Entering the Operating Room: Doula Support for All Births

Are times changing? I say, YES! Doulas entering the operating room (OR), as a primary or secondary support person, and I am thrilled that I have experienced this in our city! Imagine this all-too-common scenario: you’ve worked with your doula for a while now, learning all things birth preparation, newborn care and (of course) caring for yourself postpartum. You’re feeling connected to your doula, and you and your birth partner are thrilled to have your doula’s tender hands and calm demeanour present for the baby’s birth, whenever that day may come.

You know the benefits of doula support and feel a sense of ease knowing you’ve picked the right doula for you! But wait, you’re unexpectedly (or expectedly) being wheeled into the OR for a belly birth (caesarean section) and told firmly your doula isn’t welcome in the OR. You went over what to expect for a surgical birth but didn’t truly imagine you’d find yourself in this position – your birth partner looks at you with support but, really, you know he or she is terrified of what’s to come next. The OR doors close behind you and your doula remains on the other side.

Thankfully, this familiar scene may not be the case any longer! Here are the words of my clients who advocated for me to join them in the OR and were told a big, juicy YES when the baby’s heart decelerations didn’t resolve despite many efforts from the hospital team.

“Kaitlin was a valued part of our birth team for weeks, solidly empowering us for what was to come. In the few minutes before we were sent from our birthing room to the OR for an emergency C-section, weexpressed our desire for Kaitlin to be present and the medical team agreed. We are extremely grateful that she was there. Her presence not only made us feel infinitely more safe and secure – having a knowledgeable advocate for myself, my spouse and our baby – but she also was able to capture the experience in photos and videos that we will cherish the rest of our lives. Birth is such a big event and can easily be traumatic. The presence of a doula can be transformative in a positive and profound way, especially when you find yourself in unexpected situations.” – Alex and Aaron

One-third of births in Alberta in 2022 were via caesarean section. Alberta caesarean rates continue to climb and were an all time high of 34% last year. Considering this high rate (World Health Organization recommends 10-15%), Alberta Health Wise writes that doula support is invaluable, “The doula’s job is to help make your birth experience—and your partner’s experience—the best it can be. This can be especially helpful in a hospital setting, where labour and delivery nurses usually are busy with more than one patient.”

I am delighted to have been welcomed into the OR as a second support person to my client and to continue my doula role as emotional and physical support during and after her belly birth. Doula support in the OR can help clients to feel seen & heard, maintain continuous supportive care, promote early skin-to-skin contact, and promote early breastfeeding. Doula support also extends to birth partners who feel overwhelmed, or uncomfortable in the OR setting. The cherry on top of this is the priceless photos and videos which clients can carry with them. Belly birth is birth. Period. And the same treatment of ongoing doula support can be achieved!

It is very exciting to see this small shift in doula’s being allowed into the OR in our city. Spreading this news and sharing the experience of my clients is so exciting for all doulas and families under doula care. In the words of The American College of Obstetricians and Gynaecologists on improved birth outcomes in virtue of the presence of support persons such as doulas, “Given that there are no associated measurable harms, this resource is probably underutilized.” I can’t wait to see a movement of doula support in the OR setting move throughout our city. A special thank you to the care team at Foothills Medical Centre for valuing doula presence in ALL birth settings, and pushing healthcare forward with an upstream, client-centered mentality!

References

Alberta Interactive Health Data, Government of Alberta, 2022. Webpage: http://www.ahw.gov.ab.ca/IHDA_Retrieval/selectSubCategoryParameters.do

Hodnett ED. Pain and women’s satisfaction with the experience of childbirth: a systematic review. Am Obstet Gynecol 2002; 186(5) S160-72.

Hodnett ED, Gates S, Hofmeyr G J, Sakala C, Weston J. Continuous support for women during childbirth [PDF]. Cochrane Database Syst Rev 2011, Issue 2

Lanning, R. et all. 2019. Doulas in the Operating Room: An Innovative Approach to Supporting Skin-to-Skin Care During Cesarean Birth. Midwifery Womens Health. Issue 64(1), pp 112-117. DOI: 10.1111/jmwh.12930

MyHealth.Alberta.ca, Government of Alberta, 2022. Webpage: https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=tn9822

Richards, E. & Lanning, R. 2019. Volunteer doulas’ experiences supporting cesarean births: A qualitative analysis for preliminary program evaluation. Midwifery. Issue 77, pp-117-122. DOI: 10.1016/j.midw.2019.07.001

The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, Safe Prevention of the Primary Cesarean Delivery; American Journal of Obstetrics and Gynecology, March 2014. Webpage: https://www.acog.org/-/media/project/acog/acogorg/clinical/files/obstetric-care-consensus/articles/2014/03/safe-prevention-of-the-primary-cesarean-delivery.pdf

WHO Statement on Cesarean Section Rates. Department of Reproductive Health and Research World Health Organization. 2015. Webpage: file:///C:/Users/kaitlindavid/Downloads/WHO_RHR_15.02_eng.pdf