Cesarean Awareness: A Doula’s Humble Reflection

by Erin Stertz-Follett, CLD, LCCE, HBCE


My journey into birth began 10 years ago after the birth of my first nephew, Micah. I wouldn’t fully embrace birth as my calling until many years later, after the birth of my own two girls and the ‘birth’ of the passion inside me to bring services of meaning to pregnant women and their families.
I will never forget that moment. After an induction that lasted more than 24 hours, and “arrest of descent” of the baby during pushing, my sister was told that she would need a cesarean section. I watched as her face turned from determination, to disappointment, to resignation, and to sorrow. As my mom and I left the room while they began the surgical prep, I said to Mom, “That’s not what we wanted.” With tears trickling down her cheeks, she shook her head, “No.” The grief for what Sarah so badly wanted – a vaginal birth with minimal interventions – was palpable.

A few years later, as I was pregnant with my first child and wanting to learn as much as I could to avoid my own surgical birth, Sarah invited me to an ICAN (International Cesarean Awareness Network) meeting. At that time, the group was small and had just begun reforming here in the Twin Cities. I happened to attend on a night when a wise midwife named Gail Tully was on hand to provide information and practice in ‘optimal fetal positioning’ for birth. I didn’t know anything about birth halls or Rebozos, or the side-lying release. I just knew that it felt so good (and kind of funny!) as I was used as the ‘pregnant model’ for Rebozo belly sifting.

Two babies later, both of which included my sister’s attendance and support, I began the true path to birth work as a Lamaze Certified Childbirth Educatordoula, and HypnoBirthing Certified Educator. Again, my journey was largely inspired not only by Sarah’s first birth, but also by her successful HBAC (home birth after cesarean) her second time around.

To offer full disclosure, I dreaded as a doula the first time I would need to step into the surgical suite and witness a mama experience a cesarean birth. In some small way, I was traumatized by my sister’s experience. Now with several under my belt, I can say that my perspective has changed. Yes, it is still difficult. But, with my doula hat on, I enter the experience with an open heart and an open mind, with nothing but how I can best support that mama in that moment as my focus. It is at that time that we turn our trust over to the trained surgeon whose job now is to safely bring the baby forth from the mother’s womb. I offer a grounding hand on the forehead, an explanation of what to expect and what is happening, sounds and smells that calm the mother, words of reassurance to the partner, and pictures if mama desires.

I have seen mothers who view their surgical births in many different ways: From full-on acceptance (even requesting one at the end of a long, stalled labor); to complete devastation (offering my doula hands to wipe away tears); to somewhere in the middle (perhaps with resignation and a resolve to process the experience later).  I have seen cesareans that are completely medically necessary, and those that fall in a grey area.

Look, the cesarean rate in this country (32.8%) is too high. There’s no way around that. We can do better. For women, for babies, and for their families. It may feel daunting to tackle this subject on a grander scale and I know many of us birth workers often feel at a loss. But here is what we can do:

  • Approach the subject with mamas (clients, patients, friends, family) with gentleness, understanding, an open heart; and, when needed, the statistics.
  • Remember and value the fact that not all mamas view their cesarean as traumatic or unnecessary. Don’t assume that all mamas do and meet them where they are, especially as they plan a subsequent birth.
  • Educate. Educate. Educate. Knowledge truly is power. Whether it is ways to more optimally position baby for birth, or methods for deep relaxation, or just knowing all options and all places of referral. Education is key. The ability to ask questions and have them honestly answered is tantamount.
  • Refer to birth providers who offer options for mamas in pregnancy and labor; and who understand normal, physiologic birth… Those whose rates of cesarean birth are on the lower end (including out-of-hospital options if the mother desires).
  • Refer mamas who have experienced cesarean birth, especially those that view their births as traumatic, to resources such as ICAN and Homebirth Cesarean groups.
  • When a surgical birth becomes truly medically necessary either before the birth or during the laboring process, we can offer support and guidance for having a more family-centered experience.
  • Put our time, our money, and our voices behind organizations that support mamas in having births with low interventions.

And finally, as doulas and as friends or family, we can hold hands. Wipe tears. Validate fears. Lift them up. Walk down to the lowest lows with them. Remind every mama how strong they are… that they brought their baby into the world; that they can do it again with love.

cesarean awareness

Erin Stertz-Follett owns Flutterby Birth Services, located in Burnsville, MN. In addition to doula services, she offers HypnoBirthing, Lamaze, and Breastfeeding classes as well as other workshops and events. She is the mother to two lovely and lively little girls.

Editor’s Note: This post first appeared on the Flutterby Birth blog. Photos credited to Stephanie Ryan Photography.  All birth stories used with the permission of the mothers. 

Ask a Doula: How can a doula assist my family during a planned, medically necessary C-Section?

A doula assists a birthing family in the OR at Abbott Northwestern.

A doula assists a birthing family in the OR at Abbott Northwestern.

We are excited for our first “Ask a Doula” post to have responses from not one, but two of our Collective doulas! On the heels of April’s International Cesarean Awareness Month, a mama on our Facebook page asked, “How can a doula assist my family during a planned, medically necessary C-section?”   Women having a necessary surgical birth still have choices for this important day! If you know you’ll be having a surgical birth, interview several providers and find one who can help you have the cesarean birth experience you want.  If you’re interested in learning more, check out this video on the  Natural or Family-Centered Cesarean movement being implemented in the UK. 

Our first doula response comes from Karrie Nesbit CD(DONA), CLC, HCHD: 

When considering a planned surgical birth, getting the information you need to make informed decisions is critical.  A doula will ensure you understand all of your options, and because a doula is not accountable to your provider, she will provide you with unbiased information to help you make the decisions that are best for your family.  With such a wide variety of birthing options available nowadays, it can be comforting to speak with a doula about her experiences with different birth techniques, providers, and birth places.  In short, if you are not completely comfortable with the options you are getting from your provider, a doula can help you find more of what you are looking for with other providers or birth places.

Once the decision to have a surgical birth has been made, your doula will prepare you for what you are going to see, hear, smell, and feel during the birth.  I find that for most families, just knowing what to expect takes away a lot of the anxiety.  Sometimes the  hospital staff forget to explain the details, or they explain them in a way that is not calming or easily understood.

In the operating room, your doula will explain procedures as they happen to reassure, comfort and calm everyone throughout the process. She will help you understand the circumstances immediately following the baby’s birth. If the partner needs to leave the operating room with baby, the doula will remain with momma. Whether in the operating room or recovery room, your doula can help facilitate skin to skin and breastfeeding.

Above all, doulas encourage and help you to speak up for what you need and want for your baby’s birth.  No matter how your baby comes into the world, the presence of a doula will help you to look back on your baby’s birth as a positive and empowering experience.

Our next response comes from Gina Picht with Partners in Birth: 

Sometimes when a family finds out they need or chooses a planned Cesarean birth, they stop thinking of it as a birth.  It becomes a procedure, a “section”.  Something that the doctors do to them, not them birthing their baby.  A doula’s role becomes the keeper of the birth, bringing the focus back to the family and how they can best work with their circumstances to welcome their baby is a gentle, interactive way.

Your doula will likely meet with you before the day of surgery to review options, which some families are surprised to learn they still have!  Cesarean birth is more and more viewed as an experience that can be tailored to a family’s wishes.  Hospitals and even doctors themselves handle the surgical experience in their own unique way.  It is worthwhile to ask questions beforehand to better understand what options may be available to you.  Your doula can arrive early with you and help keep you relaxed through the preparation process, giving massage, using scented oils, dimming lights, and offering guided visualizations, just as in labor.  As questions are asked of the family by the medical staff, the doula can help give context for those questions, and help get more information when needed.

When the mother goes into the OR to get anesthesia, the partner is usually left alone outside the room.  Your doula will stay with your partner during this time and can be a calming presence in an unfamiliar time and environment.  Most often, the doula is allowed to join the family in the OR where she continues her support, using massage, her calming voice, and maybe a scented oil to mask any surgical odors.  If desired, the doula can narrate the procedure to some extent, letting the family know at what stage the surgery is and when the birth is close.  The time it takes to get to the baby can seem incredibly short, and the doula helps the family participate emotionally in the process, anticipating that moment when the baby is born.  She can encourage the screen to be lowered so the family can see the baby when it’s born, and advocate for the mother’s hands to be unstrapped so she can touch and hold her baby.

In certain cases the mother will feel ready to attempt nursing while the surgery is being finished.  If not, the doula can assist with this in the recovery room.  If the baby needs to leave the OR for any reason, the partner usually goes with the baby so the doula will stay with the mother.  She can help the mother process the experience, and go to get updates on the baby’s condition, maybe bringing back photos to help the mother stay connected.  Of course as soon as possible, the doula will encourage the mother and baby to reunite, facilitating skin-to-skin contact and breastfeeding.  And lots of photos!

A Cesarean section is still a birth.  In the end, a family is born, and a doula can help bring the focus back to that family.

Karrie Nesbit is a doula and lactation counselor who recently relocated to sunny Southern California. Find out more about Karrie at Birth, Etc.

Gina Picht has been a birth doula since 2001 after the birth of her second (and last) child. She is Treasurer of The Childbirth Collective and lives in Eden Prairie.  She believes all women already know how to birth.  www.partnersinbirth.com

Cesarean Prevention is for EVERY birthing mother….

by Chandra Fischer

“I never paid any attention to cesareans.”  “I ignored the part about cesareans in our childbirth class because I was planning a natural birth.”  “My care provider told me that he only does a cesarean when the baby is in trouble.”  “I was shocked when I had to have a cesarean.”  “I had no idea that an induction or epidural would increase my chance of cesarean.” “Isn’t a cesarean a better choice if I want to protect my pelvic floor?”

Sound familiar?  That’s the echo of thousands of pregnant women bypassing an issue that will, in effect, impact at least 1 in 3 pregnant women in the United States.  Yep.  You heard right.  One in every three women in this country will have a surgical birth.  Some of those will be life-saving.  Some of them will be necessary.  A great majority of them are entirely preventable, with higher risks to you and your baby.[i]  Because, let’s face it, an intervention that is unnecessary has NO benefit.  It’s all risk.

With that in mind, here are a few important things you can do to avoid an unnecessary cesarean:

  • Read.  Learn about what a cesarean surgery entails.  Learn about the times when it *is* truly necessary.  Educate yourself about the risks, benefits and alternatives.  One fantastic, evidence-based, resource is “What Every Pregnant Woman Needs to Know About Cesarean Section” — downloadable booklet located at http://www.childbirthconnection.org.  Another is the International Cesarean Awareness Network’s (ICAN) website http://www.ican-online.org, and your local ICAN chapter at http://www.icantwincities.org.
  • Hire a Doula! Research fully and repeatedly backs up the importance of trained labor support in the reduction and prevention of a variety of interventions, including cesarean section.[ii]
  • Stay active and mobile during your labor.  Gravity and freedom of movement are a birthing mother’s best friend.  The ability to change your position allows you to respond to your baby’s spiraling movements and descent down the birth canal, opens up your pelvis and helps your baby to be born gently and easily.  This mobility can help prevent your baby from getting stuck in a less advantageous position, and, if your baby is already malpositioned, it can enhance your baby’s chances of moving into a better position for birth.  If your movement is limited or if you are confined to bed, ask your doula to help you change your position every 30 minutes.  [iii]
  • Avoid induction of labor unless there is a true medical reason to do so.  Simply put, induction of labor, especially in first time mothers, increases your chances of a cesarean by 50%.  [iv]

The work of parenthood begins in pregnancy.  Advocating for the healthiest birth possible is just the beginning.  So, cesarean prevention isn’t for the other women.  It’s for you.  It’s for your baby.  It’s for this pregnancy.  This labor.  This birth.

-Chandra Fischer, Birth Doula

Prajna Birth Services


[i] http://www.motherfriendly.org/Resources/Documents/TheRisksofCesareanSectionFebruary2010.pdf
[ii] Cochrane Database of Systematic Reviews, Hodnett ED, Gates S, Hofmeyer GJ, Sakala C, Weston J. “Continuous Support for Women During Childbirth” 2011, Issue 2
[iii] http://www.lamaze.org/ChildbirthEducators/ResourcesforEducators/CarePracticePapers/FreedomofMovement/tabid/484/Default.aspx
[iv] Labor Induction and the Risk of a Cesarean Delivery Among Nulliparous Women at TermEhrenthal, Deborah B.; Jiang, Xiaozhang; Strobino, Donna M.Obstetrics & Gynecology. 116(1):35-42, July 2010.