Do I need a doula for an unmedicated VBAC?

August 4, 2018 11:32 PM

I’m 30 weeks pregnant with my second child and I want an unmedicated VBAC. Should I hire a doula? Complication: postpartum PTSD.

I know there are lots of “should I hire a doula” questions here on Ask Metafilter, but I think my situation is unique in that I want an unmedicated VBAC in a hospital and, due to postpartum PTSD, I can’t do research or hypnosis training or whatever people normally like to do to prepare for unmedicated childbirth.

I’m very emotionally fragile when it comes to my C-section — baby was breech, so when my water broke, I got wheeled into surgery within about four hours and never got to experience labor. I feel fucking terrible about it. Recovery was really awful (and would be more awful this time since I have a toddler to care for) and it presaged our inability to exclusively breastfeed due to very, very low supply. (I know lots of people successfully EBF after C-sections, but I’m not taking the risk this time. That’s also why I don’t want an epidural. If we’re unable to make it work, I want it to be be because I’m simply physiologically incapable of it, not because of any decision I made or event in delivery.)

When it comes to research, I tried to read a highly-recommended childbirth book, but it had a whole page on how the US is the only country “backward enough” to require caesareans for breech babies, and it made me ugly cry. I don’t want to read more books like that. And I have this terrible feeling that any other kind of preparation — hypnosis training or whatever — will be a waste of time, much like all those useless nursing clothes I wasted money on during my first pregnancy. I can’t bring myself to do it because it leads to intense, intrusive negative thoughts about how I’ll just end up in the operating room again.

So would a good doula be able to coach me through this experience if I do nothing else to prepare? If not, what else would you recommend I do? I already intend to see a therapist soon (although I realize we’re running out of time).

My obstetrician says I’m a good candidate for a VBAC, if it makes any difference, although I’m of “advanced maternal age” and technically obese. The C-section was more than two years ago, so you’d think I’d have gotten over it by now...

posted by anonymous to Health & Fitness (14 answers total)

Yes I think you should. I think it'll help you a lot, feeling protected and less panicky. I'd get the toughest one you can who is really well respected by the doctors and nurses to boot.
posted by fshgrl at 11:47 PM on August 4, 2018 [1 favorite]

Yup, get a doula wearing army boots and pay her for significant pre- and post-partum care as well. You definitely need to build a support system. If you do end up having another c-section, get child care in for the toddler and newborn so you can recover.

Don’t beat yourself up for not getting over a traumatic experience less than three years ago. Especially three years of being sleep deprived with very little time alone to process what happened. Good for you in recognizing this is a bigger challenge than you can handle alone.
posted by saucysault at 11:58 PM on August 4, 2018 [8 favorites]

As a resident of Another Country, what you read in that book is not exactly true. There's a lot of agendas out there when it comes to how we birth, and when people recommend a book it just means it fits with whatever preconceptions they already have. If you feel a doula would support you, I think it's a good idea.
posted by chiquitita at 3:13 AM on August 5, 2018 [9 favorites]

A good doula will help immensely. Interview a few about their thoughts on VBACs and be clear about the kind of support you need.

I will gently say that if you can barely even think or read about birth now, you may find yourself really overwhelmed when it actually happens. Avoiding thinking about it is probably not the strongest plan.

There's a hypnobirthing exercise called "fear release" that you do with your partner- you list all your fears about birth and parenting this baby, on paper, and then discuss and try to ameliorate the fears. Maybe get your doula and your OB to help you talk through some of what comes up for you.

There are also some Hypnobirthing visualizations and affirmation meditation recordings that might really help you. Hypno is actually great if you find a good practitioner to guide you- maybe you need a more personalized, talky approach rather than a book to read.

Remember, you already had a hard birth and you managed... you can do this.

Congrats on your little one- you got this!

PS if you want to add your city to this post (PM a mod), perhaps someone can recommend a doula? I know a great one in Toronto, PM me for contact info if you happen to be near the GTA!
posted by pseudostrabismus at 5:27 AM on August 5, 2018 [2 favorites]

Please, please, please see a therapist as soon as possible! I would put this as priority #1. I am worried for you because even in the best candidates, there is a significant chance of another cesarean unless you are willing to put the baby at huge risk. At this point it seems like that would feel like the end of the world for you, and that makes me nervous. And ignoring anything related to childbirth... it sounds like you are not feeling good and a therapist can help!

I think a doula could be really helpful with pain management. However, it would be important to interview several and find one who can support an unmedicated birth without having such a strong bias towards no medication that they make you feel worse if you change your mind or need another csection. If this is too much for you right now, you could potentially outsource first round interviews to a close friend or family member?

FWIW I have PTSD-like intrusive flashbacks to the UNMEDICATED part of my birth. Some women find it empowering but it’s not a good experience for everyone, and how much it hurts is largely luck of the draw. Not to say your goals are not good, but just, birth is a hard thing and there’s no one way out that is guaranteed to leave you traumatized or not traumatized.

I don’t know if reading things that are opposite of your negative feelings is helpful to you at this point, but I really like this essay celebrating csection moms. That blog is a little too polemical in the opposite direction, but I found it helpful to counteract some of the natural childbirth stuff I read, which to me was very shaming despite being couched in the language of empowerment.
posted by sometamegazelle at 5:42 AM on August 5, 2018 [26 favorites]

I'm with sometamegazelle - a doula is a good idea, but so is a therapist who specializes in traumatic births. This is a specialty you can Google for.

I also had an unplanned c-section, at 25 weeks with both my life and my daughter's life in the balance. I was very anti-cesarean and it was extremely traumatic, made more so when my OB told me afterwards that I would never be a candidate for VBAC due to the complications I experienced. I had just a few sessions with a therapist who specializes in PTSD and traumatic births, did some EMDR and TFT therapy, and went on to have an positive and healthy second pregnancy and c-section two years later.

Struggling with this level of grief and trauma is not something you have to do alone.
posted by peanut_mcgillicuty at 6:38 AM on August 5, 2018 [8 favorites]

In addition to a doula you might want to see if your OB also works with midwives. Depending on your jurisdiction they can provide a lot of pre- and post-partial support while the OB handles the actual birth. For example, where I live the midwife appointments are about an hour long and quite frequent and can be held in your home. They do not replace therapy but can certainly be part of your whole team.
posted by saucysault at 9:19 AM on August 5, 2018

Just wanna day that having kids— who you adore, would lay down in traffic for, etc.— can be a huge mindfuck. I experienced rough PPD following the birth of my second child. It was related to a really tough birth, but it was also very helpful to have folks remind me that this happens to a lot of women. That basically my number just happened to come up in a truly crappy lottery.

So, all that said, I think doulas are amazing. I had one for both of my births. In the first instance the doula was extremely helpful in the second (a different person) I actually think it made things worse. Be sure to ask questions, share your hopes and anxieties and then listen to your gut.

This person would be supporting you in a challenging and vulnerable time. Make sure you feel really, really good about having her by your side.

But overall big thumbs up for thinking about support and yay for doulas, therapy, whatever it takes. Good luck!
posted by jeszac at 10:33 AM on August 5, 2018

Absolutely. In addition to the support a good doula would provide to you, they will advocate on your behalf when you are in too much pain to be able to advocate for yourself. You have a clear intention to try for a VBAC, but most hospitals these days will try to steamroll over your wishes in that regard. You need at least one person there to assertively shut down attempts by hospital staff to pressure you into another C-section just because they prefer them for convenience, legal risk mitigation, or just general bullying justified by medical language.

I LOVE the suggestion above to find a doula who wears army boots. Figuratively if not literally. Her priorities will be your welfare and your baby's welfare. Unfortunately, you cannot rely on hospital staff to have those two things as their highest priorities.
posted by nirblegee at 11:28 AM on August 5, 2018 [2 favorites]

Do you have a close friend you can enlist to be your partner in finding the professionals (doula, therapist, whatever) who will be part of your team? I’m worried that handling all of this yourself might be too overwhelming for you, and contribute to the difficulty of the situation. (Your SO could be this person, but I think it would be helpful to enlist a friend who is a bit more removed from everything.)
posted by ocherdraco at 11:35 AM on August 5, 2018

Your situation sounds very similar to mine. I hired a doula and was very very happy I did. They successfully supported my unmedicated VBAC.
posted by emkelley at 1:46 PM on August 5, 2018

Wow, I'm so sorry about how hard your last birth and post-partum experience were.

I wanted my son's birth to be unmedicated, so i hired a doula, and it was unmedicated, for the first 48-60 hours (depending on where you think early labor turned into active labor). My answer to anyone who wants to do an unmedicated birth is, yes absolutely hire a doula, and also do whatever you can to prepare yourself mentally.

The thing about unmedicated birth is that it's both physical and a total mental game. At one point during admission when I was in pain and almost hyperventilating, a nurse (best one I encountered) ran her hands over my shoulders saying "you can do this, your body is healthy and strong" (or something like that) in a very soothing voice. I relaxed ... and stayed relaxed for about an hour ... and the pain was so much more minor. It was amazing.

To answer your question, yes, a doula will totally help. I had one. Once she got there, she worked wonders with counterpressure massage. When birth was taking a long time, she helped us have the space we needed to think through whether we / I wanted to start pitocin. She really helped create a supportive and empowering space, so I would absolutely recommend it.

But in reading your post, I'm wondering if there is anything you can do between now and the birth to help ease some of the intense feelings you're having and prepare yourself to have those arise during the birth process. It sounds like you're really carrying a lot of grief and pain and trauma from your last birth. Whatever you can do to compassionately sit with those feelings will make it easier for you to have the birth you want next time and to deal with the unpredictable journey that birthing is. For instance, hearing that hypnosis gives you intense intrusive thoughts makes me realize how much the idea of birth leads you (understandingly!) to feel panicked and upset. But the first reaction to being panicked is to tighten up, when giving birth is about opening up. The mental and emotional side of things are connected to the physical side of things, so if you can prepare yourself to mentally handle not only your body's reaction to pain but also those thoughts and memories, it could really be worth it.

Just to finish my own story, I did ultimately get an epidural after two days in labor. I was exhausted, and to force myself to keep going would be to have my "purist" side overrule my pragmatic and self-compassionate sides. Getting those 4-6 hours of sleep helped me have energy for the pushing stage and to then stay awake with the newborn after birth, and was the right decision given how exhausted I was.

But back to your question. Yes, hire a doula. Get a doula pair so that one of them can be there from the start, or get a lot of support from friends and family, because those hours 0-24 when it wasn't time to go to the hospital or have the doula come yet were the hardest for me. And consider the idea of working with a therapist or midwife who specializes in traumatic birth. Best wishes to you and congratulations on your pregnancy!
posted by slidell at 2:44 PM on August 5, 2018 [4 favorites]

Yes, a doula is a good idea for all the reasons folks have already mentioned--but ALSO think about talking to a lactation consultant. It sounds like exclusive breastfeeding is really important to you, and that's something that you can work towards in addition to/alongside your goals for the birth. As you say, lots of people do exclusively breastfeed after c-sections; and the converse is also true, lots of people still have trouble exclusively breastfeeding even after unmedicated vaginal births.

I'm also wondering whether having some support specifically on the breastfeeding side might help to take a little bit of pressure off the birth plan. This doesn't have to be an all or nothing situation--obviously yes, you should work towards having the kind of birth and postpartum you would like, but if one part does not go as planned that doesn't necessarily mean you need to let go of all of what you want.
posted by snorkmaiden at 3:10 PM on August 5, 2018 [4 favorites]

You might see if there's an ICAN (The International Cesarean Awareness Network) group that meets near you. My wife has a history similar to yours, and she found the meetings very helpful, and eventually ended up volunteering for the local chapter. You might also be able to get a referral there for a VBAC-friendly doula.
posted by Otis at 12:44 PM on August 6, 2018