April is Cesarean Awareness month. The World Health Organization considers the ideal cesarean rate to be 10-15%. However, in the US, the C/S rate is well over 30%. The American College of Obstetricians and Gynecologist (ACOG) recognizes the need for reducing this rate. They also recognize the value of a doula in minimizing the need for surgical birth: "Increasing women’s access to nonmedical interventions during labor, such as continuous labor and delivery support, also has been shown to reduce cesarean birth rates." Evidence suggests that having a doula may decrease the risk of having a cesarean birth by up to 39%. Wow! That's significant. So how does a doula do this?
Help you navigate choosing a provider and birth place. The number one indicator of whether or not you will have a cesarean is your choice of birth place and provider. While the doula should never give her opinion, she can guide you in asking the questions to ask your potential provider.
Encouraging labor to start spontaneously. First time mothers in particular are at higher risk of having a cesarean when labor is induced. Doulas can provide evidence based information regarding inductions and help make informed decisions about whether the induction is medically necessary or routine convenience.
Providing a calm environment in which to maximize the effects of natural labor hormones. Oxytocin, the love hormone which also causes uterine contractions and beta-endorphins, the body's natural pain reliever are the most effective in a calm environment. The doula is trained in anxiety reduction techniques such as breath work, touch and emotional connection between birthing person and partner and medical professionals and anyone else who may be at the birth.
Reducing the need for pain medications such as epidural. Evidence suggests that having a doula reduces the requests for pain meds by 9%. There is also indication that first time moms who have epidurals may have an increase risk of cesarean especially if it is administered early in labor. A doula can help with relaxation, movement and positioning to facilitate better fetal position which can lead to an easier, shorter labor.
A doula can also help when a cesarean is needed:
Provide a calm, reassuring presence prior to the procedure and facilitate questions and concerns being addressed.
Assist with skin to skin in the OR.
Maintain sense of calmness during the surgery.
Help with breastfeeding, self care and newborn care once surgery is complete.
Postpartum doulas can provide support in the home upon discharge from hospital.