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How Do C-Sections Affect Doulas?

Serving as a doula with South Phoenix Healthy Start in Arizona, I had the traumatic experience of supporting a mama; whom we will call “Michelle”; through an unplanned C-Section, when what she really wanted was an unmediated birth.

Due on, or the day after Christmas, when Michelle passed her estimated due date, her doctor scheduled her for an induction.  In one of our 2-hour sessions, Michelle and I had talked about induction and its link to Cesarean Section. I was disappointed when she complied with the induction, but at this point in my service with South Phoenix Healthy Start, I was accustomed to that feeling.

Before births, I spent hours in womens’ homes or in public meeting spaces talking and educating. I shared personal and professional experiences. Sometimes we connected, other times we simply agreed, but we shared the same goal–natural, unmediated birth…their doctors gave them some reason to doubt themselves. I would get my hopes up, pour my all into helping them achieve the natural birth they all said they wanted and when the time would come it seemed as though they would make a different decision.

Looking back though, most of the mamas I coached still maintained a level of authority over their experience and their wishes were, for the most part respected.

I understand now that this is attributed to the work we did in those sessions, as well as to my protective presence at their births. On the other hand, having small children, lacking childcare, and sharing 1 vehicle with my husband, I was not always able to be at every birth at the very beginning and sometimes I had to leave during a birth and return an hour or so later. For these reasons, I accept that some of the “failures” were possibly on my part.

Most of the mamas I supported birthed entirely alone; without their own mother, without their conception partner, and sometimes without both. Additionally, I also later realized that mamas are treated entirely differently when they are alone than they are treated when I am present.

However, as a young birthworker who had never been mentored, I had not yet developed that level of insight. I figured: if we talk about it and if I give you to tools, you can just do it whether I’m there or not; especially since I would only be absent for an hour or so. I was wrong.

Before this understanding though, I resorted to frustration and resented mamas for choosing drugs or an epidural. I discounted the importance of my presence and the difference it made in each mama’s outcome. Though her outcome was far better than it would have been had I not been there, I judged her performance when she did not fit into my idea of “perfect” and after a while, I adopted the other extreme of just quietly inserting myself into a room and going along for whatever ride whichever mamas chose for her birth.

I settled on the thing that all birthworkers at some point must remind themselves: this is not my birth; it is hers; and so, when Michelle complied with her induction, I didn’t push the issue. I looked at the bright side instead: “hey, at least I know exactly when I’m going to this birth.”

I wish I had fought harder for Michelle.

On the scheduled day of the induction, I met Michelle and her baby’s father in the hospital waiting room. Once assigned a room, the nurse checked Michelle’s cervix and it was discovered that she had no cervical changes: no dilation, no effacement, no softness, no change in position.  The nurse then asked if Michelle had been checked at her last doctor’s appointment.  Michelle answered that she had been checked.  The nurse paused and looked a bit concerned, but she didn’t say anything else and they began the induction anyway by vaginally inserting Cytotec, a drug used for induction but not FDA intended for induction.  I warned Michelle about the negative reviews of the drug, but under the pressure of her environment, she continued with her induction. I didn’t press.

What I know now is what that nurse knew then: Michelle should not have been induced because she was not at all a candidate for induction

When there were no changes in Michelle’s cervix, the nurse suggested they give Michelle Pitocin to speed things along, so I asked if we could have a birth ball and if we could walk around the hospital instead.  We were given an hour to do so and we did.  When we returned to Michelle’s room, there were still no changes in her cervix and she was given Pitocin.  Because inductions take longer, I stayed for a few hours in the beginning, went home to check on my family, and returned the next afternoon.

When I returned, Michelle still had no cervical changes and a few hours later the nurse came in and turned the Pitocin off.  She explained that Michelle’s baby was not responding well to the contractions and it was concerning her and the doctor, who would be coming in to talk more about what that meant.  Once he finally did come into the room, he sat on a stool and told both of us very certainly that he recommended a C-Section because of how the baby was responding to contractions. 

He nonchalantly rattled off the risks and his staff began prepping Michelle for her C-Section. The nurse looked bothered, but like me, she didn’t say anything.

Besides me, there was no one else in the room with Michelle. Her boyfriend had left and still hadn’t returned.  When they placed her in her wheelchair to take her to the operating room, she began to cry.  I exhaled and rubbed her shoulder.  She cried silently still, but her tears flowed faster.  I imagined all the things that must be going though her mind at the moment, although she never did say a word.

In the operating room, Michelle still cried.  I held her hand and empathized with her.  The doctor and nurses kept trying to tell us what to feel, “take pictures!” they exclaimed.  They made a bunch of other suggestions and said a bunch of other empty phrases that basically meant, “she didn’t get what she wanted but y’all be happy anyway.” 

Neither of us was happy. 

Michelle was in tears and I was angry.  When Michelle’s baby was born, my anger was overcome by my nerves.  I have seen at least 20 births up to that point and I have never, to this day, seen a baby come out looking the way Michelle’s baby looked.

While most babies I’ve seen born do not come out crying as they do on TV, they do move.  Some wiggle vigorously, others open their eyes and look around for their mother, and others calmly open their hands and wiggle their sweet little toes.  This baby did none of that.  She was purple/blue and she lay limp in the doctor’s hands.  I thought I had witnessed my first infant death. 

I prayed…and I’m pretty sure I stopped breathing for a moment.

It took a while, but the baby finally started to move and she soon started to cry loudly.  To make matters worse, the nurse handling the baby was unnecessarily rough.  With Michelle still in surgery and unable to monitor her baby’s treatment, I was able to fill in for her.  I stood, watchful, over this nurse making eye contact and asking questions about the baby’s condition.

The night ended with Michelle and her baby doing well and with her thanking me and blissfully enjoying her first moments with her baby.  The baby’s father had also shown back up by then so I felt better about leaving when I finally did.

I went home.  It was over, but I wasn’t the same.  That birth stuck with me for days, but I had no idea what I felt.

It wasn’t until I recounted the birth, in a phone conversation with my best friend, that I realized just how much it had traumatized and stressed me. I was in tears sobbing as I told her the story.

“I’ve never seen a baby look like that,” I recalled.  “I thought she was dead!”  I never wanted to witness that again and I never wanted another baby to come that close to death on their birth day. I have seen birth; in it’s purest, most authentic, and most beautiful form.  Witnessing that C-Section was the antithesis of my previous testimonies and I hated it. .

What I hated even more is that Michelle and her baby didn’t even know what they had missed. They both only knew this C-Section and that they both had survived it.

I took pictures of Michelle’s baby as she was first pulled out of Michelle and I took some later while she was on the warming table and after she was swaddled. When Michelle asked for the pictures I took, I only sent the ones from the warming table and from later. My intuition told me not to send her the others.

During my postpartum visit with her, from what I could see, Michelle was recovering well. She only said a few words about the actual birth experience but focused mostly on that fact that she was happy to be a new mother. She and baby were doing fine. In that moment, though I thought I had one before, my professional campaign with the unplanned C-Section began.

I can’t say what Michelle did or did not feel, and I can’t say that she didn’t truly feel what she told me she felt. What I do know for certain is what I felt, and I felt raw and fragile. I kept those pictures of that purple/blue baby in my phone for a while and would just stare at them every now and then. I kept seeing the faces on all those people in that operating room and hearing the condescension in their voices.

They all knew. I could identify a few who did not agree, but they all knew it was not a favorable situation.

I finally deleted the pictures and closed that chapter in the book of my birthwork experiences. Every woman has a right to choose her birth. If a woman wants a C-Section, by all means, she should have one.

However, there is no reason for a low-risk, first-time mama desiring a natural birth to be set up for an unplanned C-Section. It is only a broken, evil system that believes these practices are non-consequential. As a birthworker, and as a voice, it is my responsibility to remind a consciously forgetting industry that they, in fact, are…

2 responses to “How Do C-Sections Affect Doulas?”

  1. Thank I always enjoy your information about your work.keep It up.Johnnie  “In everything give thanks; for this is God’s will for you in Christ Jesus” (1 Thess. 5:18).

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