Being a Doula for Scheduled C-section. Any suggetions? - Mothering Forums

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#1 of 14 Old 07-10-2006, 02:38 AM - Thread Starter
 
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I have been asked by a friend to be her doula. She is planning a scheduled c-section. This is her second c-section; the first was emergency, so she is scared about birthing vaginally, since her first birth was so traumatic and scary. I know as a doula it is my job to educate her on the risks, etc. But, my ultimate job is to support her as a pregnant mom. I would love suggestions of how I can be useful for her pre-op and post-op.

I had an emergency c-section (it was actually going to be a scheduled, but got complicated), and I was so grateful that my doula was there. However, I was under GA, so I know my situation is different than hers, and would love ideas.

What we have so far: I will be there pre-op, to reassure her and Dad. Post-op, Dad will be with baby until baby joins Mom, so I will be with Mom quietly in a corner if she needs me for anything, or if she wants me to call ppl, etc.

I wish I didn't have to put this, but please, no flames. This is a decision she came to with her doc and hubby. I have talked to her about her options, and she still may change her mind. BUT that is her choice to make.
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#2 of 14 Old 07-10-2006, 03:05 AM
 
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make sure that the hospital knows that Mom and Dad plan to have a second support person in the op room. Some hosp/OB/anesthiologists won't "allow" this. I would make sure she knows what exactly is going to happen. An emergency cs can be diff from a planned cs. Go over what happens during a surgery. Make sure she knows the epidural/anesthia (sp?) process. Go over how she can have a family centered cesarean. Mirrors if she would like to see the baby come out, baby not taken away, arms not strapped down, catheter in after epidural, mom shave herself before she comes in. The list goes on and on. If mom wants to BF baby goes with her to recovery and make sure no bottles/pac. Also make sure she knows that every birth is different. Just because she had one experience does not mean that the second would be like that. Also no bath/other procedures (vax, eye ointment, etc) for baby until he/she can meet mom.

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#3 of 14 Old 07-10-2006, 03:15 AM
 
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She can also ask to bring her own music, that the doctors explain in detail what is going on, if she wants, that general chit chat is kept till after the birth.
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#4 of 14 Old 07-10-2006, 09:38 AM
 
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Helping her continue to process her first birth will help too. I really like An Easier Childbirth: A Mother's Workbook for Health and Emotional Well-Being during Pregnancy and Delivery by Gayle Peterson. You need to get the workbook. I loan it out to my clients who have had traumatic births. You could read up on some of the PTSD stuff out there. Polly Perez has spoken on the topic, you might be able to get one of her tapes?
Wonderful that you are there to love on this mom.
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#5 of 14 Old 07-10-2006, 10:30 AM
 
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I just doula'ed for two scheduled c/s this week. (OK, don't get me started that this doc scheduled two primary c/s on the same day, how convenient! She had my clients terrified of their big babies, but that's a rant I won't go into right now).

Have you been in a c/s before? It was actually helpful to me to be able to tell them, step by step, exactly what would happen prior to going in. The staff doesn't mention things like the fact that their hands will be strapped down, or that mom has to go in for anesthesia quite a while before her support is allowed in, or that if she feels like she needs to vomit, it's normal and to tell us.

Once dad and I are in the room, I let him sit at her head, and I take some pictures of them (just their faces, close together) and encourage them to talke about their baby. I stand aside but close, and tell them step by step where they are in the surgery. Once the baby is born I try to get a first pic of the doctor holding the baby (you have to be quick), then hand the camera off to dad and have him go with the baby. I then sit down at mom's head and try to figure out if she has a sightline to the warmer. I talk to her, describe what is being done with the baby, and assure her that baby is beautiful/ok/perfect and will be with her soon. I stay glued to mom until dad comes back with the baby, talking to her the whole time, holding her hand.

When dad returns with baby, I step aside again and get the pictures of her meeting her baby for the first time. I try to keep them as close as possible as to not scream "OPERATING ROOM".

Once mom is out of surgery and in her recovery room, I generally ask the nurse if we can get mom on her side to nurse for the first time in the side lying positon. I find it's best to do this one fairly quickly while the pain meds are still in effect, so is latching well before mom starts hurting.

I've been in both planned and semi-emergency c/s, and I must say that the postpartum stuff in the planned c/s is much easier. Moms are awake and alert, are eager to nurse and snuggle their babies. Once the babes are nursing, I spend some time talking with them about the realities of recovery-pain management, nursing after a c/s, their physical recovery. I then leave them to rest. I try to plan a post partum visit the day they get home (or the day after) to make sure they are taking it easy.

I hate to say I feel like I do a good job of this because I have done it way too often. I had a run of c/s early this year, for everything from failure to progress in a homebirth to planned c/s for family convenience. I have really struggled to accept my role as a doula-although I do my best to educate the families before a decision is made for a planned c/s, after that point, they are paying me to support them and their decisions. I try to do so in a loving, knowledgeable way,and to make their recovery as gentle as possible. At the end of the day, it's the birth of their baby, and the birth that they chose. I'd much rather women having a planned c/s use a doula than think that it's no big deal, and they don't need any help or support, kwim?

Megan- mama to 3, midwifery student , doula, , runner , knitter .
Violet Lane Birth Services Doula care and placenta encapsulation serving Seattle to Mount Vernon
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#6 of 14 Old 07-10-2006, 12:52 PM
 
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Megan, you sound like an awesoem attribute to the c/s world (not that there needs to be a "c/s world" but since there is...you are a wonderful version of what should happen for all women having c/sections!)

Namaste, Tara
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#7 of 14 Old 07-10-2006, 02:29 PM
 
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Not a doula, but having had one planned c/s due to fear from previous birth trauma, I can tell you there were a couple things that fell through the cracks even though I had DH with me as much as possible, which a doula could have helped tremendously with.

I couldn't verbalize hardly at all once the IV meds were started but I wanted to know what was going on and didn't get enough info.

I had trouble breathing after the meds took, and instead of telling me what was going on as I panicked, they just silently adjusted the meds & I think sedated me. I would have calmed down without sedatives, if someone had told me what was happening and that I'd feel better in a moment.

I didn't know they were going to knock me out during the closing phase of the surgery, I would've requested they not do that, but it would've been nice to have a familiar voice/face to wake up to. DH was gone to the nursery with ds.

Sidelying to nurse was not an option for me as lying down stretched the abdomen somehow and pulled horribly at my incision. Having someone who knew to stack pillows under my elbow and on my lap so I could have support to nurse ds in recovery was really great.

And most importantly, I wish someone had unwrapped ds so I could touch his skin somewhere or put his cheek to mine when I saw him for the first time. They did lay him by my head but I wanted contact so badly though I couldn't verbalize it in my drugged state, and had to wait til he returned and I was awake enough in recovery. That still bums me out to this day.
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#8 of 14 Old 07-10-2006, 03:55 PM
 
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How to serve women who must birth surgically?

First off, honor that their birth is STILL a birth. Acknowledge their fears and give them a opportunity to verbalize them. Encourage them to have a concise birth and baby care plan. Suggest that they watch the birth, take pictures, ask medical staff to keep conversations limited to medical communication, mom and baby focused. Play music, assure her that some tugging and pulling (especially with an epidural) is normal, ask her frequently if she is in pain. Keep a cold wet wash cloth in a baggie in a pocket of your scrubs...she might at times feel hot and nauseous.

If she is really scared, use the same kind of breathing and relaxation techniques you would use with a laboring women. Be prepared that when they insert the uterus back into the abdomen she might have a few minutes of intense nausea...slow her breathing down...wet wash cloth helpful here...it usually passes without a problem. If she is unable to see her baby right away, describe to her what he/she looks like. Hold her hand and tell her how brave she is. Whisper to her what a great mom she is. If baby and mom are stable, assist her in holding the baby during repair work. If babe is stable advocate that baby remains in the surgical suite. Once stable in recovery help her nurse. Spend the night with her or have a back-up do so, so she can keep her baby with her at all times.

Encourage her in the postpartum to get up and move around. Also, encourage her to take pain meds as long as she need them...might even be for 6-8 weeks. Hopefully, she will receiving her postpartum care where they actually feed you as soon as bowel sounds can be heard. Hopefully, too they will let her have water.
Mary
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#9 of 14 Old 07-10-2006, 05:32 PM
 
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I don't know if she is going to bf and I am not sure if she did the first time. But for me, I was too out of it to bf'd so the nurses told me they were giving formula because my son had low blood sugar. I told them I wanted to bf'd and they said "you can't, what formula do you want." I was too sick to argue. Next time if I have to have a c/s I will make sure someone latches this baby on no matter what state I am in.

Also, they put a mask on me (which I thought was oxygen) but it was something that knocked me out. I woke up 8 hours later in a room without my babies. I would this time not sign the normal consent form and make sure they don't do that again.

Those are just some things I could think of.
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#10 of 14 Old 07-10-2006, 11:09 PM
 
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Quote:
Originally Posted by MamaTaraX
Megan, you sound like an awesoem attribute to the c/s world (not that there needs to be a "c/s world" but since there is...you are a wonderful version of what should happen for all women having c/sections!)

Namaste, Tara
Thank you. I've seen more than my share of c/s in the time I've been a doula, mostly though some twists of fate. My very first official birth was a c/s after 3 hours of pushing, ,my first homebirth client transported after 3 days of labor and climbing bp's, ending in a c/s. I had a few more after that, way more than my doula sisters, and I thought it was something *I was doing. A very wise sister told me that I was at these births, with these women for a reason, and they needed ME.

My entire perspective on c/s support has changed. Of course I prefer that women birth vaginally, but in this country in this time, we all know that it's not always reality. Women having a c/s, even a planned one, are terrified, and need a doula just as much (if not more) than a woman who has a vaginal birth. My work with c/s moms has opened my eyes to things I had never considered based on my training and personal experience, and has led me to do more and more postpartum doula work.

Someday I hope the universe gives me a higher percentage of vaginal births, but in the meantime, it's good to feel that I am making a difference.

Megan- mama to 3, midwifery student , doula, , runner , knitter .
Violet Lane Birth Services Doula care and placenta encapsulation serving Seattle to Mount Vernon
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#11 of 14 Old 07-11-2006, 02:45 AM - Thread Starter
 
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Thanks so much for the great responses! This is a LOT to process, but I will be printing all this out and saving it

For clarification: At this time, only one person is allowed with Mom during an epidural c-section. No one is allowed during GA c-section. Per Mom’s request, Dad will be the one attendant there during the actual surgery. I will only be there before and after the surgery (and of course whenever she wants while she is in the hospital, and after she is discharged).

For those doulas who are able to attend c-section as a second attendant, can you email me a copy of hospital policy for this? I would love to get the policy changed at our hospital. Thanks!

Thanks for all the questions on bfing!! This mama is such a lactivist; it is so great! She had her first baby as a teen and breastfed her for 11 months with no support, even though her little one was in NICU after she was born. I talked to her about having Dad instruct everyone that baby will only get breastmilk. That is part of the reason I will be there for her post-op. Dad will be “guarding” baby .
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#12 of 14 Old 07-11-2006, 11:04 AM
 
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Quote:
Originally Posted by ozzyemm
Thanks so much for the great responses! This is a LOT to process, but I will be printing all this out and saving it

For clarification: At this time, only one person is allowed with Mom during an epidural c-section. No one is allowed during GA c-section. Per Mom’s request, Dad will be the one attendant there during the actual surgery. I will only be there before and after the surgery (and of course whenever she wants while she is in the hospital, and after she is discharged).

For those doulas who are able to attend c-section as a second attendant, can you email me a copy of hospital policy for this? I would love to get the policy changed at our hospital. Thanks!

Thanks for all the questions on bfing!! This mama is such a lactivist; it is so great! She had her first baby as a teen and breastfed her for 11 months with no support, even though her little one was in NICU after she was born. I talked to her about having Dad instruct everyone that baby will only get breastmilk. That is part of the reason I will be there for her post-op. Dad will be “guarding” baby .
It's my understanding that the anestheologist is the one who can authorize a second support person (they are the most legally liable because you are sitting right there next to their work station). Often I have been told "we only allow one person", and the family then asks if the nurse can ask the anestheologist. I've yet to have one say no, although I may have just jinxed myself. We always ask after I have been there and the nurse has seen me with the mom for a while, so she can assure the doc that I am not a raving lunatic.

Megan- mama to 3, midwifery student , doula, , runner , knitter .
Violet Lane Birth Services Doula care and placenta encapsulation serving Seattle to Mount Vernon
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#13 of 14 Old 07-13-2006, 08:24 PM - Thread Starter
 
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Quote:
Originally Posted by memiles
It's my understanding that the anestheologist is the one who can authorize a second support person (they are the most legally liable because you are sitting right there next to their work station). Often I have been told "we only allow one person", and the family then asks if the nurse can ask the anestheologist. I've yet to have one say no, although I may have just jinxed myself. We always ask after I have been there and the nurse has seen me with the mom for a while, so she can assure the doc that I am not a raving lunatic.
That is great info! Thanks for that! I remember that a nurse asked the OBGYN if DH could be there for my c-section, and she said no. I know that GA C/S are different, but I just thought the OB had the last word. That is cool that they don't. Hmmm, how would I be able to make an impression on the nurses if it is a scheduled c-sec? If I got lucky, we would get the GREAT nurse who attended my birth. She would put in a good word for me
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#14 of 14 Old 07-13-2006, 09:45 PM
 
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Quote:
Originally Posted by ozzyemm
That is great info! Thanks for that! I remember that a nurse asked the OBGYN if DH could be there for my c-section, and she said no. I know that GA C/S are different, but I just thought the OB had the last word. That is cool that they don't. Hmmm, how would I be able to make an impression on the nurses if it is a scheduled c-sec? If I got lucky, we would get the GREAT nurse who attended my birth. She would put in a good word for me
At the hospitals I work at, the nurse that preps you for a scheduled c/s is generally going in with you. Be there from the time mom checks in, be charming and helpful, and ask You could also have your client ask her OB to clear it ahead of time, with clear arguements why it would be helpful.

Megan- mama to 3, midwifery student , doula, , runner , knitter .
Violet Lane Birth Services Doula care and placenta encapsulation serving Seattle to Mount Vernon
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