Doulas in Cesareans

I am sitting in a labor and delivery room waiting for my client to return from her scheduled cesarean. I came in this morning and helped keep nerves low, talked through hand expression and early breastfeeding, and witnessed the lead up to the moment. While talking about the surgery, the OB offered to let me stand in the corner of the operating room. I was delighted!

The Landscape of Chicago and Further Afield

Generally speaking, doulas in the Chicago area are not allowed in the operating room during cesareans. If I didn't work in New York before this, I would have probably just accepted this as a medical rule, but I DID work in New York before this and so I know that this is a hospital policy - not a medical necessity.

It seems to be different everywhere. In some hospitals in New York, two support people are allowed in the operating room (OR). I have a colleague in New Hampshire who works out of a hospital that allows doulas in once they take a training on the basics of sterile fields. I've heard from CNMs in other cities that it is on a case by case basis, determined by the anesthesiologist. I've even heard stories of Chicago doulas who are well known who use their reputation and relationships to get into an OR. I know a photographer who has begged the anesthesiologist to be allowed in to document and gotten permission. A mentor of mine who specializes in supporting cesareans told me that the best we can do is demand to be in recovery. Admission to ORs is all over the place.

It infuriates me.

Doulas make the medical team's job easier by keeping clients calm and centered. We've worked on breath work in advance and can guide them on slow deep breathing. We make clients' experiences better. Increase birth satisfaction. We witness birth so that we can help clients process their story in the coming weeks and months. I'm not trying to be in an OR because I'm curious (if I wanted to be in an OR that bad, I would go to medical school). I'm trying to be in an OR because I know that me being there is what is most supportive to my client. It is what my clients want.

My Experience

Today, I was thrilled that a doctor was willing to entertain the idea of me being in the room. I knew that it was because the partner was also a doctor, and a colleague at the hospital, but at least it is a step in the direction of possible. Maybe I would be able to gain a foothold if just one person let me in. My clients look of relief was obvious. I would remain with them for this scary moment.

"We need a bunny suit for them," my clients said excitedly to our nurse.

"Who?!" The nurse replied, feigning confusion behind two silver dollar sized eyes.

"Our doula."

I watched her brain break. "We have never had more than one support person in the OR!!" she said as she ran down the hall toward the nurses station. Later I found out that she was so flustered that she felt the need to involve hospital administration and override the doctor's decision.

Later in recovery, she had the audacity to apologize to me, "I am so sorry that you couldn't go in the OR. That is just not something that we have ever done. There isn't any room for a second support person."

Except that I've seen midwives attend cesareans as the second support person time and time again. I'm not saying I'm a midwife, just that there is in fact room for a second person.

Doulas are, by definition, neither friends nor medical staff. We are some other entity - a bridge between. And we should be allowed to do our jobs even when the birth is surgical. I'm not saying we are special and should get special treatment. I am saying we have specialized knowledge and a knack for bringing humanity into the room. It is a loss for everyone when we are not there.

Client being wheeled to the OR alone

Cesarean Birth is BIRTH

Vaginal birth belongs at least somewhat to the client. Clients don't ever fully own their birth in a hospital, because doctors tend to assume that birth can and will go bad -- and fast. Ultimately, when you are on a doctor's turf, you are beholden to their risk profile and comfort levels. It is like being on safari: your driver is going to insist that you stay in the vehicle and on the road at all times even if the animals are far away. They have seen and heard about elephants charging or monkeys biting and they aren't willing to risk it. Fair enough, since they are ultimately the ones held accountable for the decisions made. But, clients can at least have preferences.

But surgical birth? That is a fully medical event. SURGICAL. Not owned by anyone except the doctors in charge. As if somehow the literal sterile environment means that the birth itself must also be energetically sterile. As if it is just a "section" and not the birth of a human soul onto this plane.

The treatment of cesareans as surgery is, at the crux, a misunderstanding. Yes, cesareans are a major surgery, but belly birth is still birth. No less sacred. Birth is always a wild, untamable force. Just because we schedule the OR and follow important protocols doesn't mean that birth isn't happening. In fact, Pam England talks about "pushing from the heart" in Birthing From Within. You must still birth your baby, even if you are getting the help of a surgeon.

Birth in an operating rooms takes courage and calm just as labor and vaginal birth do. It may be quicker on the clock, but it is no less sacred or scary (sacrary?).

A Surgeon's World

Ultimately, I think it comes down to whether you believe that pregnant people give birth or OBs deliver babies. I personally feel as though only one person can deliver the baby: the person carrying the baby. You might catch a baby. You might administer life-saving medicine to stop the uterus from bleeding. You may be called upon to stitch a tear or help clear a baby's airway. But unless the baby is coming out of your body, you cannot deliver it. As Rebecca Dekker likes to say, "Babies are not pizzas; they are born not delivered!"

I get the sense that medical staff is relieved that doulas are not allowed into the OR. Almost like the tree that is "base" in tag. You might be able to chase me all around this hospital witnessing what I do and how I interact with our shared clients, but you can't chase me in here. This paradigm ultimately assumes that we are not on the same team, and that is the mistake. I do not go into an OR looking for mistakes. I go into an OR as a guide and a witness for my client. My job is not to worry about how their surgery is going in 99% of cases, because they are in good hands and I am not a doctor.

We all have different jobs: Ken's job is Beach, Doc's job is Surgery, and mine is Doula. I wish we could all sit around and talk about the ways we can help each other. Sometimes doctor's, relieved after I help a client understand a procedure, say "You are the best doula I have ever worked with." No. I am just doing my job. Staying in my lane. This is what you are missing! I often wonder where the insecurity of doctors does come from. What are they so afraid of me seeing? In what way to I threaten them? Are they really so self-important that they think I am going to be paying my attention to them when I have a whole, brand-new family on my hands?

I suspect that doctors think only about what they have to lose by allowing a doula into the space. Their minds probably go to risk-management because that is the flawed system that we all exist within. Sadly, they are not asking, "What do we have to gain by allowing a doula into the OR?" They don't seem to think beyond keeping everyone alive to consider patient satisfaction, stress levels, and long term mental health.

Partner being escorted to the OR by a nurse

Imagining Another Way

adrienne maree brown reminds us all the time to imagine the future we want to see. It can't exist if we don't believe in it. So, imagine if doulas were part of the team. We would come to the hospital early, suit up, and then walk with our clients as they made their way into the tightly packed OR. We could remind them of what to expect. Maybe we would catch some photos and help timestamp the event. Or breathe with them as they feel the tugging of their body birthing their baby. Maybe we would just stand quietly in the corner as a witness. Witness to the new one's first cry. Witness to the suctioning and weighing at the baby warmer. To the smells and the chatter. We would walk alongside the bed as our client is wheeled into recovery. Help them with skin to skin, with latching. Hold their hand and coo at their beautiful new one. Remind them the nausea will pass.

None of that happened this time. The nurse, in all her anxiety about the way things are "supposed to be done" won out. I sat in a room alone, writing this blog post, while my client birthed her baby. I my client later to tell me about her baby's first cry.

Doula's view of a hallway leading to the restricted OR