Having a Home Birth After a C-Section

Having a Home Birth After a C-Section

Illustration: Palesa Monareng

Because no two paths to parenthood look the same, “How I Got This Baby” is a series that invites parents to share their stories.

When Julissa found out she was pregnant just a few months after her wedding, it was hard for her to fully take in the news. She and her husband had only been casually trying for a few weeks and she was in the middle of a doctoral program. “I was in shock,” she recalls. “I was thinking, How in the world am I going to do this with no family around, trying to get my Ph.D., and on this little doctoral stipend of $1,500 a month?” 

At times, Julissa even found herself questioning whether she really was pregnant since she didn’t have any morning sickness. But as she shared the news with her classmates and professors, they rallied around her — especially those who were also pregnant or already had kids. In the absence of having family nearby, these other Black women became her village.

“They became my family, my aunties,” she says. “When I was worried about having the baby, they were like, ‘You’ll be fine, bring him to class. I’ll hold the baby while you write your dissertation.’ While I was scared, I wasn’t alone.”

Hoping for an unmedicated birth, Julissa and her husband, Anthony, researched local OB/GYNs and talked to friends and colleagues before landing on a physician of whom they’d heard wouldn’t be quick to push an epidural. The couple also hired a doula. Although Julissa envisioned an unmedicated birth, she also wanted to give birth in a hospital in case anything went wrong. As an African Puerto Rican woman researching race in higher education, Julissa was no stranger to microaggressions and blatant racism in the medical system. Nevertheless, she was optimistic that she would be able to carry out her birth plans as she intended. 

Julissa’s pregnancy progressed without complication, and because she was feeling so well, she opted not to have ultrasounds or any screening that was considered optional. When her due date arrived in June, Julissa’s doctor performed a contraction stress test, which revealed she would need to deliver the baby soon. Julissa wanted to wait to see if her labor would progress naturally, but her doctor scheduled her for an induction seven days later. 

Determined to go into labor on her own, Julissa went to get a pedicure the morning before her scheduled induction and asked the nail tech to give her a “really strong foot massage.” (Certain pressure points on the foot are thought to induce labor.) She began having contractions during her appointment, then met Anthony for lunch. Halfway through the meal, the contractions started to intensify.

Julissa called their doula, who recommended Julissa hook herself up to a breast pump — the suction sensation, she said, could release hormones that trigger labor. After using the breast pump for about a half-hour, the doula suggested rubbing jasmine oil and coconut oil on her belly to keep the contractions consistent. Julissa labored the rest of night at home; by the time she and Anthony arrived at the hospital the next morning for her scheduled induction, she had been in labor for 12 hours.

Julissa recounts what happened next.

Soon after I got to the hospital for my induction appointment, I found out I no longer needed one because I was about four centimeters dilated. I labored at the hospital for about another ten to 12 hours. During that time, my OB was in and out of the room. She checked in on me probably three times or so.

The nurses in the hospital were watching me go through labor, and they kept trying to push an epidural. They only asked me once, but they kept pestering Anthony and the doula about it. They kept saying, “It’s not too late. She can change her mind if she wants.” But I, Anthony, and the doula were all very stern about not taking it.

When I was almost fully dilated, I started to feel like I wanted to push. That’s when my OB said she wanted to check one more time to make sure we were good to go. It was very uncomfortable to lie down for her exam; I was in full-blown labor and we had to wait until I wasn’t having a contraction. When it was finally time, she started doing these abdominal palpitations to feel where the baby’s head was positioned. She feels around my stomach and looks up at me and has this face of shock, which is not something you want to see when you’re in labor.

Anthony and I looked at her and she didn’t say anything at first. She took her gloves off and eventually said, “You know, the past three times when I’ve checked you, I was pretty sure what I was feeling was the head. But I just realized I’m not feeling a head, I’m feeling a butt.” Somehow she had just realized that the baby was in the frank breech position.

Being a naïve, first-time mom, I was like, “Well, is that a problem? Can I not push him out that way?” And my doctor said, “No, you cannot.” She said the only option was a C-section and we needed to do it right away even though my heart rate was fine.

I had just labored naturally for a whole day. To get to that point and not be able to deliver vaginally, I needed a minute to process.  She wanted to take me directly into the surgery room, but Anthony and I asked for 15 minutes alone.

I was about seven centimeters dilated, so I was still getting very intense contractions. I had to stay still while they put the epidural in my spine and that was really hard. We had to wait for the contractions to pass and, of course, I couldn’t control when they were coming.

Despite the circumstances, the birth was a special moment. Anthony was right next to me and he was the first one to see the baby and hold him. I heard Elijah crying and Anthony held him up to my face and put him cheek to cheek with me and said, “Here he is.” Elijah was screaming and I started talking to him, saying, “Hi, baby, it’s your mama. It’s okay. Don’t cry.” As soon as I started talking to Elijah and he heard my voice, he immediately stopped crying and opened his eyes. It was like something out of a movie. Then he went silent and looked around. Of course, babies hear your voice when they’re inside of you, but to actually see him recognize my voice that quickly was really amazing.

After I was discharged, I realized I had a lot of pent-up frustration, disappointment, and anger about my birth experience — some directed toward my OB and the medical system and some toward myself. A lot of well-meaning people in my life said things to me like, “At least you got your healthy baby.” But my feeling was, The birth was not what I had hoped for. It was not what I worked for. And why doesn’t a physician — after two decades of being a physician — know the difference between what a butt feels like and a head feels like?

As a first-time mom raising a baby and finishing grad school, I didn’t have the time or capacity to deal with my emotions. I convinced myself I would get some kind of closure at my first postpartum visit six weeks after giving birth — I thought the doctor would remember her mistake and offer some semblance of an apology. So I dragged my exhausted self — and my baby — to her office. But the doctor was unaware, aloof, and cold — completely disconnected from how affected I was by her inability to help me have the vaginal birth that I wanted. Not only was there a lack of sympathy, empathy, and remorse, but there was a lack of overall care. I had put a lot of stock in her helping to remedy my upset, and after that I realized I needed to work through all of that on my own.

Afterward, I switched doctors. But because of this experience, I got this idea in my head about myself: What did I do to mess up? What did I do that caused my baby to be in a breech position? 

I think that giving birth to Elijah triggered some sort of storm within my body. In his babyhood, I had deep fatigue and achy joints that made it difficult to bend over and pick him up. No amount of sleep would take the fatigue away. I was also cold all the time — I was wearing sweatpants and hoodies in the middle of the summer — and experiencing brain fog. It felt like I had no brain cells left, which was especially difficult because I needed to finish my Ph.D.

For a while, I just thought this was life as a postpartum mom and that I was supposed to feel this way. I visited several different doctors and told them my symptoms, and over and over again, they either didn’t listen or didn’t believe me when I described what I was dealing with. I couldn’t help but think that part of the reason they weren’t listening was because I’m a Black Caribbean woman and I present as one. I’ve read all of the research about how primarily white physicians perceive patients who look like us. And after Elijah’s birth, I was even more aware of this medical bias.

Eventually, I took a semester off, and I did nothing with my dissertation and instead focused on myself. That’s when I saw a functional-health doctor — a Russian woman who happened to also be a mom. She knew exactly what to test me for, thank God, and I was diagnosed with Hashimoto’s, an autoimmune disease that causes your immune system to attack your thyroid.

When you get one autoimmune disease, you’re statistically more likely to develop another one every three to five years. I was determined that that would not happen to me.

So in addition to recovering from the way Elijah’s birth played out, I also had to figure out how to live with this new diagnosis and how to change my lifestyle without medication. I wanted to focus on lifestyle changes rather than medication because of the side effects. But many of the endocrinologists I saw didn’t know what lifestyle changes would be helpful nor did they care to investigate. When I would bring it up, they were condescending and dismissive. They just wanted to write a prescription.

By the time Elijah was in kindergarten, he was begging us every week for a little sister. He even said that he had a conversation with God. Elijah told us, “He’s sending me a little sister.” Anthony and I both started to feel the pressure to have another child, but he wanted to push the timeline a bit further. We were just starting to be able to breathe and get our heads above water.

I knew my body would have a hard time carrying a baby past age 35, and I was adamant that if I wasn’t pregnant by then, we were just not having a second kid at all. I started doing pelvic floor therapy and taking natural herbs. My diet was already pretty healthy because of my autoimmune disease, but I tightened it up even more. I went really hard in the gym to prepare my body. I started tracking my cycle to pinpoint the best day for us to start trying. We started trying and I got pregnant immediately.

This pregnancy was the complete opposite of my first one. I felt horrible the entire time. I also had gestational diabetes. I decided to manage it without medication, which meant I couldn’t have any sugar or carbs. I pretty much did keto. I was also barfing until almost the beginning of my third trimester. I could not wait to get the baby out of me.

But with this pregnancy, I also knew that in order to be treated with a sense of humanity, dignity, and respect, I needed to be surrounded by people who looked like me and by women who would understand my journey to that point. I was determined to create a different birthing experience than the one I had with my first child. I needed to prove to the system and to myself that I could do it.

I knew that if I went to a traditional OB/GYN, they would tell me that because I had a C-section the first time, I had to have another one the second time. There’s actually a VBAC (vaginal birth after cesarean) calculator that medical professionals use to calculate the likelihood that a woman can have a successful VBAC. One of the inputs used to be a woman’s race and ethnicity. As a result, if you identified as Black or Latina, then the odds of being told you could have a successful VBAC were cut in half. They were basing the calculation on how much melanin you have in your skin, but VBAC success has nothing to do with your skin — it has to do with how you’re treated when you’re in your skin by the medical system. It wasn’t until 2021 — a year after I had my second — that they updated the calculator to not include those data points as a factor.

Before I even found out I was pregnant, I knew that I wanted to pursue a midwife of color. At the time, there was only one option in our state. She was Latina and her name was Amelia, and she booked up fast.

When I got that positive pregnancy test, I called Amelia about two seconds after peeing on the stick and seeing the plus sign. She knew I was pregnant before Anthony, and I think I was the last client she took for the month I was due. We also decided to work with a new doula whom Amelia had worked with before and recommended.

Anthony and I talked it over and we both decided we wanted to have a home birth. We knew that there were going to be friends and family that were projecting their own discomfort onto us, so we decided not to tell many people. I just didn’t want to deal with some of the conversations that might come along with that.

I had written about my birth with Elijah, but I hadn’t spoken about it out loud, which I felt was an important next step. I talked about it in therapy, then shared the experience with Amelia and her assistant. Amelia told me I needed to resolve my feelings around that birth if I wanted to have a successful delivery with the second baby.

As part of every appointment, she didn’t just check up on my physical wellness and the baby’s, she asked me questions about my psychological well-being and mental health. She asked how I was feeling about everything and if I felt confident about this second birth and if I knew that what happened with my first delivery was not my fault. She asked me if I trusted my body to do what it needed to do and what it was supposed to do this time around. She would often remind me:  “The experience you had in your first birth was not your fault. That was not on you. There were things that they should have done or that they should have caught.”

My prenatal appointments were always one hour long and were mostly held at the midwife’s office, which felt more like someone’s living room than a medical setting. It was very warm and cozy. In the waiting area there were couches and artwork of pregnant women.

My midwife was able to tell me how to physically get ready for birth. She felt my C-section scar and just from feeling it, she determined that there were internal adhesions on it and recommended pelvic-floor therapy, which I did for three to four months. She was also able to support my husband. She knew what it means to support a husband who is supporting their Black or brown wife through labor. She always encouraged and invited Anthony to come along to appointments. He couldn’t always be there because of work, but when he was there, he was fully incorporated and she had a whole list of questions for him.

At the first few appointments, I wasn’t ready for all of this and I was a little uncomfortable. I had to get used to the approach because it went against the norms of the American medical system. But soon they came to be kind of a refuge and a space I really looked forward to having.

During the last month of my pregnancy, the appointments moved to our home, which was nice because getting in and out of a car was cumbersome at that point. Amelia encouraged us to invite people who would be at the birth to the last few appointments, so Elijah was able to join and he and Amelia had their own little relationship.

I had a really big presentation at work — my last presentation before my maternity leave — and I started having contractions. And in true second-time mom manner, I was like, I’m just going to see how much work I can get done with these contractions. How many more emails can I squeeze in? I kept working and I made it through the afternoon. I went home at 4:30 p.m. and I knew when I was walking out of that office that I was not coming back the next day. I didn’t say anything to anyone.

I picked up my son, got dinner, and we went home. I didn’t really eat much because I wasn’t that hungry. I didn’t say anything to Anthony about experiencing the contractions and we went to sleep. Then I was woken up in the middle of the night by my contractions, so I woke Anthony up because I started to need to breathe through them.

We went into the living room and called my midwife and the doula and our birth photographer. When Amelia answered, she asked Anthony to hold the phone up so she could listen as I was having contractions. Then she said, “Yep, it’s time. I’m on my way. I’ll be there in half an hour.”

We also called my sister and asked her to come over. My sister was the person we were depending on to take care of Elijah while I went through labor. But we intentionally didn’t plan for anyone else to be in the house. My midwife had stressed to us that anyone we invited over would bring whatever preconceived feelings they had about HBAC (home birth after cesarean) with them into the house. Some risks of an HBAC include severe blood loss, uterine rupture, and postpartum infection. So she said it was really important that I be mindful about the invitation list. And for that reason, I actually did not invite my mother to be there while I was birthing. I knew she would be too scared and worried, because this was not normal for her and I did not want those feelings to impact me.

The doula was the first to arrive at our house. The first thing I wanted to do was sit in our bathtub, so I did that and when my midwife arrived, I asked her to check the position of the baby. Because of the first birth, I was extremely paranoid about having a breech baby. And throughout the pregnancy, I did a lot with the hope that it would help the baby be in the right position — head down. I was a little obsessive. My midwife was able to put her hands on my belly and feel around and know the exact position the baby was in.

I started out laboring in the bathtub for a few hours, which kind of slowed things down. As I was getting ready to get out of the bathtub, my sister and the photographer had arrived. The whole gang was there. I spent a few hours going up and down our stairs because that was helping to kind of rock the baby to get her in the right position. Going up and down the stairs also stimulates contractions. I continued to labor for about a day with support and encouragement from my husband, the doula, the midwives. At one point, Amelia pulled Anthony aside and said, “We’re going to need you to support her later on when she’s pushing, so go sit down, take a break, and let me and the doulas work.”

My midwife told me I needed to sleep in between contractions to conserve energy. So there were a few hours where I was just laying in bed with pillows stuffed between my legs. I would go into a deep sleep and wake up and deal with my contractions and immediately go back to sleep.

To manage the pain, they did a lot of massage with essential oils and also held various pressure points. Our midwife also used a rebozo wrap, which is this ancient ancestral technique where she wrapped this big cloth around my belly and when I had a contraction, she would stand behind me and pull the wrap and that would help relieve some of the pressure that I was experiencing.

There was this unexpected feeling of calm and peace in our house throughout the whole labor. When the media portrays women in labor, particularly women of color, it’s often this chaotic emergency. When my midwives and the doula arrived, they just brought this unwavering feeling of peace and faith into the house. And that created a feeling like I was going to labor at a retreat or spa. I felt very protected.

Our son had been at school all day and I didn’t even realize a whole day had gone by until I saw him appear before me. That’s when I was like, “Oh my God, What time is it? Am I still in labor?” That was a moment of panic for me. I started to get a little disappointed in my progress. My midwife checked the baby and said, “She’s stuck. There’s something there and she’s stuck.”

In order to try to get her to turn a little differently, the midwives started putting me in all types of positions. I had to lay with my butt in the air and my head down. They were putting pillows under my chest. I remember at one point feeling very discouraged and exhausted. At that point I had been laboring for 24 hours.

But then Amelia took my face into her hands and she was like, “Talk to your baby.” She said, “We’re going to leave the room and I need you to talk to your baby. Connect with her and talk with her. Tell her what you need her to do.” She said, “Julissa, you can do this. You’ve done it. You have the strength to do this and it’s in your blood to do this.” I followed her advice and had my first stern talking to with my daughter and eventually she got into position and I was able to start pushing. I pushed for an incredibly long time. I think it was about four to five hours total.

There was so much buildup to her coming out for everyone involved. Her head came out first, and Anthony always says she looked like a little angel. I couldn’t see her because my eyes were closed, but he was in pure disbelief.

I was recovering from the ring of fire that happens when you push a baby’s head out and I needed a breath before I pushed the rest of her body out. After maybe ten minutes had passed, my midwife looked at me and said, “With the next contraction, you’re pushing your whole baby out. You’re going to have this baby in your arms.”

The midwife was holding me and I was looking at her like, Are you serious? I’m so tired. But I pushed with everything I had left in me and Mariah was born around 6:30 a.m.

Anthony helped the midwife catch Mariah when she came out and they placed her on my belly. I was in complete disbelief and shock that I actually did it. It was an out-of-body experience. She was on my belly for a bit and then eventually I sat up and held her.

In the meantime, Amelia started massaging my stomach so that my placenta could come out. When it finally came out, my midwife was shocked. She said my placenta had been working overtime and that I was lucky it didn’t lead to any complications. It turned out that I had circumvallate placenta, which is a rare condition that happens in 1 to 2 percent of pregnancies. We don’t know why my placenta was in that condition, but she showed it to me and said “none of this is supposed to look like this.”

What I missed in my first birthing experience was exactly what I got from my Black and Latino midwives. They truly saw me. They heard me. They felt me. And they were able to support me. I jokingly say that one of the biggest accomplishments in my life is giving birth to a little brown girl with no white people in the room. I fought so hard for that and we were able to make that happen.

I feel healed from what happened with Elijah’s birth and I truly think it happened for a reason. Mariah’s birth wouldn’t have turned out the way it did if I didn’t have Elijah’s birth first.

Every year on Mariah’s birthday — she’s 4 now — we watch her birth video about five times at her request. Sometimes even when it’s not her birthday, she’ll ask me to watch it and as she’s gotten older, she’ll ask me questions. I always remind her that she was born into a room full of Black and brown women and that there’s something special about that, which she should carry with her.

I also very intentionally talk to Elijah about midwifery and birth so that he can support the women in his life one day to have a successful and healthy pregnancy. The medical system was not built with us in mind, and I feel strongly that we as women of color are at our best and healthiest when there are people like us providing the care.

The practice of midwifery is ancestral. It comes from Black and brown communities. My great-grandmother had a midwife and all nine of her children at home. These women created that practice and, because of the American model of medical education and care, we’ve forgotten that and our ties with that have been cut. I think there are a lot of opportunities for our community to get back in touch with that.

The names of the subjects have been changed to protect their identities.

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