Doulas and Hospital Births

“I like the idea of a doula, but I want a hospital birth”. Sound familiar? I get it. Our collective mental image of a doula looks something like a kindly older woman showing up at your home birth and acting as Midwife Lite. Home births are beautiful, and absolutely perfectly suited towards doula care. So are birth centre births. And hospital births. And OR births. Simply put, all births are suitable for doula care. There is no wrong way to birth your baby, period.

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So what does that mean? How do I support a hospital birth in practice? It starts prenatally. There is no one way to birth in a hospital setting, and I want to know what matters to you. I’ve attended completely unmedicated, midwife attended hospital births. With mom labouring in the water, and double hip squeezes doled out in dim lighting. I’ve attended extremely medicalized surgical births. In both cases, the client left the hospital feeling she had been supported, and had the kind of birth experience she had hoped for. So, the question is, what matters to you? Do you want a drug free birth, and are concerned that won’t be possible in hospital? Do you want a family centered cesarean? You have options, and a hospital setting doesn’t change that one bit.

Contrary to popular belief, clear protocols in hospital births can be a great thing. Do you want your doula AND your spouse with you in the ER if surgical intervention becomes necessary?  A quick call to the hospital will reveal whether or not that will be possible. Birth plans can be controversial, and for good reason. Birth can be unpredictable, and impossible to micromanage. Going over your birth plan with your doula prenatally does not ensure we’ll be able to create the perfect outcome. We’d love to, but unfortunately we don’t have that power. What we can do is take in your wishes for your birth. Know what our client’s hopes and goals are, and do our best to help make it a reality when possible.

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This handsome devil’s family and I had the most amazing time celebrating his birthday, in hospital.

How do I support a low/no intervention hospital birth? Almost identically to the way I support a home birth. My goal is always to make my client feel as welcome and comfortable as she would in her own home. Step one is always checking in with the staff. I introduce myself at the nurse’s desk, greet any staff present in the birthing room. This may feel like a small detail, but it’s vital. Supporting positive communication between doula, family, and medical staff is crucial. I’ll wash my hands and unpack my supplies, and check in with my client.

Ottawa is an amazing city for low intervention hospital birthing. Our midwives have hospital privileges, we have a local baby friendly hospital, we have facilities that allow intermittent monitoring and water laboring. The options are limitless. For a client without an epidural and continuous monitoring, we may go for a walk. We may have an impromptu dance party. Or we might sit quietly and hold space. If it makes you comfortable and does not interfere with medical care, it’s doable.

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Perhaps your birth will be more medicalized. Maybe an epidural is right for you. Maybe you’re opting for IV fluids and continuous monitoring. Maybe the health of your baby and/or yourself calls for greater intervention. Your doula will still be there for you. Ever encounter the epidural itchies? I can nip those in the bud! You have positioning options with an epidural in place. We may get to know the peanut ball intimately. Regardless of the interventions that arise, having someone there just for you and your comfort will make a huge impact. One client required an unexpected vacuum assist. It was overwhelming for the parents, and they were unsure about what to do. As their doula, I was able to explain in laymen’s terms what was happening. To take over positioning my client’s legs when the job became overwhelming for dad. To simply stroke her hair, look her in the eye, and tell her how strong she is. To tell her I’d seen her baby’s hair, and it’s beautiful. Support during interventions is extremely impactful, regardless of whether or not the intervention was planned.

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Perhaps your baby is making an entrance via the sunroof. Congratulations! Belly birth is birth, and birth is beautiful. There’s a misconception that doulas are no longer needed when a cesarean is called for. Patients have options, in or out of the OR. Your doula can walk you through it.

There are three major categories of cesarean support. Emergency cesarean, planned cesarean with doula in OR, planned cesarean without doula in the OR. In an emergency, things happen very quickly. There are few things more overwhelming than experiencing a medical emergency, being rushed to fill out consent forms, and asked to wait for an anesthesiologist to arrive or an OR to open up. Your doula can recentre the room. She can meet you eye to eye and explain, yes, this is happening, and yes, you’re doing great. She can debrief you on what to expect when you arrive in the OR. She can support your partner if you’re momentarily separated for surgical prep. Sometimes, the event that necessitated the emergency cesarean will require mother and baby be separated. No one wants to head to recovery without their baby. Your doula can be with you through that time. She can run between recovery and nursery to provide updates on baby’s condition. She can take photos. In some cases, the client’s partner and doula can each take a person to focus on. The family can rest easy knowing someone is with both mother and baby at all times.

Hospital policies vary. With a planned cesarean you’ll have the advantage of checking policy ahead of time. In some cases, both the birth partner and doula will be allowed access to the OR. So how does a doula support in the OR? You shouldn’t experience pain with an epidural or spinal in place, but there’s still a great deal of unfamiliar sensation. You may experience pressure, chills, nausea, the sensation of pulling. Much like your doula would provide comfort care for labor pains, they can help you through the sensations of cesarean birth. You’ll have options available to you, and your doula can empower you to ask for what you’d like. Perhaps you’d like an arm, and your chest free for skin to skin or nursing. Perhaps you’d like a “gentle cesarean”. You may want the sterile field curtain lowered at the moment of birth, to see your baby. In some cases, you may be able to request your doula watch or photograph the birth, updating you on what’s occurring along the way. After the birth, your doula can attend to your needs while your partner cares for baby, or vice versa. We can also assist with skin to skin, or the first feed, right there in the OR.

But what if your hospital only allows one support person in the OR, and your doula doesn’t make the cut? What’s the point in hiring a doula if she won’t even be there at the moment of birth? Doula care doesn’t just cover the half hour you’ll spend on the table. After your prenatal visits, you’ll find yourself prepared and supported. You’ll be able to contact your doula at any time prenatally to ask questions. Your doula can join you for hospital admission. Answer last minute questions, talk out lingering anxieties, help you feel prepared. After the surgery, your doula will rejoin you in recovery. She’ll help you with comfort care, and start on the journey of baby care. Every ‘first’ is a bit different after surgery. You may find the support navigating first feedings, diaper changes, and baths after the birth very handy. Your doula will remain your doula for a varying amount of time postpartum. For me, that means support for the first six weeks. How do you breastfeed a baby without putting pressure on your incision? Who can you talk to about your feelings regarding the birth? How can your partner best support you? Your doula can walk you through all this and more, and refer out to a postpartum doula for longer term hands on help.

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“I like the idea of a doula, but I’m having a hospital birth.” Next time you hear it, you’ll know what to say. Doulas support ALL birth.

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