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EPISODE 09

Carla’s Story

An OB/GYN Chooses a Home Birth

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Episode 9: Carla’s Story: An OB/GYN Chooses a Home Birth

Episode Description

What happens when a medical insider opts to give birth outside the hospital? For one, we should all pay attention. In this week’s episode, Dr. Carla Williams, a Black Latina OBGYN in New York,  shares why she had her first birth at the hospital and never went back for baby number two, and as we spoke days before she was about to give birth to her third child, she was preparing for another home birth. Many people think home births are for the “crunchy granola” crowd but more and more mainstream mamas, including corporate types and even medical professionals have seen the in-hospital experience and choose to find their joy at home. Dr. Williams also shares tips for those considering a home birth and advice to her OB/GYN colleagues on what they can do to improve the birthing experience for Black people.    

Resources/References

Birthright is funded by the California Health Care Foundation.

 

Carla Williams, MD

I had a water birth at home and being comfortable and being surrounded by people that are, you know, giving you your, your space and your time, not pressuring you. It really just, it really eliminates or substantially reduces the fear that sometimes is associated with birth.

 

It even makes it less painful because you just, feel so supported, which was something so important for me. You have your space to just deal with it. What you’re feeling, however you want to, um, and you don’t feel any inhibition. It was just a very different experience for me. 

 

Kimberly Seals Allers

Welcome to Birthright, a podcast about joy and healing in Black birth, where we focus on positive Black birth stories as a way to find lessons to improve the Black birthing experience, to inspire hope and leverage joy in our fight for birth equity.

 

Well, the statistics don’t lie. Now, more Black women are exploring at home births, which admittedly used to be deemed the choice for tree huggers and granola types but now is slowly gaining more mainstream recognition. And in today’s episode, we hear from a board certified OB-GYN, who after her own upsetting experience and watching her colleagues in the field, decided to give birth at home. An insider to the medical system, stepping out and speaking out. 

 

Carla

My name is Carla Williams. I’m the mother of two children- currently expecting my third. And this is my birthright story.

 

Professionally, I’m an OB/GYN. I serve patients out of Westchester County in New York.

 

So with my first birth experience, that was the birth of my daughter, Eva. It was a hospital birth. I was a resident at the time. And, for me, the natural thing to do at that moment or what was going to be most convenient for me was to deliver in the hospital setting. Um, so I went ahead with that and overall, I would say that, uh, the experience was not terrible. Um, but there were certainly things that I would have, um, liked to change and some experiences in particular that really led me to want something different for my next birth.

 

So as usual, I went to the hospital whenI started to feel contractions that were regular. Like I said I was a resident so I was familiar with the process of being admitted and under what conditions of when that would happen. I spent a day in labor. I had all the standard procedures that are done, several interventions and, uh, I was in bed for a day, you know, just, um, having my contractions and, and in that early stage of labor, And after being in labor for over 24 hours, I was what they would say “stuck at six centimeters” and was spoken to about having a C-section.

 

And at that point I thought, you know, maybe I needed to do something different, uh, to achieve the natural birth that I really wanted. So, I asked the doctor to give me some more time and thankfully the doctor, uh, agreed to that. And told me that, “okay, let’s give it another two hours and let’s see what happens.”

 

So she did that and I decided that I wanted to get into a different position, to see if that would help the baby descend and for me to dilate. So, I got in hands and knees position and thankfully, uh, that really helped in an hour later, my daughter was born. So, um, overall the labor process…there were some things, like I said, that I would want to change about that and do differently, but ultimately what really led me to not want to birth in a hospital again, was after having my daughter, I had an unpleasant experience with the pediatrician that came to see the baby, because he said he was asking my husband and I questions about our insurance situation.

 

He was asking us questions about the, um, insurance and, and asked if we had anything like Medicaid, because he didn’t accept that because he took care or wanted to take care of people who were “productive members of society.” So that was very striking to us, um, and made us feel quite bad. Um, yes, so that was definitely something that made us feel uncomfortable and we didn’t want to experience anything like that again, we wanted, we wanted a different experience. That’s what led us to, um, to go for a home birth with our second child. Part of what led us to do that.

 

Kiki Jordan

My name is Kiki Jordan. I’m a California licensed midwife and I’m based in Oakland, California in the bay area.

 

Black midwives were the primary home birth attendants in the United States, um, in the late 1700s through the early 1800s.

 

And it, as we moved into the late 1800s, early 1900s, obstetrics grew, and as obstetrics grew the practice of home birth. In general for all midwives, but specifically for black midwives almost became criminalized. If black midwives didn’t have a particular set of standards, it became illegal for them to practice.

 

And so most home births, many, many home births, but for Black folks and for white folks were attended by Black midwives, um, until the late 1800s. 

 

So as we see the growth in obstetrics, and as we did, we then also start to see birth moving into a hospital setting, and we start to see the practice of home birth or the choice to have a home birth be considered lower-class or dirty or unsafe. Um, and I think Black folks and many people of color, um, and many immigrant folks have held on to that narrative. And so now, as you see Black folks hearing more and more about the safety of home birth and seeing themselves as midwives are seeing themselves as home birth attendants and feeling more drawn to it because they see themselves. There’s still a little bit of that old narrative and fear about it being unsafe or unclean.

 

Kimberly

That narrative was powerful and pervasive. And, the story that was being told was that either that midwifery was unsafe or that they were a part of the fringe culture. But when someone on the inside of the OB/GYN field stars looking outside, it’s time for us all to pay attention.

 

Carla

So initially, I felt that I would, uh, have a different experience if I worked with, uh, midwives instead of, um, Instead of OB/GYNs and I decided I wanted to birth at a birthing center. So that was my initial plan closer towards the end of my pregnancy. When I was around 34, 35 weeks, I met my doula and through conversation with her I ultimately decided that I wanted to go for a home birth. 

 

And that is, that’s what I ended up doing. I researched different, um, home birth midwives. I also listened to my doula’s recommendations regarding, uh, those providers. And I went with someone who she recommended, who also attended her, um, birth at home. And it was an amazing experience and I hope to have the same kind of experience with the baby I’m expecting now. 

 

Kimberly

Tell us about your decision making process in getting to a home birth. 

 

Carla

So first I decided that I wanted to go with a birthing center, but I then, uh, decided that, did I say the right thing? No, I wasn’t okay. Okay. So I first decided that I wanted to go with a birthing center for, um, my second birth, but I then decided that I would move towards a home birth. And I feel that for women that are low risk, uh, that don’t have a medical many, you know, medical problems that could affect their, their labor and birth negatively that, uh, they should have be afforded that opportunity and have that as an option. And I felt that it was an option for me. And, I decided towards the end of my pregnancy, that I would, uh, go with home birth and home birth for me, meant that I was going to be able to be in the comfort of my own home.

 

I was going to have the people there present that I wanted to be present. I was going to be supported by my family members and friends. I was going to be able to do certain things that aren’t routinely allowed in the hospital. Like eating if I felt like I was hungry, moving, if I felt like I wanted to move, uh, going anywhere in my house that really just made me feel comfortable.

 

Dim lights, if that’s what I wanted music, if that’s what I wanted, uh, having my daughter present, if, if she wanted to be present and she was able to be around for what was going on and, um, That familiarity, um, is something that, uh, I wanted. Um, and, and I got that. 

I had a water birth at home and being, being comfortable and being surrounded by people that are, you know, giving you your, your space and your time, not pressuring you. It really just, it really eliminates or substantially reduces the fear that sometimes is associated with birth.

 

Kimberly

Wow, Dr Carla, that sounds amazing. Okay, Let’s talk about water births. On Instagram, they look lovely. On TV and in the movies they are a mess. What’s the reality here?

 

Kiki

A water birth, I think, is actually usually pretty clean. Most of the,  we call it, the products of conception are contained in the pool. We use a sanitary process to drain the pool after the birth. Um, yeah, it’s usually pretty clean and, and, and honestly, I think it’s a really, um, relaxing and safe option for the mom and the baby. Most of our clients choose water birth.

 

Carla

The, it even makes it less painful because you just, you, you feel, feel so supported, which was something so important for me. You have your space to just deal with what you’re feeling, however you want to, and you don’t feel any inhibition. It was just a very different experience for me. And it transformed me and the, and it led me to just understand and know that moving forward, that was the only way that I would be, I would feel comfortable and want to birth again.

 

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Kimberly

Okay, you were all in Dr. Carla, but what about your husband? Sometimes our men aren’t on the same page. Especially around home births where they have a fear of something going wrong as a Black or brown husband.

 

Carla

My husband, thankfully, has been extremely supportive. And, you know, from day one, he’s always been in tune with what it is that I want for myself. And he, he, he’s trusting and, and he knows that I’m going to make the decision that is, you know, the best for me and for our family. And he’s definitely just, he couldn’t be more, more supportive of the process. So he sometimes has questions. He asks questions. I, I tried to, you know, answer to the best of my ability, but at the end of the day, he feels like it’s a process and an experience that I choose how I want to go about it. And, and, and he trusts what he trusts, you know, what my decision is. So thankfully that’s been my experience with him.

 

Kiki

 

So I encourage partners to come into the prenatals, come in to every visit or as many visits as you would like to. Let me show you how to touch her belly. Let me show you how to feel the position of the baby. Allow you to listen to the baby’s heartbeat. Do you have any questions? So really allowing them to be a part of, again, the midwifery care, which is essential to preparing for the home birth.

 

And what I noticed is they start to get comfortable. We build trust, they start feeling like it’s a safe place for me to ask questions. It’s a safe place for me to say, I don’t know. And I also appreciate the answers that I’m getting from my midwife, because I’m also his midwife. Um, And then at the home birth, the, the, the encouragement to, to be physically supportive.

 

And also we talk a lot in the prenatal period about how to be emotionally and verbally supportive, that continues, you know, making suggestions for how to support her physically. Kind words, how to match the energy in the room. I mean, they really do become a part of the midwifery team on some level. Um, and then we also invite them to catch the baby with us.

 

If they are interested in receiving their baby, they totally have that option. I think most of our clients, most of our partners period, but the male partners are excited about receiving the babies into their arms. And, also I want to be clear that we’re right there. We can do a forehand and catch with them.

 

Um, and, and, and again, I just want to say after they go through that experience, which is just as transformative as them, as it can be for the birthing person. Um, they tell the story, they love to talk about their home birth experience and tell other men about their home birth experience. We usually end up inviting them to childbirth classes so that they can start normalizing, um, just birth and pregnancy and birth.

 

Kimberly

Midwife Kiki says she is also the partner’s/father’s midwife too. I love that. So, Dr. Carla, as a board certified obstetrician gynecologist who chose to not give birth in a hospital anymore, what advice would  you give others who may be considering home birth, but, maybe think it’s too unsafe or just think it’s weird?

 

Carla

So the, the advice that I would give to someone who’s considering birthing outside of the hospital, birthing at home is, um, to first, educate yourself about birth itself. Um, look up different providers as well. Try to find someone who aligns with, with what your desires are, what your values are and what you’re looking for.

 

And always understand that you can ask questions, you have the right to say no to, to, to a person or, or something that’s being suggested to you that just doesn’t fit. And you can always, like they say, quote, unquote, “fire your provider”. If, if someone is not respecting you, if someone is not honoring your wishes, if someone is not at least open to educating you, conversing with you and explaining things to you and making you feel comfortable about the process you’re going through, then you should move on to someone else.

 

So, that’s my advice is to just seek as much information as you can. And when you are more educated, when you have that, that, that information, you feel more powerful and you feel less fear. So that is my suggestion.

 

Kiki

Home birth is not just about the act of giving birth at home. That’s a big piece of it, but it’s also about midwifery care. Midwifery care is, um, personalized, individualized, human based model of maternity care.

 

So with home birth comes midwifery care, and that is super valuable during the pregnancy, birth, and the postpartum period, which gets missed a lot. And so we can change birth experiences for black folks. If they are able to see themselves as their personal maternity care provider, if they’re able to get that one-on-one connection from their midwifery provider, if they know that their family can be included in their birth experience, because they’re comfortable with who’s providing care with them, we speak the same language.

 

Midwifery care is costly. It can be expensive to plan a home birth, and that can make Black folks feel like it’s not available to them. There are lots of midwives, specifically certified professional Black midwives who are looking at ways to, like I said, tailor their care, um, reinvent, recreate. Think creatively about what maternity care can look like so that it can be more accessible to Black women.

 

Kimberly

To be clear, the number of mamas who have given birth at home has increased during the pandemic where many people were afraid to go to hospitals. Others did not want to be forced to birth alone without a partner or doula- as many hospitals mandated. And all of us saw the folly of medicalizing birth and forcing people who are not sick to go to a building full of sick people as their only option for birth. It doesn’t make sense.

 

Now that more and more women, and yes, even OB/GYNs are opting out of a hospital delivery, providers need to recognize that they must work to improve the experience of care for Black birthing people.

 

Carla

I would, I would say that, um, I really wish that providers would, make it their priority to, you know, bring joy and happiness back into, you know, the process of birth and just prenatal care and everything. You know, it, it, it really it’s disheartening when I hear people’s, you know, birth stories or when I hear how they’ve been treated in past experiences and how they don’t want to go through that again. Um, and just the fear that women have of birth it’s, it’s, it’s horrible. So, I just feel like definitely as providers, we can do our part to make it a more pleasant experience for our patients. They shouldn’t feel rushed when they come to see us, they should have their questions answered.

 

Um, we should be…we should be open to that. And we should be, we should be just trying our best to, to make, make our patients feel or help our patients feel comfortable. And, just help, help for it to be a joyous occasion and, and, um, And eliminate some of the fear that, that we’re, you know, the media gives us other people, unfortunately their experiences, but sometimes those experiences and those awful birth stories come from, you know, things that the providers have, have done and are causing to, you know, to our patients.

 

So, so, I would just say, you know, to be very mindful of that and, um, Just give patients the respect and that they deserve and the time and, and proper care.

 

Kimberly

So simple yet so true. And this is a big part of the work we do at Irth. Turning your reviews into data and actionable insights for hospitals and providers, so they provide more respectful, more dignified and equitable care.

 

Speaking of respect, Dr. Carla, I close every episode with asking this question- WHAT IS OUR BIRTHRIGHT? 

 

Carla

I would say that our birthright is to have the experience that we desire and to, and to find joy in the process of birth and for it to be a happy experience. And I think that’s, that’s our birthright.

 

Kimberly

What do you say, Midwife Kiki?

 

Kiki

So you have a right to have a celebratory pregnancy and birth and postpartum period. You really are welcoming a new member of our human family. I’m from Berkeley, California,

so I know I sound hokey and hippie, but it is true. You are really welcoming a new member of our human family. You’re welcoming a new member of our Black family. You get to be in full celebration of that during your whole pregnancy. Your entire birth and your entire postpartum and everyone who is in your life during that time should be in celebration with you. If there is not a feeling of joy and, and empowerment and a willingness to uplift your choices or, or invite you to participate in your choices, then that’s not the right team. You have the right to create a team that is fully, fully supportive of your joy. That’s your birthright.

 

Kimberly Close: 

Ultimately, giving birth at home is not a fringe experience and we should educate ourselves on who created that narrative that midwives and home births were unsafe.

In fact, I think we need a movement to normalize midwifery care and home births in our community, so that i’s not seen as something just the for the Erykah Badu types. 

Instead, everyone should know that you can bring your lace front and your bundles to your homebirth. It should be an option for anyone and everyone who can. And when Black OB/GYNs are saying, “I’m not giving birth in a hospital”, perhaps we all soudl at least give it a listen and give it some research. 

 

Thank you for joining me for the Birthright podcast, where we reclaim our birthright one story at a time. Our season will be ending soon so I hope you will catch up on episodes 1-8 and get ready for our season finale, another powerful restoration episode for healing birth trauma. You won’t want to miss it.

 

About Carla Williams, MD

  • Carla Williams, MD,  is a board-certified OB/GYN and holistic women’s healthcare provider serving patients in Westchester, NY. She attended medical school in the Dominican Republic and completed her residency in obstetrics and gynecology at NYC Health + Hospitals/Lincoln in Bronx, New York. She offers patient-centered care with a dual approach: a focus on nutrition and movement for overall wellness coupled with conventional medical practices as necessary. She is a married mother of two who has personally experienced birth in both the hospital and in-home setting. She’s currently expecting her third child and preparing for her second home birth.

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