What is a Homebirth Cesarean

Success is about so much more than our vaginas. And a cut in our bellies is not a failure.
—Leah (2012/HBC, Western U.S.) 

unnamedHomebirth Cesarean (HBC) Defined
A homebirth cesarean (HBC) is not a surgical birth performed at home by midwives. The term describes a planned out-of-hospital birth that ends in cesarean. Even though the word homebirth is used, the intended location of the birth can also include freestanding birth centers. Women who choose to birth unassisted, meaning without the help of midwives, can also be homebirth cesarean mothers. HBC may be applied to women who transfer care before labor starts, referred to as pre-labor homebirth cesareans, and to those who transport to the hospital during labor.

By bringing the terms homebirth and cesarean together as a single definition, we honor the homebirth dream that mothers lost during their surgical birth experiences. Through this name, we begin to change the way we relate to these birth journeys, reaffirming the importance of the HBC experience in the homebirth and natural birth communities.

My experience, and the trauma I’m healing from, are directly related to the fact that I planned an out-of-hospital birth and ended up at the hospital. I went from intimate care with a midwife to a hospital I had never visited and people I hadn’t met, people who didn’t know me at all. I went from client-first support, to caregivers who had a strict set of rules that determined how they treated me. For many of us homebirth cesarean mothers, we are dealing with more than the loss of a vaginal birth.We’re struggling with a shattering of our expectations and identities.
—Jo (2012/HBC, Western U.S.) 

Prenatal Planning
This illusion of control drives humans to make better decisions, yet it also leads people to believe that they hold more power over circumstances than they actually do. For a homebirthing woman, it is often incomprehensible to accept that her willpower, educated choices, and desires are only a small component in a greater picture of how labor and birth will unfold.

I’m a perfectionist and always believed that you can control anything as long as you do all the right things. My HBC was a huge life lesson that that’s not true. You can do everything that birth expert Ina May Gaskin would ever want you to do and still end up with something different from what you wanted.
—Ann (2011/HBC,Midwestern U.S.) 

Leaving Home
As the birth team disperses to expedite leaving home, a laboring woman is often left to manage contractions on their own. While her support team is busy attending to the necessary tasks that must be accomplished before everyone can leave, a mother may no longer be sure who is helping her, and may perceive this change of focus as desertion. Now, more than ever, she needs continued attention and support. If she is in the stress response, she will experience a rise in blood pressure, and blood flow to her uterus will dramatically slow as her nervous system launches into survival mode. These and other physiological changes may result in a racing heartbeat and unbearable contractions. 

We started this journey at 11:45 Friday evening. At 6 a.m. Sunday we made the decision to transport.With that decision, everyone flew into action–Gary and our doula rushed around packing a bag, I got dressed between contractions, our midwife’s assistant gathered their supplies and got the bedroom back in order for our eventual return home. Our midwife tried to put things in perspective when our urgency and anxiety grew as we realized that this was not what we planned and that things were about to change.
—Leah (2012/HBC, Western U.S.) 

The Cesarean
Homebirth women find satisfaction in the active roles they plan for their births, and believe that an out-of-hospital birth will be the ultimate route for carrying them across the threshold from maiden to mother. When pregnancies end with cesareans, these same women sometimes view their births as a kind of death rather than a triumphant entrance into motherhood. 

I expected birth to be a rite of passage from the easy, responsibility-free life of the childless to that of the strong and determined mother. Instead, birth didn’t just try my resolve—it destroyed it. It obliterated me. It was a birth, a death, a re-birth, and an initiation all in one.
—Kate (2012/HBC, Southern U.S.) 

Returning Home from the Hospital
Leaving the hospital may be a time of great relief and nervous anticipation. No matter what the mother is feeling, this is when she will struggle with another flood of emotions and physical pain that comes with increased mobility, and if she planned a homebirth, a dread of facing that environment once again. 

I was an emotional wreck when I came home. The apprentice cleaned our house after transporting, but the birth supplies were still out. That made me awfully sad to see.There I was, back in the room where I failed to progress, failed at birthing, and failed my birth team. I felt like a bad birther. I was walking around in circles, flapping my arms, and crying. Luckily, the apprentice came by and calmed me down, tucked me into bed, and let me cry and talk before she even checked the baby.
—Maia (2012/HBC,Western U.S.) 

High Stakes Breastfeeding
To offset feelings of disappointment or body inadequacy, HBC mothers who choose to nurse want to excel at breastfeeding as a way to reconnect with their bodies, hold on to a vestige of their homebirth dream, build confidence, and prove their competency as mothers. 

I already felt like a failure for not being able to birth my own kid, so our nursing success was huge for me as an emotionally recovering c-section mom. Overcoming my negative thoughts was made easier by knowing I was awesome at feeding him.
—Alexis (2011/HBC, Midwestern U.S.) 

Relationship with the Birth Team
As the fog from recovery, fatigue, and caring for a newborn begins to lift, the strong emotions left behind by the birth are revealed. The HBC mother has been in survival mode for weeks, and she now may look back and begin to realize that she feels upset about the care she received from her birth team. 

When a homebirther has a cesarean, the surgery itself is rarely the trauma. Usually, there is some kind of disruption in a relationship that is the most disturbing aspect to the mother—someone wasn’t there, the midwife backed off, and there is now a painful connection with the natural birthing community.
—Pam England, Author and founder of Birthingway from Within,Western U.S.

Changing the conversation
It is a delicate balance for mothers and childbirth professionals to champion out-of-hospital birth and still celebrate homebirth cesareans. Welcoming HBC mothers back into the homebirth club involves open conversation about homebirths that end in cesarean. This level of comfort around HBC requires midwives, doulas, and childbirth educators to openly share HBC journeys, posting them on their websites, and inviting HBC mothers to speak at their functions.

I will never be invited back to share my experience in the childbirth class I took because they don’t want pregnant women to hear my kind of birth story. My story isn’t posted on my midwives’ website even though I could write a version they could be proud of. It would show that cesarean does happen and that it is valid. Moms could read it and critically think about that possibility. If moms never hear about HBC from their midwife, they may never think about it happening to them.
—Alexis (2011/HBC, Midwestern U.S.) 

Subsequent Pregnancies

If HBC experiences have taught us anything, it is that women need to feel supported and heard, regardless of where or how they decide to birth. Along with welcoming homebirth cesareans into the natural birth community, we must support women in all their birth choices. 

If I ever come to a place where I’m pregnant again and wanting another child, not just another birth, I envision scheduling a repeat cesarean. If I decide I’d like to go through birth again, I deserve what all women do, which is to make my own decisions without judgment from others.Whatever my choice, I believe it should be honored, respected, and supported by not only compassionate care providers, but by the other mothers in my life.We can never know what it’s like to walk in another woman’s shoes, to live with the wisdom she carries in her bones, born of her unique life experiences. Judging another woman’s choices in birth is ignorant and cruel. Birth is hard enough without someone else pressing their views on us.That was true when I was criticized for planning a homebirth. It will be true if I decide never to have another child. And it will be true if I decide to schedule a repeat cesarean.What is at stake is women’s right to determine how it is best for them to birth, whether it’s at home, in a tub, or on an operating table.
—Ann (2011/HBC, Midwestern U.S.) 


Text and quotes from:
Jarecki, Courtney with Mednick, Laurie. Homebirth Cesarean, Stories and Support for Families and Healthcare Providers” Inciso Press, 2015.