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How doulas can play an important role in C-section births

More women are using doulas to make the process less stressful

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July 18, 2018 at 4:07 p.m. EDT

Adapted from a story by Sara Toth Stub for The Washington Post.

While plenty of women hoping to have a natural birth have used doulas for decades, women having C-sections have also begun to use them. Many who give birth by C-section hope that doulas will make their hospital experience less stressful and less medicalized. The goal is to have surgery interfere as little as possible with the process of bonding with and caring for their newborns.

“I think there’s a recognition that social support provided by doulas can help women in many different situations” — not just in a pregnancy where a baby is delivered naturally but in C-sections and even pregnancy-termination situations as well, said Julie Chor, an assistant professor of obstetrics and gynecology at University of Chicago Medicine. Chor’s research has focused on the effects of doula support during pregnancy termination and other obstetric procedures.

Most hospitals only allow birthing mothers to have one companion — usually their partners — in the operating room. But even if doulas cannot be with women during the surgical procedure itself, Chor says the presence of a doula can be emotionally beneficial before and after the procedure.

To become a certified doula, DONA International, the largest doula-certification body, requires a 16-hour workshop plus additional classes in childbirth education, breast-feeding education and other topics; completing a required reading list; and having references and evaluations from health-care providers and clients.

Given that doulas are not medical professionals, and they do not deliver babies or examine women to assess their stage of labor, certification is not actually required.

According to the American College of Obstetricians and Gynecologists, studies have found that doulas or similar support can lead to more-beneficial outcomes for laboring women, including a lower instance of Caesarean sections. (Studies have shown better outcomes for women who have “continuous support” during pregnancy and labor.) According to the Centers for Disease Control and Prevention; Caesarean sections accounted for about 32 percent of all U.S. births in 2016, which is up from about 20 percent in 1996.

“For a while, helping women during C-sections was all I did, even though it wasn’t my goal when I trained to become a doula,” said Rachel Leavitt, a registered nurse who is also a doula in Marshall, Mo.

“A lot of the same techniques for natural births can also be used before and just after C-sections, like foot massages, aromatherapy and music — anything to help the mother relax.”

The use of doulas for pregnancy has become more common, and the number of trained doulas has been increasing, according to DONA. The proportion of American women who reported using doulas for birth doubled to 6 percent in 2013 from 3 percent in 2006, according to data from the National Partnership for Women and Families.

Kim Jones is the co-founder of DoulaMatch.net, a Seattle-based online database that provides listings for about 9,000 doulas around the country. According to Jones, the national median cost for a doula’s services is $922.

Doula care is rarely covered by private insurance. In recent years, Minnesota and Oregon have expanded Medicaid to cover assistance from doulas, according to the National Partnership for Women and Families, and New York has announced plans to do the same.

Craig Salcido, an obstetrician-gynecologist in Mission Viejo, Calif., says he talks to his pregnant patients about the benefits of doula care, no matter what kind of delivery they expect.

“They really just do a good job making sure the patient feels comfortable in an unfamiliar environment,” he said. “And they provide some coping skills for the family of the woman having the C-section.”

Stacey Ward of Elmont, N.Y. heard from several friends who had gone through C-sections and felt traumatized not knowing what was going on during the birth process. Ward, who was carrying twins and scheduled for a C-section, decided to hire a helper. The doula stayed with her and her husband during the surgery at New York University’s Winthrop Hospital and helped calm her.

“Walking into the OR for my Caesarean section was honestly the scariest experience of my life,” Ward recalled. “If I hadn’t had the doula there to support me, explain things and simply hold my hand, I don’t know if I could have done it. Having my husband was, of course, important, but he was just as scared and inexperienced as I was.”

After the babies were delivered, her husband accompanied them for weighing and medical exams while the doula stayed with Ward. “What could have been a terrifying memory actually turned out to be a calm, beautiful experience,” Ward said.