Doulas in the OR
A few weeks ago, I unexpectedly hit a doula milestone: I was able to continue birth support in the operating room during a Cesarean birth.
WOOHOO!
Now imagine my surprise when five days later, I found myself scrubbing up to join another client in the very same OR for another Cesarean birth.
Yup, talk about some serious déjà vu.
OOTD, birth style
As I scrubbed up for that first birth, I kept my excitement hidden and practiced my own deep breathing.
I ran through what I knew about supporting a Cesarean birth in general, and the choices that my clients and I had discussed during our prenatal appointments. I knew what sort of environment they wanted, what mom did and didn’t want to be told about during the birth, what the plan was for dad after baby was born, and what they wanted to do with the placenta.
Before heading into the operating room, I spent about 30 minutes one-on-one with the dad, which was beautifully valuable time. We talked about his feelings and thoughts, his worries and fears, his excitement and feeling of being completely blessed to be so close to meeting his first child. In such a woman-/mom-/birthing person-centered event, it can be rare to get this level of deep, quality time with the partner. Birth is an exciting thing for the entire family, and I cherish my role as the one to explore that.
Supporting dad while he supports mom while she gives birth to their beautiful daughter
Let me back up, however, to what it took for me to get here. Even before COVID, it was typically difficult for a doula to be admitted to the OR as part of the team. And once a global pandemic had its stronghold on us? Yeah, it was pretty much unheard of anywhere in the US.
We’re now two full years into this thing and only within the past 8ish months have doulas in my area been considered to possibly be welcomed to the OR with their clients, in one particular hospital. Within the last year, we had one incredible doula, with a fantastic reputation among the staff, who was able to go back with her client. That opened the door for another well-seasoned doula some time later. There may have been another here or there that I’m not aware of, but the number of births that have been doula-attended in Lexington is very slim.
Those who have gone before me have paved (/are still paving, really) an invaluable path. It is because of their years of hard work and advocacy that this is even now an option. The decision of allowing a doula in the OR nearly always lands on the lead anesthesiologist. It takes time and effort and energy and patience to form a relationship and leave a good impression on the anesthesiologists, and we absolutely would not be where we are now if it weren’t for the effort made from doulas before me.
My view from behind the drape
An absurdly huge amount of credit also goes to the nurses and midwives who advocated for my presence during these births. This is what I really want to highlight. This advocacy reaches so much farther than my voice can when it comes to medical staff. To feel fully supported, not just like I’m asking a favor, goes a long way for me to be able to give my best support.
In both of these births, I had numerous nurses and midwives vying for my presence, telling the anesthesia team that my role makes a measurable difference to the patient and encouraging them allowing me back in the OR.
In the first birth in particular, a fantastic travel nurse kept sharing that it makes no sense for a doula to support the entirety of labor, only to be kicked out of the birth space. The lead nurse chimed in and told me she will always fight for doulas to be allowed in the OR because it is still labor support. (Sho’ is.) This sort of affirmation and positive energy not only made me feel good, but helped my clients feel fully supported too; their entire birth support team was solid and would be there for them no matter what. Imagine you’re in the position of facing major surgery and this newcomer to the team wants to kick out the one who’s been with you the entire time. These aren’t the things you should be focusing on in labor.
Immediately following this first Cesarean experience, the travel nurse kept exclaiming—to me, to my client, to her coworkers, almost from the rooftops—that it was hands down the best C-section she’d ever been part of.
The direct quote that is forever burned in my memory is, “every single C-section needs to have a doula and a midwife. That was absolutely perfect.” Honestly, I couldn’t agree more.
“Every single C-section needs to have a doula and a midwife.”
A doula’s scope is that of pregnancy, labor, and birth support; that stays constant in all places where birth happens. Whether in the woods surrounded by stars, at a birthing center in a tub, or laying on your back in a hospital bed, a doula is here to support birth. When babies are born in the OR, that is still a place of birth and needs to be treated as delicately and beautifully as any other.
Cesarean birth is TOUGH no matter what and not all folks who find themselves in the OR planned to be there. Whether it’s plan A or plan Z for baby to be born by C-section, surgery is often a scary thing and birthing families need support. (You could even argue they need more emotional support than a vaginal birth, in some ways.)
A doula’s support—holding calm space, lightly rubbing your hair, letting you know what’s going on, relaying your needs to the medical team if your voice is weak, telling you what a fantastic job you’re doing, reminding you that it’s almost time for a birthday party, holding the bucket while you puke then vacuuming the rest out of your mouth, taking a trillion photos—belongs in the OR with every single birth. Period.
Fresh, sweet babe on her birthday