Finding a Voice for Homebirth Cesarean

The following is an interview with Courtney Jarecki, co-author of the Homebirth Cesarean project. Courtney also runs a homebirth cesarean support group in Portland, Oregan.

Tell us about how Homebirth Cesarean was born.

The term Homebirth Cesarean (HBC) originated as a way for me to distinguish my birth from the options on doctor's intake forms. My ego wouldn't allow me to select the cesarean checkbox and my shame at a failed homebirth kept me away from the homebirth selection. I spent nine months preparing for a homebirth and even though I had a cesarean, the spirit and philosophies of the natural childbirth movement still applied to my experience. So, to make myself feel better, I wrote homebirth over the cesarean option on an intake form and I started calling myself a Homebirth Cesarean mama.

The Homebirth Cesarean book began as a conversation between me and my midwives, eight months after my birth. I reached out to provide feedback about their care and we were able to process the birth together. This topic sparked an interest in Laurie, one of my midwives, and she wanted to write an article on homebirth transfers that end in cesarean. I wanted to write a book about my experience, but knew it needed to be bigger than just me. I asked her to partner with me on a book that shares both the mom's and midwife's perspective of homebirth cesareans. From that conversation, this project was born.

A few months later I created the Homebirth Cesarean Facebook page and invited every birth worker and HBC mom I knew. I wasn't sure what my purpose with the group was, but knew it needed to be out there. An hour later there were 50 new members and now, a year later, there are over 800. It quickly became clear that the intention of the Facebook group is to bring both HBC moms and birth professionals together so practitioners can listen, observe, ask questions and learn how to better support HBC mothers. This group has helped so many moms in their healing process and changed the way midwives, doulas an childbirth educators talk to their homebirth clients about cesarean.

What have been the key components to your moving through this experience?

For years prior to becoming pregnant I was studying to become a homebirth midwife. I had completed a year of apprenticeship at a birth center and had my own doula and childbirth education business (http://fullmoonsdaughter.com/). My entire identity and career was based on the idea that low risk women can birth at home.

The cesarean experience left me devastated, isolated and feeling like a failure. My shame and hatred of myself was deepened when, no matter what I tried, I wasn't able to make breast milk. It felt I couldn't do anything right and like I was an outcast from the homebirth and natural birth community. I was ashamed of my birth, my body and my lack of ability to feed my daughter.

I started talk therapy at 6 weeks, which saved me. Over the course of two years I have sought many healing modalities for my body, scar and spirit. Of course, this book has been the biggest component of my healing.

Laurie calls HBC the homebirth community's dark secret. And it's true! Other homebirth moms don't want to hear about our births, midwives don't post our birth stories on their websites and friends and family members tell us that we should just be grateful for a healthy baby.

Our homebirth cesarean work is focused on providing a platform to discuss these births so that mothers and midwives can regain the power and confidence that can be lost in the process.

For mothers, we seek to hold space so they can tell their sacred birth stories. For midwives, we seek to provide new opportunities for them to talk to, for, and on behalf of these mothers.

Is there any evidence yet as to rates of homebirth transfers resulting in C-sections?

We are still awaiting data from MANA, an organization that is conducting a large homebirth study in the US. However, many midwives we've spoken with estimate that of homebirth transfers that occur in labor, about 50% result in cesarean.

Individually, homebirth midwives have a very low cesarean rate. For example, a typical midwife in the Portland, Oregon area transports about 10 out of every 100 clients to the hospital - some prior to labor, some in labor, and some just after birth. Of those 10, if half have cesareans, the midwife will have an overall 5% cesarean rate. For a midwife seeing 50 clients per year, that means she will have at least 2 or 3 clients who will have a cesarean every year.

Stats aside, if a homebirth cesarean happens to a mom, it doesn't matter if her midwife had a 0% cesarean rate, for this mom it is 100%.

What are some ways women considering home births could prepare for the occurrence of an unexpected hospital transfer and C-section?

Every midwife needs to be talking to their clients about the realistic possibility of transport AND cesarean throughout their care, not just in the initial interview or at 36 weeks.

A lot of homebirth women never even consider that a cesarean could actually be their story, and they don't know what the experience would be like if it did happen for them. When women have a realistic sense that they could have a homebirth cesarean, they are more willing to plan for what that birth would look like. In turn, if women can clarify their hopes and options for a hospital stay and cesarean birth, they will be more satisfied with the outcome, despite it not being their first choice.

Therefore, many moms report feeling blindsided and unprepared for a cesarean. The moms who had a midwife that suggested a hospital tour or had frank discussions about all interventions, including cesarean, had an easier time integrating their birth experience.

How do you see partners involved in the discussion, preparation, education, etc.?

Partners play a big role in our book. We plan on sharing birth stories from the partner perspective as well as highlighting partner's intuition during the birth and those critical minutes when the partner is away from mama as she's being prepped for surgery.

In 100% of our interviews with partners they, at some point, felt helpless in the birth or caregiving process. They also never thought of self-care for themselves in those early postpartum weeks. Helping midwives bring a bit more attention to the partner during the birth and postpartum can go a long way for mom's own healing.

How would you advise women to approach concerns about HBC with a homebirth care provider?

Ask lots of questions and really feel how your care provider is responding to your questions. If you tell your midwife you're worried about being able to push a big baby out and her response is that she's helped many women do that very thing, does that feel helpful for you? If it does, great. If you tell her your worst fear is cesarean and her reply is that it probably won't happen to you, that certainly isn't helpful.

Sometimes it can be hard to get really clear on what your deep fears are around birth. If you feel like a fear is hanging around or you feel like something just isn't right, talk about it. Conversation around what's bothering you will bring it out to the light and, hopefully, transform the fear into conversation to plan for all possible outcomes.

Women and their providers need to be open when planning for birth and not be bound to a specific place of birth. Approaching birth as a journey into parenting, which is all about flexibility, resilience and open-mindedness is a great place to being.

What have been some of the surprises in this project?

A big ah-ha moment is how close to death, either physical or spiritual, so many HBC moms feel during transport or the cesarean. Even if moms aren't physically close to dying, they may feel like they are. When women experience HBC, they are faced with the daunting physical recovery from labor, then major surgery, then the emotional fallout from the birth, all the while providing for the intense needs of a newborn! This makes it hard to process the fear and trauma they experienced during the birth and it plays into their postpartum recovery and coping skills as a new mom.

Co-authors Courtney Jarecki and Laurie Perron Mednick have been interviewing HBC moms, midwives, birth professionals and care providers since 2012. They are done with the majority of the interviews and we will have interviewed more than 150 people when the project is complete. Their goal is to find a publisher this year and have this book available to the public in the next couple of years.