By Julia Schetky CD(DONA) from Do It All Doulas- Vancouver, Washington
And Meaghan Grant from Toronto Family Doulas – Toronto, Ontario
On a weekly, sometimes daily basis, I pop onto the doula forums and see this question:
“My client is having a planned section*, do you discount your fee for these moms?”
(*So first off, I’ll address the language in this question. It’s not a grapefruit, it’s a birth, so I always refer to a birth through the belly as a cesarean birth. But that isn’t the topic of the day, so I digress. If you’d like to read more about my thoughts on the language of birth click HERE and HERE.)
Meaghan and I live on separate coasts, and even in different countries, but she truly is my doula twin. We often discuss the things we see and read about, and this one is in our top ten of most frustrating. How come? Let’s start with a quick point by point:
1. Discount- The idea of a discount implies that the product/service/good is “less than” in value. To discount a birth, because of the exit method, is saying to fellow birth workers, to families, and to the community at large that cesarean birth is a “less than” birth. In a world where caesarean mothers often already deal with feelings of regret, insecurity, and sadness, I strongly believe that we as birth workers need to come together and proclaim “A Caesarean Birth is a BIRTH!”
2. Value- When we serve a client, we go on call weeks before her Estimated Due Date. Whether there is a caesarean birth scheduled or not, we still often are “on-call,” as sometime women go into labor before her scheduled birth. This time is compensated through our fee. We stick closer to home, we have childcare on alert, and our client occupies a space on our calendar. During a caesarean birth, our skills are put to the ultimate test. Often our clients have to advocate very strongly for us to be in the operating room with them, and as doulas, we work exceptionally hard to support both mom and partner during the birth. We take photos, we bring in comfort items, and speak to mothers and partners if they get nervous. We sit next to our client if their partner needs to go with the baby outside the room. We help normalize the birth experience and assist strongly postpartum while helping the breastfeeding relationship. The ways we support during a caesarean birth are endless, and a huge challenge. I often return more exhausted from caesarean births because of the emotional intensity of support than with long vaginal deliveries.
3. Time- Often doulas think that scheduled caesarean births will take less time. In both of our experiences, often we serve these families longer in person than in vaginal births. Clients are expected to check in several hours before their birth, and are often bumped for more emergent mothers. I arrive upon check-in to help my clients remember any last minute questions, to prepare their room for their return postpartum, and to spend time with them to assuage their concerns or fears. The birth itself takes around two hours, recovery is two hours, and postpartum time after that is another two hours. In that case, in the smoothest of circumstances, I am already in attendance for around 8 hours. That’s assuming that we don’t get bumped and all is smooth. Recently, I supported a family for 20 hours during a planned caesarean birth.
4. Perception- Clients who are given the unexpected news that they will be meeting their baby via a caesarean birth often have feelings of regret or sadness. (Some do not.) In this case, many also feel that they are losing the birth experience they wanted. By returning money to clients, we may be inadvertently saying “hey, I totally get it, and since it’s not the birth you wanted… so here’s some money back.” First, this backs up their feelings of a caesarean birth being less desirable. Second, this is also starting a slippery slope of doulas being outcome oriented. I do not guarantee an outcome, thus I do not return money based on an outcome.
Julia said I was her “doula twin” which is ironic since we bonded over a mutual passion for serving multiples families! I often find that, reading something aggravating, I will open up a chat window to express my frustration, only to see she has already sent a message about the very post that is pushing my buttons!
Julia has talked in the past, and in this post, about the language of birth. It is something we are both extremely passionate about. As she said, “it’s a birth, not a grapefruit”. You will never find either of us calling a caesarean a “section” or even a “C-section”. It is a birth, end of story.
But there is more to it than just calling it a caesarean birth. I have noticed that when doulas talk about caesareans, the “section” shortcut is just the tip of the iceberg. The entire discussion becomes much less about choice, about birth, about emotion and connection and bonding. With the rise in availability of family centered caesareans, we are seeing more discussions around options with cesarean birth, but not always.
Too often I read comments like “well she can’t have skin to skin” or “doulas aren’t allowed in the OR”. Maybe those things are true, maybe they aren’t. Has the client asked? One of the things that we, as doulas, need to remember is that nothing can change if no one asks the question. Don’t assume defeat just because it has never been done at that hospital before, or because that was true for your last client. Things change all the time.
Now that whole thing seems like a big, long tangent that has absolutely nothing to do with a doula discounting for a caesarean birth. But it has everything to do with not discounting. Language has power. Not just individual words like caesarean vs. section, but sentences, framework, context, and discussion all have power. When we start to use language that suggests we do less work at a caesarean birth (a myth Julia thoroughly disputed) we start to feel like we have to justify our price.
If we don’t believe in our heart that a caesarean birth is as much a birth as a vaginal one, then we start to doubt if the price we set is too high. In order to change the idea that a cesarean birth should be discounted, we need to change the way we think about caesarean birth.