To Whom it May Concern:
My name is Dez Weyburn and I am a birth doula here in northern Utah. I support vaginal and cesarean birth. In my ten years of serving local families, I have watched hospitals make huge strides toward evidence-based and patient-centered care in Labor and Delivery. When I started as a doula, my clients had to fight for basic things like immediate skin-to-skin, the “golden hour”, and delayed cord clamping. Now these things seem to be more or less standard at most of the births I attend, which is incredible.
But we all know I wouldn’t be writing an open letter just to heap praise on the system for beginning to catch up to what families have needed all along. Just like in this post, I would like to point out a glaring lack of forward motion: cesarean births.
Ten years ago, I learned how to support a cesarean birth. I learned how to behave in an operating room, what sights, sounds, and even smells I could expect, and how to best support my clients in the event of a cesarean birth. There were stories and photos from ORs across the US of cesarean births with doula support.
Despite the evidence that shows that doulas improve birth outcomes and satisfaction (and the evidence showing that cesarean births lead to higher rates of birth trauma related PTSD), despite families asking for exceptions, I am still barred from OR more often than not. Often, when my clients ask, their OB is on board, their nurse is supportive. And anesthesia shuts it down without any conversation. When pushed, they have claimed the reason to be anything from increased risk of infection to hospital policy to just not giving a reason.
These same hospitals often turn around and ask my clients if students can watch or even help with the surgery. It’s such a disconnect that it’s almost funny, if it weren’t for the strain it puts on my clients and families everywhere.
Imagine for a moment that you’ve been laboring for hours or even days with the support of your partner and doula. Something has changed and your care team is recommending a cesarean birth. This was not your plan and you’re scared. Maybe you’ve never had surgery before. Maybe your partner does not do well with blood and gore. Or maybe you’re just physically and emotionally drained and you just don’t need one more thing to change. So you ask if your doula can come into the operating room and be with you and your partner. The doula that has been by your side your entire labor while staff was in and out of the room.
And you’re told no. No conversation, no options, just a flat denial.
How would you feel?
I’ve watched clients cry when told this. I’ve seen the fear flood them, fear that I had been helping hold back by giving them information about what surgery is like. Their care team may have explained the risks, the actual surgical logistics, but I’m the one explaining the process from their point of view. The things they will see from the table, where their partner will be, and how soon they’ll get to see their baby. Sometimes they push back. They ask for an explanation or an exception to be made. Very occasionally they will be successful and the anesthesia team will allow me back, or agree that I can “tag in” if their partner and baby have to leave OR for any reason. I am so grateful when the staff takes my clients’ emotional needs into account.
But the bar is on the ground. Hospitals elsewhere have welcomed doulas in for over a decade and we can (and should) too!
Let me share a different story.
This is a story where the staff welcomed me into OR and it was soooo helpful for my clients. After a long induction, a less than stellar epidural, and nearly five hours of pushing, my clients were advised that intervention was indicated. Their doctors recommended the use of instrumental delivery or a cesarean birth. Not only did the staff give my clients plenty of time to decide, but they also came back in more than once to answer questions that had come up. When my clients decided that a surgical birth was the best option, they asked if I could be there with them as I had been for the past 24 hours.
It took a bit of back and forth, but I assured the anesthesia team that I had attended cesareans before and was trained to do so. I affirmed their concerns about infections and space and assured them I would be on my best behavior. I was allowed in to sit with my clients for what we all expected to be a standard cesarean birth.
Her birth was anything but standard. The baby came out easily and quickly enough, a healthy cry rising over the sterile drape within about five minutes of my client’s partner and me sitting down with her. Her partner was able to cross OR to be with their baby while I stayed with my client, who was wide awake and anxious despite her exhaustion. She was also freezing and asked that I simply hold her hand where the IV fluids entered her body to help warm them. Her partner came back to show her pictures of the baby, and later brought the baby to her.
Then the atmosphere shifted. The staff spoke with a bit more urgency and more people entered the operating room. They explained to my client that they had brought in a urology team as a precaution after seeing what appeared to be blood in her urine. What is typically an hour long surgery ended up being five and a half hours. During that time, I never left her side, leaving her partner free to be with their baby when she felt too unwell to hold the baby. Despite the crazy circumstance, they were well taken care of.
And a compromise.
Another client was having a preterm baby when she had her cesarean. Her partner asked if I could go in with them and didn’t give up when he was told no. He asked if I could come in with her once he left with the baby and the staff relented. I’ll never forget the look on their nurse’s face when she tossed me the scrubs and said, “We never do this.” She was unhappy that they had bucked the status quo. I simply thanked her for advocating for my clients, who went on to have a beautiful birth and postpartum experience. This sort of deal should be seen as the bare minimum!
Similar to how many hospitals still lag behind the research and don’t allow laboring patients to eat (this statement from the American Society of Anesthesiologists is eight years old), hospitals are often behind the times when it comes to giving their patients the right to choose evidence based doula care regardless of the method of delivery.
I urge hospital administrators, OBGYNs, nurse-midwives, anesthesiologists, and labor and delivery nurses to talk to local families and local doulas. Make a plan for how to safely allow better support for your patients and their partners in OR. The 23.4% of your patients having cesareans deserve better!
We’ll talk about VBAC access another day.
Your friendly neighborhood doula,