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

This is a nice piece written by two Doulas in the Twin Cities. There is so much to do in the area of birthing a baby to make the whole experience a pleasure and anxiety free.

The Childbirth Collective

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…

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Ten Easy Steps to attaining Baby Friendly Status and Video

There are many things that we do every day that make it a whole lot easier to implement Baby Friendly. BFHI has been an International program since 1991, an aftermath of the Innocenti Declaration in 1990. The Ten Steps to Successful Breastfeeding as published by WHO and UNICEF set the stage for tremendous success in infant nutrition globally. I remember in 1993 when the Ten Steps was launched at my medical school, University of Nigeria Teaching Hospital, Enugu, Nigeria. As a medical student then, I knew this was something big. I however never anticipated that after 21 years I will be writing about these same ten steps and helping healthcare providers and supporters understand that these steps are within reach.

  1. Have a written breastfeeding policy that is routinely communicated to all healthcare staff. In deconstructing this first step, the keywords are “policy”  and “routinely communicated”. Every  hospital has policies, so that is not new. Routine communication with staff is the norm thus including the Baby Friendly policy in communications with staff like orientation materials, retreats and monthly updates is an easily achievable goal.
  2. Train all health care staff in the skills necessary to implement this policy. Healthcare staff is usually interpreted to mean those providing direct care. Thus we are talking about nurses, doctors, nurse practitioners and physician assistants. As an added effort, success becomes more sustained if all other hospital staff know there is a policy and know who to ask questions/direct people to.
  3. Inform all pregnant women about the benefits and management of breastfeeding. Pregnant women in the course of their prenatal (antenatal) care come in contact with healthcare providers. In discussion of feeding options for the baby, information, educational materials and resources that explain the breastfeeding advantage can be included. This could be a one-page fact sheet about advantages of breastfeeding or online resources and links to credible websites including WHO, UNICEF, La Leche League and Breastfeeding Coalitions locally. A 10 minute visit with the lactation team/IBCLC if available also could be an addition to help.
  4. Help mothers initiate breastfeeding within one hour of birth. After the baby is born, what is next? Feed the baby. Yes, I know there may be no milk, but really that IS the point. Put baby to breast and the milk let-down/oxytocin cycle will follow. Some potential barriers have been operating room deliveries where the OR is perceived as being too cold for the baby thus leading to separation of the mother-baby pair (that should never happen). 1 hour is still a very long time. The original recommendation is 30 minutes which pushes it unless the institution is doing skin-to-skin at delivery irrespective of whether it is operative or not.
  5. Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants. Breastfeeding education can be provided by the delivery nursing staff. This would build on previous education delivered in the prenatal phase of the pregnancy (step 2 above). In the case of separation (critically ill requiring higher level of care or NICU transfer), pumping which is a universal phenomenon can easily be taught. Initially hand expressing would work for colostrum (which is of value despite its small quantities). Subsequently by day 3 for many, the milk comes in and volumes increase. Mothers can start pumping at that time and the expressed milk should be fed to baby.
  6. Give newborn infants no food or drink others than breastmilk, unless medically indicated. Medical indications could be use of Sweatease for procedures or nutramigen for low blood sugar. Also some infants of poorly controlled diabetic mothers sometimes would require feeds sooner and to avoid the risk of dangerous hypoglycemia. For most other conditions, a peripheral IV would be placed and dextrose solution given. Thus this is another easy step to implement. Barriers include the free availability of formula. If there is no formula available in the birthplaces, unless via prescription, this step can be implemented with moderate to minimal effort.
  7. Practice rooming-in-allow mothers and infants to remain together—24 hours a day.  How hard can that be. Keep the baby with the mother. I have experienced some difficulties with this at a couple of hospitals as parents there expected separation at birth, as was done in the old days. New mothers have the expectation that their new baby will be taken to the “nursery” to allow her rest. In certain cultures, that is the norm. It is thus our duties to set the correct expectations for families especially mothers and grandparents who may not have been in a delivery hospital since the new mother was a baby 20 to 40 years before.
  8. Encourage breastfeeding on demand. Breastfeeding on demand is a skill that mothers need to learn. I translate it to “In case of discomfort, offer breast FIRST”. Babies can not talk so they will never really “demand” breastmilk. Thus this step asks that we teach these mothers to respond first by offering their milk. Use the phrase above. It delivers the learning point for mothers succinctly. Eventually as the baby gets older many mothers get accustomed to the different types of cry of their baby
  9. Give no artificial teats or pacifiers to breastfeeding infants. If there is none obtained (purchase or gift) by the hospital, there will be none given to the infant. Some families would bring theirs from home. In that case by making your hospital  policy known to the new mother, including making a copy available to her, there would be more success with keeping the passies out.
  10. Foster the establishment of breast-feeding support groups and refer mothers to them on discharge from the hospital or clinic. Having a ready place to send mothers for support is all that is needed. This could be internal such as the Lactation Consultant in the same hospital, local breastfeeding support groups such as La Leche league, WIC Program or the local breastfeeding coalition.lalecheleague