Mothering Forum banner

1 - 7 of 7 Posts

·
Registered
Joined
·
658 Posts
Discussion Starter #1
I am interested in the ways that doulas attend women who have surgical births. I am not really interested in debating about c/s ....I am most interested in the ways that you have served women whos births turn surgical for whatever reason.<br><br>
The hospital that I usually end up working with only allows one support person for mom. That is almost always dad. I know some other area hospitals that have allowed doulas in surgery, but usually I am not allowed to be present for the birth.<br><br>
I haven't actually been present because, in these two instances, they had asked me not to come because they felt they were all set. I saw my role as helping with initial breastfeedings, staying with mom in recovery....going on to maternity and staying with mom or going with baby to the nursery. (mandatory 2 hours in nursery <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad"> post birth ).<br><br>
I think I represented the birth they were not going to have...Im sure of it in one of the cases.<br><br>
anyway, I have tons of compassion and wish I could be of more service...or at least better explain my role in the event of surgery.<br><br>
What do you do?
 

·
Registered
Joined
·
254 Posts
In one situation, I was able to be in with mom while she got her epidural (something she was especially nervous about), and then I left the room and dad came in for the actual birth. In another, the section was the culmination of a very long and complicated labor (I got called 2/29, baby born 3/5). Mom ended up losing anesthesia mid-procedure and needed emergency GA. I wasn't in the room at all, and I think dad may have had to leave after the GA. I stayed in the labor room and when dad came out of the OR, I was able to provide support to him. Poor guy just burst into tears--the whole experience (especially when mom lost anesthesia mid-surgery!) was super traumatic for him. (On a side-note, mom had a 6 hr labor and successful VBAC 2 yrs later, which I also attended. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/thumb.gif" style="border:0px solid;" title="thumbs up">) Then I went with dad to the nursrey to spend some time with he and babe while mom was finishing up/still out with the GA. As soon as mom was concious (about 2 hr after the birth), I left, as I was BEAT. In retrospect, I wish I had stayed, as they ended up having a really hard time establshing BF (due in no small part to insistance on supplementation by the hospital staff <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/irked.gif" style="border:0px solid;" title="irked">: ). I wish I had been there to help them with that, as I know they could have used it. However, I'm not sure at that point if I had much left to give, so perhaps everything happened the way it needed to.<br><br>
That's my experience. Hope it's useful. I do think that doulas have a roll in ceasarian births, even when we can't be physically present during the birthing. I think our roll can be especially important post-partum in these situations (as I learned). I also think a hand-out to clients, saying what you see as your roll (supporting them at their birth no matter what transpires) and listing some ways you can be helpful even if things don't go as planned, might help people aviod the "can't have the natural birth I had hoped for so I won't need/want the doula" fallacy.
 

·
Registered
Joined
·
9 Posts
There are several hospitals i attend births at and the nursing staff there knows me and is thrilled upon my arrival (they know i proceed prepared parents) they still cannot bend the "one person in the OR" rule for me but do allow me right outside the OR door, i still get to witness the birth and am quickly ushered in when dad leaves to take baby to nursery. I promise my clients to will never abandon them, sharing this with nurses, dr.s ect followed with a brief insight to how mom feels, on that table with her new baby what feels like miles away and her main support gone to, there is a huge need for support there. Historically i have found myself being very reassuring to her, wiping tears, even blowing hot air on FREEZING fingers. Maybe try asking to follow when dad leaves with baby, parents usually pipe up quite loudly on that, dads especially, they are faced with the decision on who to leave.
 

·
Registered
Joined
·
1,613 Posts
So far, most of my support has been right before, or right after. I have not yet been able to attend the surgery, even though I was the main support person for one client (and she did want me in there with her, but when it came down to it, she just didn't want to fight).<br><br>
I discuss the possibility of a section with all of my clients- mostly under the heading of, "We're thinking clearly right now at this moment- where are your comfort levels in this situation" kind of a thing.<br><br>
My first C-section client ended up having one after her super impatient doctor got into a bit of a pissing contest with the nurses at a hospital in Aurora, IL. He checked her (after the nurses called him repeatedly saying she was +1 and 10 cm and ready to go), brusquely snapped off his glove and barked at the charge nurse, "Give her paperwork for a section," and stormed off. The nurses in the room were PISSED and quiet, and no one was talking to my client (the doctor never said a word to her- not "Hi," or "I'm going to check you," or "F- You" or anything). So, she looked at me after a few stunned moments (I was helping her get resettled and get her stupid gown back over her body after the VE) and said, "Suction? They're going to suction my baby out?" I talked to her at great length about her options at that point, and her feelings about them. She ended up deciding on a c-section, and my next 30 minutes with her were really just verbally supporting her, and still helping with comfort measures.<br><br>
After the nurse (she was the head nurse, or manager, or whatever for the night) brought the baby in (an aside- the baby looked as though it was pushed through a birth canal. I took one look at him and said to the nurse, "Oh, he was delivered before the section?!?" She shook her head, and told me -very upset- that the baby started to deliver vaginally, but the doctor made the incision anyway, and pushed the baby back through to get it out of the abdomen), I stayed with the baby and made sure the mother's wishes were met in regards to his post-birth care. After mom was wheeled in, I stayed with her to help with her latch (and held her arms so she could hold the baby, as her arms were numb from the shoulders down), and just talked with her some more. Post-op, she wasn't really talkative, and mostly wanted to rest. It was in the post-natal appointment and follow-ups afterwards that she needed support in processing.<br><br>
So, that was a long way of saying that my C-section clients needed a ton of emotional support during and afterwards. My client without a partner really needed a lot. A married client still needed support, but the baby's father needed it as well.<br><br>
Clara
 

·
Registered
Joined
·
1,590 Posts
If it is a scheduled c-section, mom is able to arrange for me to enter when dad goes with baby. I go to the hospital with them to help them get settled in and try to keep it from being too scary or nerve wracking or sad (moms that did not want a c-section but due to health circumstances (previa, etc) must). I then help through recovery. Normally helping get rid of the shakes or the "itchies" or getting their baby brought to them, or breastfeeding, etc.<br><br>
If it is the ending result of a long and difficult labor then sometimes I am allowed in and sometimes not. If not, and it is appropriate, I may take a quick nap in the chair in their room, or straighten up the room, take a break to care for personal needs (eat, brush teeth, change clothes, take a walk outside, call someone to debrief.) I am normally (all but once since moving here 3.5 years ago) allowed in recovery with mom to help her with the circumstances listed above.<br><br>
My clients, moms and dads both, have been very happy that I was there. I also think it is comforting for them to see me when they get out of surgery. Also since I am there, I can help them place good thoughts about what happened into their minds, pointing out things they may not have thought of. When a couple makes all the "right" choices especially, and ends up with a c-section, it is good to help them process the what-ifs.
 

·
Registered
Joined
·
658 Posts
Discussion Starter #6
Thanks for all the ideas...please keep them coming!<br><br>
This last birth has been very challenging for me. I really felt that I could have offered them very good support that was in line with what they have wanted all along. I also knew that they didn't really know what they were in for and how much help I could have provided them. They weren't especially interested in discussing options or how I could help them, so I wasn't going to push the issue. I did validate their decision, left all options open for me to support them in whatever way they needed, and then left the ball in their court for them to contact me when they wanted to have me come or talk about the birth. That is really the best I could do with the situation being what it was.<br><br>
I, myself, had two unscheduled emergency c sections, so I have my own experience to draw from there. Having a doula made all the difference in the world for me when my VBAC didn't work out. I had so much more peace...and support.
 

·
Registered
Joined
·
226 Posts
<i>I received this great handout at my CAPPA doula training 2 years ago...</i><br><br><span style="text-decoration:underline;">The Doula's Role in Cesareans (RMDE 6/05)</span><br>
According to ICAN, the cesarean rate in the United States was 26.1% in 2002 (preliminary numbers for 2003 show another 6% increase, to 27.6%). Colorado's rate was only marginally better at 21.1 %. While much of the work as doulas is aimed at preventing unnecessary cesareans, there are times when their clients have cesareans, necessary or not. We must change our focus as we support these mothers. For a birthing mother, effective support during and after a cesarean can mean the difference between a traumatic experience and a manageable one. Here is a list of support suggestions for three scenarios: emergency cesarean, cesarean after labor (failure to progress, failed induction, etc.), and planned cesarean.<br><br>
Emergency Cesarean<br>
The sounds from the monitor are alarming and the room suddenly fills with nurses. Or a mom’s water breaks and the cord is swept into the birth canal. Emergency cesareans are done for a variety of reasons and are marked by the staff rushing to get the mother to the OR, often with only minimal explanation. What can a doula do to help?<br>
 They will not diagnose, but translate what they hear the staff saying. They will let their clients know that it may be a true emergency and they should prepare themselves for a c-section.<br>
 If the mother is unmedicated, they will let her know she might need general anesthesia, and help her get an answer from a nurse, or from the doctor when he/she comes in.<br>
 They will help dad find out if he can go into the OR with mom. Most of the time this is permitted. It is highly unlikely the doula will be permitted in, but it is worth asking.<br>
 They will help dad get changed into scrubs and make sure he has the camera.<br>
 They will ask mom and dad if they want help calling anyone or inform family in the waiting room.<br>
 If at all possible, they will accompany mom down the hall toward the OR so she can at least hear a reassuring voice. They let mom know that they will see her in recovery.<br>
 They will return to the room quickly and gather up all their clients' belongings. They will not leave your belongings unattended.<br>
 They will follow the nurse's lead with regard to caring for mom in recovery.<br>
 They will ask mom if she wants the doula to go to the nursery to get an update from dad on the baby, or bring back a digital camera with photos of him/her.<br>
 They will help mom breastfeed in recovery. They will be respectful in asking if mom minds if she minds the doula touching her.<br>
 Mothers who have had general anesthesia will not remember their births. Doulas will help compile all the details from dad, the nurse, and the doctor to create a birth narrative for mom.<br>
 They will encourage mom to be very proactive about asking for pain medication. No martyrs allowed; mom needs her pain managed so she can enjoy her baby and breastfeed him/her.<br>
 They will help dad to arrange extra postpartum help.<br><br>
Cesarean after labor<br>
After a long induction, the mom is just not dilating and the nurse says the baby is looking a little stressed. Or the mom has pushed for hours but the baby is not coming down and the doctor says he may be asynclitic. Whatever the reason, it is often very disappointing to mom and dad to face a cesarean after labor. How can a doula support them? Many suggestions from Emergency Cesarean will apply, but here are some additional things a doula can do.<br>
 They will help mom and dad to ask all the questions they need to ask. They will encourage them to use BRAND (Benefits, Risks, Alternatives, Nothing, Decision). They will help the parents understand the answers they get.<br>
 Mom may feel that she has failed. The doula will reframe by using phrases like, "your baby is telling us he needs some help", if applicable.<br>
 They will encourage the mom to ask about 2-layer sutures to enhance her possibility of VBAC in the future.<br>
 They will acknowledge the parent’s feelings (fear, disappointment) but at the same time can express calm confidence.<br>
 They can help mom arrange a consult with a lactation consultant. Breastfeeding after a cesarean is more challenging.<br><br>
Planned Cesarean<br>
Say the mom has placenta previa and will have a scheduled cesarean at 37 weeks. Or she had a myomectomy last year and laboring is ruled out as unsafe. Occasionally, doulas are hired to support the parents through a repeat cesarean. How can a doula help make this birth memorable and positive? (Refer to previous sections for applicable suggestions as well.)<br>
 They will help the parents prepare a birth plan. Do they want music in the OR? Can dad announce the sex of the baby? Can the drape be dropped at the moment of birth so mom can see the baby emerge over her belly?<br>
 They will encourage the parents to discuss their plans and hopes with their doctor well in advance.<br>
 They will sensitively help the parents explore their feelings. Mom may be disappointed and sad, or not. Either one is fine.<br>
 They will help the mom plan for extra help postpartum. For first time parents, doulas will give them clear expectations for recovery. "I'll be fully recovered in a couple of weeks" is not realistic.<br>
Every Cesarean<br>
 They will refer mothers to ICAN. They will give them the website address, tell them about message boards or e-mail lists, and give them the schedule of local meetings.<br>
 They will listen sensitively. Processing a birth that did not go the way a woman hoped takes time and is not the same for each woman. Some women are sad. Others are angry. Some are matter-of-fact about it. Doulas will help the dad process as well, if he seems open to it.<br>
 Women who have had a cesarean have a greater risk of postpartum depression, and the doula will help her and her partner watch for that. If they see signs of postpartum depression or post-traumatic stress disorder, they will help the mom get help.
 
1 - 7 of 7 Posts
Top