Mom will be wheeled into PACU (Post-Anesthia Care Unit) recovery room, where baby and dad are, ideally doing skin-to-skin.

Your doula can feed mom ice chips, start breastfeeding, and keep things positive. The nurse will do fundal massages every 15 minutes for those 2 hours as well, but with the anesthesia, mom shouldn't feel it too much, just pressure. Mom and dad can equally do skin-to-skin, if desirable, as mom sometimes will have the shakes post-surgery, and it can feel difficult to hold baby comfortably.

​After 2 hours in the PACU, everyone will go to the postpartum room. For those first few hours, mom will likely feel pretty out of it and may forget a lot of what happened, so it's nice for photos to be taken for memories. The nurse will make sure mom is staying on top of her meds for the pain.

A birth doula will stay for about 2-4 hours immediate postpartum, so once mom, dad and baby go to their postpartum room is when your doula typically leaves, but they can definitely stay for longer to make sure everyone is a bit more settled in and ready to rest. All babies typically fall into a deep sleep 2 hours after delivery.

In the case of TWIN/NICU Babies

For twins, dad usually goes with babies at some point, either to NICU (Neonatal Intensive Care Unit) or the PACU. If the baby/ies need to go to the NICU before mom is finished with surgery, your doula will stay with mom to keep her company. Dad can advocate for skin to skin in the NICU once babies are stable. Prior to going to PACU, the staff can wheel mom into the NICU before moving to the PACU or after 2 hours, before heading to the postpartum room. Some hospitals have a room-in NICU, where mom and dad can stay.

While in the PACU, your doula can help mom by feeding her ice chips, expressing colostrum, showing photos of babies, and keeping things positive.

If the babies are in the PACU with mom, they can do lots of skin to skin with mom and dad, and even tandem breastfeed.

Surgery Recovery Tips

Recovery will be substantially more intense compared to a vaginal birth, due to major surgery. Getting your baby properly latched as much as possible will ensure success in your breastfeeding/pumping journey. When pumping, look at your babies' photos, smell their clothes/hats/etc.

Tips for recovery for the first few weeks:
- Wear high rise undies
- Wear a belly band for 8 hours/day during the daytime
- Avoid heavy lifting and stairs
- Be religious about taking pain meds, gas meds, and stool softeners on time!
- Get an ice pack in the shape of your incision (alternate heat and cold)
- Get a step stool for getting up and out of bed
- Roll out of bed still, so as not to use those abdominal muscles as much as possible
- Get one of those long-reach grabber tools for reaching things when breastfeeding/pumping
- Have water and one-handed snacks beside you at all times, especially during breastfeeding/pumping
- Place and hold firm touch to a pillow on your incision area when you need to sneeze/cough or when you laugh or cry (have it nearby!)
- Have LOTS of help during those first few weeks as you recover (ask your birth doula about a postpartum doula in advance for those first few days/weeks)

Cesarean Section Options

Some things to discuss with your provider, if they are open to these options:

• No drugs to relax for surgery (more conscious)
• Dim lighting, with the exception of surgical lighting
• Music in OR
• Clear drape for viewing baby being delivered
• Delayed cord-clamping until cord is white/stops pulsing
• Placenta be saved
• Immediate skin-to-skin (mom or dad), so long as baby is healthy and doesn't need support from medical team
• Essential oils for calming/dissolve unpleasant smells
• Baby be breastfed in the OR
• Ask your doctor for a vaginal swab. When a baby goes through the birth canal during a vaginal birth, he or she is exposed to a plethora of microbes that help build a healthy microbiome. With a gentle caesarean, your doctor or midwife can collect a vaginal swab and wipe it on your baby’s skin and in his or her mouth. Another option is to take a swab of your vagina and wipe it on your nipples before baby breastfeeds.
• Ask staff to refrain from "shop talk" during surgery
• Baby be held by mom while being wheeled into PACU
• Any and all usual post-birth procedures such as cleaning the baby and weighing the baby are delayed until parents are ready
• A doula, grandparent, or friend are permitted to photograph the birth so that parents can concentrate on bonding (most hospitals will not allow videography)

Final Thoughts

I completely understand that everything can be overwhelming at first, but this is for your benefit, to learn new things and grow from a new steep learning curve. Embrace the insanity of it all! Take things minute by minute, LITERALLY, as you endeavor a beautiful and new incredible adventure as your family grows.

Hope this helps!

Photo by Liz Foster Doula *photo used with permission*