I’ve had the honour now of attending twenty births as a doula – not many by the midwifery or OB scale, but far more than most people in the US. Six of those births – close to a third! – were cesarean births. Two were planned, and four unplanned (but not emergencies). I am grateful to have had the opportunity to support the mamas and papas through the cesarean experience, and at the same time, I’m sad to have seen so many, relatively speaking. That simultaneous happiness and sadness is a strange thing, and one shared by the families I have worked with.
I had a wonderful cesarean (unplanned but not an emergency) myself with my first son. We worked extremely hard to birth him vaginally (you can read his story on this site) and when it didn’t happen, had a gentle, ‘natural’ cesarean in which my son came straight to my chest under the drapes and I breastfed him there in the OR. I was ecstatic. I was also sad to have not birthed him in the way I had dreamed. No one ever made me feel bad about this dichotomy. Everyone respected my grief. No one said ‘at least you have a healthy baby – that should be all that matters.’ Of course it matters, but it isn’t ALL that matters. I asked myself all kinds of hard questions – what could I have done differently? Did I try hard enough? If I had pushed for another hour/tried a different position/done x, y or z, could it have been different? I made peace with D’s birth (ha – then lost it, and then found it again) and he loves to hear his birth story now.
Witnessing cesareans as a doula is very similar. I’m very fortunate not to have been at any births with what we might (quietly, to one another) call ‘scalpel happy’ care providers. I can honestly say that the cesareans I’ve witnessed were medically necessary. They did not come because of premature induction or at the end of a ‘cascade of interventions’ or at 4.30pm so someone could go home. No parents were pressured into the decision; there was no fear or panic. But there was huge sadness, later of course twinned with the joy of meeting a new baby. I second-guess myself every time. Did I try – or suggest trying – everything possible to avoid this outcome? Did I translate or interpret accurately and helpfully between the parents and the caregivers? Did I guard the parents’ space to give them the most thinking and decision-making time? Did I do enough? In the moment of decision and afterwards I do my very best to help the parents find peace – and I tell them what it helped me so much to hear: you did the right thing. You acted before there was a (likely or very likely) emergency. You will be able to bond. You will be able to breastfeed. You will recover. You will be able to try for a VBAC down the road. It’s okay to be sad and to grieve the birth you didn’t have. Whatever feelings you have, they are okay, they are yours. I will walk with you. You are a mother. You are still a warrior and a birth goddess.
If you are confronting a cesarean birth, there are some things you can do to make it feel less surgical and, well, more ‘birthy’ (all on the basis that it is not an emergency and you and baby are healthy). If you anticipate a scheduled cesarean, you can ask under certain circumstances to wait until you go into labour, so that your baby still gets to pick his or her birthday. Many OB-anesthesiologist teams will allow you to have both a partner AND a doula in the OR with you, or at least to let you have your doula trade in if your baby has to be taken out and your partner goes with the baby. Keeping your birth team with you makes a world of difference, and if your baby has to go to the warmer, then your partner can go with the baby while your doula stays with you (or vice versa). You can ask to play your own music in the OR, and even have your own scent. Ideally you can ask for a ‘natural’ or ‘family cesarean’, which more and more OBs are discovering. In these births, the drapes are lowered so that you see your baby being born (don’t worry, you don’t see any of your insides!). Delayed cord clamping may be available, and your partner may still be able to cut the cord. The baby can come straight to your chest under the drapes for skin to skin contact, with all procedures done with baby on you instead of the warmer, just as in a vaginal birth. You can nurse right there on the table. Your OB may offer to swab your vagina and wipe your baby’s mouth and face in order to populate him or her with your vaginal microbiome – an increasing number of studies are indicating how important this is for long term intestinal health (see this article). All being well, you and baby need not be separated at all.
A cesarean may not be your first choice. But there are still steps you can take to shape your experience – and your baby’s first few moments earthside.