As I lay flat on my back with morphine dripping through my veins to dull the pain from a Caesarean section, my doula gently helped me fill a small cup with the rich, antibody-filled early breast milk called colostrum. She took it to the hospital’s baby nursery, where my husband fed this “liquid gold” to our 2-hour-old daughter.
My previous two babies never got this; their first taste was baby formula while I was confined to a surgery recovery room feeling not just pain from the C-section but also loneliness as I waited to be reunited with my babies.
For this birth, though, I was calm and happy, mainly because when I realized that I’d need another C-section, I hired a doula, whose job is to support women physically and emotionally before, during and in the days after childbirth.
For decades, plenty of women hoping to have a natural birth have used doulas, but now women having C-sections have begun to use them, too. Like me, many giving birth by C-section hope that doulas will make the hospital experience less stressful and less medicalized, with the surgery interfering as little as possible with the process of bonding with and caring for their newborns.
“I think there’s a recognition that social support provided by doulas can help women in many different situations” — not just in a pregnancy where a baby is delivered naturally but in C-sections and even pregnancy-termination situations as well, said Julie Chor, an assistant professor of obstetrics and gynecology at University of Chicago Medicine, whose research has focused on the effects of doula support during pregnancy termination and other obstetric procedures.
Even if doulas cannot be with women during the surgical procedure itself — most hospitals allow only one companion, who is usually the birthing mother’s partner, into the operating room — Chor says that the presence of a doula before and after the procedure can be emotionally beneficial.
To become a certified doula, DONA International, the largest doula-certification body, requires a 16-hour workshop plus additional classes in childbirth education, breast-feeding education and other topics; completing a required reading list; and having references and evaluations from health-care providers and clients.
But certification is not required: Doulas are not medical professionals, and they do not deliver babies or examine women to assess their stage of labor, as midwives and doctors do.
According to the American College of Obstetricians and Gynecologists, studies have found that doula or similar support leads to more-beneficial outcomes for laboring women, including a lower instance of Caesarean sections. (Studies have shown better outcomes for women who have “continuous support” during pregnancy and labor.) Caesarean sections accounted for about 32 percent of all U.S. births in 2016, according to the Centers for Disease Control and Prevention; that’s up from about 20 percent in 1996.
Doulas say they have seen an uptick in requests for help from women delivering by C-section.
“For a while, helping women during C-sections was all I did, even though it wasn’t my goal when I trained to become a doula,” said Rachel Leavitt, a registered nurse who is also a doula in Marshall, Mo. “A lot of the same techniques for natural births can also be used before and just after C-sections, like foot massages, aromatherapy and music — anything to help the mother relax.”
The use of doulas for pregnancy generally has become more common, and the number of trained doulas has been increasing, according to DONA. The proportion of American women who reported using doulas for birth doubled to 6 percent in 2013 from 3 percent in 2006, according to data from the National Partnership for Women and Families.
The national median cost for a doula’s services is $922, according to Kim James, co-founder of DoulaMatch.net, a Seattle-based online database that provides listings for about 9,000 doulas around the country. Doula care is rarely covered by private insurance. In recent years, Minnesota and Oregon have expanded Medicaid to cover assistance from doulas, according to the National Partnership for Women and Families, and New York has announced plans to do the same.
Craig Salcido, an obstetrician-gynecologist in Mission Viejo, Calif., says he talks to all of his pregnant patients about the benefits of doula care, no matter what kind of delivery they expect.
“They really just do a good job making sure the patient feels comfortable in an unfamiliar environment,” he said. “And they provide some coping skills for the family of the woman having the C-section.”
For example, consider the case of Stacey Ward of Elmont, N.Y., who was carrying twins and scheduled for a C-section. After hearing from several friends who had gone through C-sections and felt traumatized by not knowing what was going on during the birth process, she hired a helper. The doula stayed with her and her husband during the surgery at NYU Winthrop Hospital, which allows doulas in the operating room. The doula helped calm her.
“Walking into the OR for my Caesarean section was honestly the scariest experience of my life,” Ward recalled. “If I hadn’t had the doula there to support me, explain things and simply hold my hand, I don’t know if I could have done it. Having my husband was, of course, important, but he was just as scared and inexperienced as I was.”
After the babies were delivered, her husband accompanied them for weighing and medical exams while the doula stayed with Ward. “What could have been a terrifying memory actually turned out to be a calm, beautiful experience,” Ward said.