In my role as a doula, I am present in a variety of birthing scenarios. Birthing centers where everyone is incredibly focused, hospitals where everyone is incredibly medical, c-sections, vaginal births, you name it. One level of difference between these births is always the energy surrounding the labor person, the partner, and the birth team. I have noticed through my experiences that oftentimes, medicated births are treated on a fundamentally different energy level than unmedicated births. For instance, when the laboring person has an epidural, the nurses may make small talk about their recent vacation while placing a catheter. Or if we are in the operating room for a cesarean, the OR team may be chit chatting about their children while cauterizing the uterus. But in an unmedicated birth, these types of casual conversations are more difficult, mostly because the laboring person is more vocal, in more pain, and more focused on the contractions than someone who may be laboring more calmly with an epidural.
I find this casualization of medicated birth problematic. Not medicated birth itself, not the practice of getting an epidural or having a cesarean, and not the process of enjoying labor in good spirits, resting, or distracting oneself during labor. But I find this energy shift that occurs when the birth shifts from unmedicated to medicated or vaginal to cesarean to be minimizing the sacred nature of birth itself. Why does the unmedicated birthing person get more vocal and emotional encouragement, when the medicated birthing person is treated like they will take more of a passive role in the birth experience? I have high respect for labor and delivery nurses, because I work with them routinely, but I place the blame over this casualization on the culture of the medical community.
Nurses are overworked, they are tired, and they do not have the resources or the energy to devote 100% of their resources to every patient, especially when 60% or more are receiving an epidural. It is easier to handle someone who is in bed, not in severe pain, and only needs to be moved every 30 minutes. Their birth experience is significantly more routine.
Doctors see surgery as a usual and entertaining procedure. They do the same thing every time. Each cesarean, for the most part, requires the same steps. This process becomes so normal to them that they can practically hold a cup of coffee in their hand while they do it.
Yet energy in the birthing room is crucial. It can affect the emotional and mental status of the birthing person, as well as the bond between them and their baby. Instead of distracting conversation that takes away from the experience of birth, we need to focus on intentional conversations that facilitate emotional processing and a positive bond between the parents and their baby. And if we cannot achieve that, then we should have silence. Sometimes distractions are helpful, but under no circumstances should the conversation shift so drastically away from the situation at hand that the birthing person feels like they are no longer in labor but instead a subject in something that is simply happening to them.
As doulas, we can help to facilitate positive birth environments. Holding space. Holding hands. Knowing when to offer guided visualizations, even for a client with an epidural or who is in the middle of a cesarean can be the difference between an emotionally secure experience and an emotionally traumatizing one. And knowing when to be still and be quiet. Knowing when to use our eyes instead of our mouths to show our clients that they are safe, and that we are with them. And empowering our clients to stand up for themselves. If the energy in their birth space is too chaotic or too distracting, it is their job to alert us, and our job to ask what they would like us to do, and then do it.