I believe everyone should have a doula - especially during a cesarean section. When you consider that one of the doula's primary jobs is to preserve positive memories of your birth, thus promoting higher self-esteem, it stands to reason that moms undergoing a cesarean are especially in need of doulas.

If you were to have a cesarean, your doula might be useful to you in many ways. First, if your cesarean was not planned - meaning that at some point during labor a c-section was recommended - your doula should be able to guide you in asking questions that will help you gather necessary information about the reasons your caregiver recommends a cesarean, the risks and benefits relative to your particular situation and any alternatives you may have. Hopefully she will then facilitate you having time alone with your partner so you may process that information and come to a decision without feeling pressured. Couples who have a chance to process a cesarean recommendation in this way are more likely to believe that they made an informed decision rather than an uninformed one and are, therefore, more likely to be satisfied with a surgical outcome.

Other ways in which a doula might help with a cesarean section, planned or unplanned, include:

• Assisting in relaxation during the administration of the spinal or epidural (this is most likely allowed by the anesthesiologist if the doula has experience in this area);
• Video taping or photographing the birth (if allowed in your particular hospital);
• Facilitating closeness between mom and baby by asking the anesthesiologist if mom's hand may be left unrestrained to touch the baby when it is brought to her, and by helping to snuggle the baby near her cheek as she and her partner offer greetings.

There are yet other ways - as you see the list goes on and on - if, as in many hospitals, the baby and father must leave the operating room for a mandatory nursery trip before the surgery is finished, the doula can sit by the mother's head and offer companionship during the long time of stitching. This is often a lonely time for the mother who has only seen her baby for a few moments and has likely not yet held him or her. A doula's presence can be very comforting.

Finally, after surgery, a doula can serve as a go-between for dad in the nursery and mom in recovery, or between mother and partner in recovery and baby alone in the nursery. Hearing positive news about her baby is likely to affect the mother positively during her recovery period. If the baby is not doing well, a doula can do her best to support the couple emotionally and buffer the situation as much as possible. And, as mom's anesthesia is wearing off (often, in my experience, before the post-op pain medications are available), the doula can assist in breathing and relaxation, just as she might during labor. And, last, but not least, the doula can assist in initial breastfeeding just as after a vaginal birth.

Though it is possible your caregiver may initially be resistant to the idea of a doula in surgery with you and your partner, you may be able to convince him or her of the possible benefits to you - especially if you work with a doula who attended at least a few. And this may not be as far fetched as it may seem. I know of at least one practice in which there are doulas who specialize in cesarean.

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