Rebecca Dekker:

Hi everyone. On today’s podcast we’re going to talk with Isis Rose about home birth for the black community. Welcome to the Evidence Based Birth® podcast. My name is Rebecca Dekker and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence based information into the hands of families and professionals across the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.

Hi everyone. On today’s podcast I am so excited to welcome Isis Rose. Isis is a full spectrum doula home birth mom, certified lactation counselor, placenta encapsulation specialist and lives in Urbana, Illinois. Isis is starting midwifery school in July with plans to become a certified professional midwife. She’s a member of the Illinois Council of Certified Professional Midwives ICCPM, which has been advocating licensure for CPMs in the state of Illinois. Isis is cohost of the Homecoming Podcasts with Chae Pounds. Together, they launched the Homecoming Podcast in 2018, in order to feature birth stories of black families who give birth at home. Welcome Isis, to the Evidence Based Birth® podcast.

Isis Rose:

Thank you so much, Rebecca. I’m really glad to be here.

Rebecca Dekker:

So tell me, Isis, how did you get into birth work? Because I don’t think it was a straightforward path for you.

Isis Rose:

That’s true. Yes. It was actually by accident that I stumbled into birth work. Back in 2016, I was a PhD student at the University of Illinois in Urbana-Champaign. And I was in the process of choosing a dissertation topic. And I really wanted to develop a feminist anthropology project and I was thinking about reproduction, and my older sister had a friend who was a doula, and I didn’t really know what a doula was before that. And so I started looking at her Facebook and trying to figure out what a doula is. And just everything that she was talking about, the work being women’s centered and playing that supportive role and helping usher new parents into parenthood. Everything about it just seemed really amazing.

And the more I started to read literature, I was very inspired by Christine Morton and Monica Basile, who wrote about doulas in particular, being agents of social change, being a really great analytical category, when thinking about theorists and how doulas can play a really important role as someone who’s introventive, if you will, in this medical space that is currently dominating birth. And so I just fell in love with the idea of a doula and then I decided to, since I was doing an ethnographic project, decided to actually take a couple of doula training to learn more about it and get that first hand perspective of what kind of work doulas actually do.

And at the time, I was doing some preliminary research in New Orleans, Louisiana. And it just so happened that there was a midwife planning to do her training in New Orleans. Her name is Whapio, she’s based in North Carolina, and she runs the midwifery school called The Matrona School of Midwifery. And so she was there doing a doula training, and then I also did Nicole Deggins or Sister Midwife Doula Training that same summer, and I just had a really great experience with both.

Rebecca Dekker:

Oh, wow. So you were working on your PhD and what was the field? Was it anthropology?

Isis Rose:

Yes.

Rebecca Dekker:

Oka.

Isis Rose:

So sociol-cultural anthropology is the field that I got my master’s degree in. I’m taking a hiatus from my PhD program. But I learned about the intimate relationship that anthropology does have with childbirth as an academic area. So like Robbie Davis Floyd, she’s written about birth across multiple cultures, and she’s been very critical of the American birth system. And so I was just, like I said, very inspired by the anthropological research that I was doing, and then also getting that firsthand experience. And I also learned about Birth Justice and the works of Julia Chinyere Oparah and Alicia Bonaparte and all these really great theorists who were thinking about the intersection of birth and Birth Justice, and how birth outcomes and the experience of birth is different for black women.

And at the doula trainings, I just met really incredible people. And they were having these conversations and it was, it didn’t so much feel like theory anymore. It was like, “Oh, these are people lived experiences.” So it was just, yeah, it was a great summer and I learned a lot.

Rebecca Dekker:

So you were immersing yourself in these doula trainings and being surrounded by birth workers. What were your thoughts and feelings when you were at the doula trainings?

Isis Rose:

Well, firstly, I would say that as somebody who at the time had never been pregnant, had only a little bit thought about starting a family because I was in a relationship at the time, with my now husband, I didn’t really fully take seriously the thought of becoming a mother until after the doula training. I think I was very intimidated by birth and pregnancy prior to the training and just being in that space with people who were called to birth work because of their own history of loss or trauma or traumatic birth experiences, but using that as a point of entry into a field where they could not cultivate their own healing but help others with healing themselves or just having a birth experience that was more fulfilling and safe, and one that was respected.

And so I was just like, I think Nicole’s training really did change my life. And I say that all the time, but it’s true. And I actually cried and had a breakdown and was like, “Oh my gosh,” it was just overwhelming to think about the fact that I never really thought about my female ancestors prior to that point. And we really dug deep and talked about the spiritual aspects of birth as well. And it was just really powerful to be in a room full of women who were sharing birth stories and sharing stories about why they were doing this really critical work in their community.

Rebecca Dekker:

So you did a lot of deep sharing, it sounds like and taLking about spiritual aspect. What else were the trainings like? Because I know the Sister Midwife Training is specifically geared towards people of color. And I was wondering if you could talk a little bit about what was-

Isis Rose:

Sure.

Rebecca Dekker:

… offered in the training?

Isis Rose:

Sure. So Nicole is amazing. She has history as a labor and delivery nurse who went on to become a certified nurse midwife. And based on the experiences that she had working with families in the hospital, she decided to start training doulas full time. And so her program is specifically created with black women in mind because she hopes to train black doulas to serve black women and black birthing people. And it was a full spectrum doula training, so it covered preconception, conception, we talked about birth, obviously and postpartum. And like I said, just the spiritual aspects of pregnancy and birth but also the fact that black women in this country have had our reproductive lives comprised, since we were brought here as chattel, so we talked about that very critical history as black women and how that informs how we birth today.

So it was not only a full spectrum doula training, but one that was focusing on those cultural competency areas that discuss disparities in maternal health and how, like I said, birth looks different for black birthing people. And I came to find out that Whapio, who is a white woman, she’s someone who considers herself to be a spiritual midwife, is one of Nicole’s mentors, and her midwifery training was also amazing. And that’s where I really learned about home birth, and this idea of unassisted birth, which blew my mind because I didn’t even know that home birth was a thing, let alone people birthing without a medical provider present. And so both were just equally as mind blowing, but very different in their approaches, but I just felt like I learned so much.

Rebecca Dekker:

Wow, it sounds like it was really eye-opening for you.

Isis Rose:

Definitely.

Rebecca Dekker:

So you said you weren’t sure if you wanted to have children yourself because you were afraid of birth. And then after these trainings, you started being more okay with the idea of motherhood?

Isis Rose:

Mm-hmm (affirmative). Yeah. So I would say that I wasn’t exactly afraid of birth, but I was hesitant about the idea of becoming a mother. And I think it took being trained as a doula to recognize that I had huge gaps in my knowledge and understanding of pregnancy and birth. And that was there, but I think the source of my fear was just very deeply personal as it relates to my own relationship to mothering and how I was mothered. And so that’s why the deep sharing really brought to the surface, a lot of my own insecurities and hang ups around building family really.

But once I’ve learned and bridged the gap in my knowledge about pregnancy and birth, that to me felt very natural, for lack of better words. And so when I did learn about home birth, I became really intrigued and excited because I’m thinking like, “Wow, that makes so much sense. I can’t believe I’m just now learning that this is an option because it feels like the logical next step for me and the person that I’m with,” who would become my husband very quickly after that training. So yeah, when I did decide to start a family, home birth was definitely on the table right away.

Rebecca Dekker:

Yeah, so take us to when you got pregnant, what were your thoughts and feelings about the pregnancy?

Isis Rose:

So pregnancy. I was definitely in denial at first, I didn’t actually learn that I was pregnant until I was six weeks pregnant. It was the very end of a really long semester. And so I kept putting off taking a pregnancy test because I was like, “Oh, maybe my cycle is just late because I’m really stressed out. I’m writing all these papers.” I had all these excuses, and then I decided to take a test because my body was doing things it had never done before I was having sensations. And so I got the test and read that it’s best to take it in the morning. So I was like, “Okay, I’m going to sleep on it.”

But that night, I had a really intense dream, and in the dream, I learned that I was pregnant. And I was like, “Okay, I guess I need to take this test now.” And so I woke up at 5:00 in the morning, bright and early, I never do that. I’m not a morning person, but I felt very strongly that I was pregnant based on the dream I had. And so when I talk about the spiritual aspect of pregnancy, that’s one of the things that I’m talking about. The things that are beyond the realm of tangible or explainable.

And it’s actually funny because a classmate of mine, maybe a week or two before I found out I was pregnant, announced to the class that she had a dream about fishes. And that’s like, I can’t speak for everyone, but in African-American culture when people dream about fish and other sorts of things, that means that someone they know is pregnant. I was like, “Oh, ha, that’s not me,” and just moved on with my day and never thought twice about it. And so when I had the dream, then I woke up, took the test, and it was positive, I was bawling and crying, and then I was like, “Oh, wow, I guess she was dreaming about me. That’s really interesting how we really are all connected.”

So pregnancy, in hindsight, it was really challenging in terms of just getting through all the symptoms and the hormonal changes. I had a really tough time with nausea. I think I might have had undiagnosed HG, hyperemesis gravidarum. The first trimester especially, was really, really hard. But, like I said, I planned very early to have a home birth and that definitely shaped how I navigated my pregnancy. And something else that shaped how I navigated my pregnancy, is like I mentioned before, it took my doula training, among other things to reveal the challenging relationship that I had with mothering.

And so that was also a theme throughout my pregnancy, which led to a lot of anxiety and pregnancy-related insomnia. And I was, at the time and still to this day, estranged from my own mother, and so that also colored my experience of pregnancy. But outside of that, I would say it was a beautiful experience. And it was one that was very intentional, I felt very supported by my husband, by my community. And I really credit making those connections when I was in the field doing my research, to having online communities and other people that I could lean on for information about, not only how to navigate pregnancy, but navigate home birth as well.

Rebecca Dekker:

So did you keep in touch then with the doulas you met at the doula training?

Isis Rose:

I did. I did. Yes, I did. And to this day, even though a lot of them live very far away, I’ve grown very close to them. And I really do see them as my friends and it’s just been great to stay a part of that community. And I chose the New Orleans area because my father’s from there. So I’ve been back a few times since that initial visit.

Rebecca Dekker:

So you said that you chose a home birth early in pregnancy. How did you go about finding a midwife in the state of Illinois?

Isis Rose:

Good question. Yes, Illinois has its own challenges with midwifery, which I know we will talk about. So in terms of how I found a midwife, a friend of a friend was here in town and I knew that she was a CPM, but she wasn’t currently practicing. She was only here because she was taking care of her mother. And so as much as I wanted her to be my midwife, I knew that she would eventually move back home to where she was living at the time. However, I asked her if she could connect me with someone because I figured, “I know you’re a CPM, Certified Professional Midwife. I know you know someone who can attend my home birth.”

And so once we had that conversation, she was like, “Okay, I can put you in touch with someone but I have to get your email and give it to her.” And I was like, “Okay.” And then she had to explain to me that CPMs are forced to work underground in the state of Illinois. And so I would have to basically be reached out to by her at some point, which did happen. And I found out I was pregnant in May, we had our first prenatal, I believe, sometime in June or July. And it was great. I was one of those people who didn’t have an ultrasound. I never saw an OB for my pregnancy. So when I was able to have my first prenatal session with my midwife and actually hear the heartbeat and confirm, “Yes, this is the pregnancy, it’s viable,” all of that, it was amazing. It was beautiful. And yeah.

Rebecca Dekker:

So you were going along with your pregnancy, planning at home birth with this midwife, what happened next?

Isis Rose:

So the funny thing is, so at the time, me and my husband were both grads students and so we were on nine months academic appointments. So we weren’t getting paid over the summer. And that’s when I started my prenatal care with my midwife. And so we actually asked her to work with us because we were like, “Hey, we actually don’t have any money right now. So can we maybe skip a couple of months and then work with you again in the fall when we get paid?” And she was like, “Okay,” which we were really surprised by because she doesn’t have a medical license and she’s not insured. She doesn’t work through the insurance company. So we were paying out of pocket. So she didn’t have-

Rebecca Dekker:

And that’s one of the problems with underground midwifery, is that you have to pay cash for it.

Isis Rose:

Exactly. So we were doing the self pay plan. And we were really pleased that she actually decided to work with us and come up with a payment schedule that worked for our budget and our payment system since we weren’t going to be paid until September, mid September. And that also meant that I would have to forego prenatal care, which I was okay with and people who are listening might be like, “What?” But this was my first time being pregnant, I had never had any real medical or reproductive complications in the past, I considered myself to be low risk. And so I fully felt that I could do it. And I already knew in the back of my mind, “There are people out here who are doing unassisted births and a lot of them don’t have any prenatal care.” I actually got a book called The Unassisted Baby and was reading up on prenatal care, and I was like, “You know, what? A couple of months, it will be okay.”

But I think that part of the story would definitely surprise people but I share that part because I want folks to know that home birth midwives will work with you if you are straightforward and upfront about what your needs are financially. And we were very pleased with the fact that she was able to work with us and she didn’t try to fear monger me or say, “Oh, that’s not safe because I need to be able to check your urine or whatever.” You know what I’m saying? It was a mutual decision that was made and one in which I felt my needs were respected.

Rebecca Dekker:

So that was towards the end of your first trimester, first part of your second trimester?

Isis Rose:

Mm-hmm (affirmative).

Rebecca Dekker:

Okay.

Isis Rose:

Yes. So we resumed care, maybe still early mid-second trimester.

Rebecca Dekker:

Okay. So bring us to the end of your pregnancy, what was your mindset like?

Isis Rose:

Wow. So like I said, in hindsight, my pregnancy was really challenging physically. It was also challenging emotionally and I was also just a student of birth, I felt very confident about giving birth, I felt very zen about the whole thing, but in terms of my actual mindset, I think around week 28, I was like, “Oh, okay, I’m actually going to have a baby.”

Rebecca Dekker:

They actually teach us that in nursing school. That there’s a specific time point where people realize that, “I’m going to have a baby.”

Isis Rose:

Mm-hmm (affirmative).

Rebecca Dekker:

And there’s another-

Isis Rose:

Right.

Rebecca Dekker:

… point you feel like, “The baby has to come out.”

Isis Rose:

Exactly, exactly. So as much as I was thinking about birth, I was like, “Oh, crap, I didn’t actually think about having a newborn.” So I think towards the end of my pregnancy, I was just like, “Ah,” a little bit unnerved by the fact that I was actually having a baby. And I think that feeling of just being on edge, it was heightened by the fact that I felt like I was pregnant forever. So for example, I thought my due date was December 28th. But I never had an ultrasound, I never really had anything other than my midwife’s fundal height checks to confirm what my due date would be. And so unbeknownst to me, she was tracking me at January 5th. And so I’m a doula, so I know, “Okay, due dates are just estimates and plus or minus two weeks is when I’ll have this baby.”

And so when two weeks past, December 28th had rolled around, I was thinking like, “Oh my God, I’m going to be pregnant forever.” But then she reassured me like, “Okay, I’ve been checking too, I don’t think your due date was the 28th. I think your due date was actually on the 5th which was only a week ago. So you could go another week or so,” which I definitely didn’t want to hear. I was really over being pregnant at that point. But I really do think that everything happened in divine timing because if the baby had come when I wanted the baby to come, my sister would have missed the birth.

So I always, always tell people about the due date discrepancy because I just think it’s really amazing how I wasn’t really planning for her to be at the birth. We were planning for her to be there sometime when I had a week old or two week old baby, but she was there. She arrived on a Tuesday, my last prenatal appointment was on a Thursday. I went into labor on Saturday. And that’s actually the day my sister was scheduled to leave. So we extended her trip by a couple of days because I’m thinking, “Well, surely I’ll have this baby before Monday.” And my daughter was born Monday, January 15th. So…

Rebecca Dekker:

Oh, wow.

Isis Rose:

Yeah.

Rebecca Dekker:

So I can see how you did feel like you were pregnant forever.

Isis Rose:

Mm-hmm (affirmative).

Rebecca Dekker:

And I can empathize with you because with my third pregnancy, I had uncertain dates, with discrepancy between the different estimates. And it was really a big mental game towards the end. We don’t know when my due date is, when will this pregnancy end, I just want this baby out. And if you’re planning a home birth, a medical induction isn’t necessarily an option.

Isis Rose:

Exactly.

Rebecca Dekker:

So tell us about the labor experience. You said it began on a Saturday and you gave birth on a Monday. So what was that experience like?

Isis Rose:

It’s so funny because my midwife at my last prenatal appointment, which I didn’t realize at the time would be the last one, I did tell her I was frustrated. I told her, I said, “I’m about five minutes away from chugging a bottle of castor oil.” And she said, “Yeah, don’t do that. I don’t think that’s a good idea.” And I was like, “Well, I just don’t want to be pregnant.” And she was just thinking, she told me, she said, “I understand where you’re coming from. I know this has been hard for you, but babies come when they’re ready, and in my experience, babies come during inclement weather, there’s going to be a storm in a few days a snowstorm, and babies also come after an emotional release. So you might have to cry.” And I just blinked at her and I was like, “What?” And I’m thinking like, “Okay, that doesn’t mean anything to me.”

And so she left and I was still very disappointed. But at that time, I wasn’t even remotely close to thinking about going to the hospital and being induced. That was way far away from my thinking. But one way or another, my husband and I, we got into an argument and I really think that that was the emotional release that she was talking about, because we argued that night and then at 3:00 in the morning the next day, I started having contractions. And so yeah, I was having contractions for like, two days. I told her about me being in labor and she said, “Oh, just have a normal day, they’re still pretty far apart.”

And then Sunday is when things started to pick up. And that’s when I had about eight hours or so of active labor. And it was great. I had a photographer there, I had my sister there, I had my husband, I had a friend who I asked to step in and play the role of doula and my midwife and her assistant were there and I had a water birth, the labor itself, in hindsight, was way more peaceful and tranquil than even I thought it was at the time just looking at the pictures. I just realized how then I was. So overall, even though it lasted for 44 hours, I would say that it was pretty great. And she was born at 1:00 in the morning on Monday. Yeah, it was awesome. It was definitely the defining moment of my life and one that was extremely transformative.

Rebecca Dekker:

Yeah. So what were your thoughts like when your baby came out in the water?

Isis Rose:

Well, I didn’t really think at all actually, I just started crying. And it was so surreal because she was born in the middle of a snowstorm. So as I was laboring and pushing her out, two feet of snow just appeared on the ground. And so my midwife was absolutely correct. Yes, I had an emotional release which triggered my labor, I think. That and her lungs being fully developed, of course. And then there was a snowstorm on the morning she was born and it was beautiful. I cried so hard because I was just thinking like, “Wow, I was really over being pregnant and now you’re here.” The first thing I said was like, “Oh my gosh, she’s so heavy.” She was eight pounds, nine ounces. And then I think the second thing I said was, “Wow, she looks just like Chris.”

And I wasn’t saying she at the time because I didn’t know the sex until the birth. It was a surprise. So it was also just amazing because I really wanted to have a girl, especially with all the things I was experiencing, in my family and being estranged from my mother and wanting to really repair that relationship moving forward with my lineage. It was just really healing for me. And I was crying, my sister was crying. My daughter, Xena, she was just very calm. She didn’t say anything. She was looking around. It was amazing. I had never expected for her to just come out and be calm, but she wasn’t crying at all. She was just chill from day one, which was really cool.

Rebecca Dekker:

I’m curious, did your midwife do the exam to estimate her gestational age?

Isis Rose:

When she was born?

Rebecca Dekker:

Uh-huh (affirmative).

Isis Rose:

No, I don’t think so.

Rebecca Dekker:

It would be interesting to see if that’s on the paperwork she filled out for her birth certificate or anything like that, because I know-

Isis Rose:

Yeah, it would be interesting because she was a little bit wrinkly, she had been in there a while. So I would be interested to know that too.

Rebecca Dekker:

Yeah. Because we didn’t know, with my third baby what the gestational age was until she was born. And I think according to one of the measurements, I could have been 42 weeks and four days. But the gestational-

Isis Rose:

Oh, wow.

Rebecca Dekker:

… for the actual newborn exam showed she was 41 weeks. So I thought that was really fascinating to find out how long she actually had been cooking inside of me. It was mystery.

Isis Rose:

Right.

Rebecca Dekker:

What was the recovery like after your home birth?

Isis Rose:

So that is something that I always like to share because it wasn’t what I expected. I think that, there were a few things that… Okay, let me back up. My postpartum recovery was not what I expected because as soon as I set my foot outside of the birth tub, I felt a ringing in my ears and I felt very dizzy. And so I don’t know who but somebody grabbed the baby, my daughter and my midwife said, “Okay, get down on the ground right now.” And so they started to check me and assess for hemorrhage, because at that point, we had noticed that the birth tub had filled up with a lot of blood. And so I did actually experience a great loss of blood postpartum. And I share this because, it’s not a scare tactic, obviously, I believe in home birth, but people need to know that emergencies do happen. And people should also know that Certified Professional Midwives are competent to handle birth emergencies. And that’s exactly what happened. Excuse me. Sorry, my allergies are like, “Ah.”

Rebecca Dekker:

Oh, I understand.

Isis Rose:

Yeah. So I was extremely well taken care of. I did lose a lot of blood. I was very weak. I did have very low blood pressure. But I did not panic my midwives did not panic. Everybody stayed very calm. And it wasn’t until the next morning that I heard my midwife actually use the word hemorrhage and shock. And I was like, “Oh, okay.” So that is what happened, but she handled it very well. She handled it like the professional that she is. She already had her equipment with her, oxygen, Pitocin. And these are things that midwives really do need and it’s important that we create paths to licensure for midwives so that they can have access to life saving medicine. And, yeah, so as weak as I was that first day, by day two, I was up walking around my house. I wasn’t moving very quickly, but I did have enough blood volume at that point and enough nourishment to walk around, to change my baby’s diaper, things that I was definitely not encouraged to do post birth that first day. But it was definitely not what I expected.

And I think some people might consider that a birth injury or a birth trauma, but I don’t have any trauma around the hemorrhage at all. I actually felt that I was really empowered to make the decision that I felt was best because there was a conversation about having a hospital transfer transfer but I was very steadfast in my decision to not set foot in a hospital. And I also wasn’t confident that I would be received really well. Because there are no established home birth transfer policies here in my community.

So if I were to transfer to a hospital that, I had no established prenatal care. It’s the middle of the morning, you know what I’m saying? I didn’t really know what to expect. And in addition to that, I didn’t want my newborn to go out in really cold snowy weather, because I wanted her to go with me, I had a plan to breastfeed. So I was just thinking, “Whatever we have to do to keep me alive and here in my own home where I’m comfortable, that’s what we’re going to do.” And it was great.

Rebecca Dekker:

It’s interesting that you share that story of postpartum hemorrhage in home birth because the research on home birth in the US does show that the vast majority of postpartum hemorrhages that are handled at home, or that happened at home or managed at home, which I find interesting, it’s not that common that they have to transfer to the hospital. Most midwives can manage it. So that’s great that you shared that story. And it’s, yeah, I’m glad that you didn’t feel traumatized by that.

Isis Rose:

Yeah, absolutely. And when we talk about maternal mortality, hemorrhage is up there as one of the leading causes. And so it’s definitely nothing to play with or to dismiss, or make light of, and so that’s why I’m sharing it because it might sound like a reckless decision, depending on who you ask, but when I tell you that my midwife was competent, and I was safe, and I was comfortable, I’m very serious-

Rebecca Dekker:

Oh, and you were believed too.

Isis Rose:

Right and-

Rebecca Dekker:

That’s a main part of it.

Isis Rose:

… I was believed. Exactly.

Rebecca Dekker:

When you said, “I feel dizzy, my ears were ringing,” they immediately jumped into action.

Isis Rose:

Right. And who knows if that would have happened if I were in the hospital? And that’s one of the primary reasons that I didn’t go because every day you hear about black women in the hospital being ignored. They have internal bleeding happening related to a caesarian that they had or they might have a blood clot or… And even people like celebrities. And that’s confirmed in the research that I’ve done. Even if you hold class constant, black women are still heavily treated differently, heavily, what am I trying to say? Heavily discriminated against, heavily impacted by the effects of racism in medical setting.

Rebecca Dekker:

Yeah, no matter your education level or socioeconomic status.

Isis Rose:

Exactly. It doesn’t matter that I’m an educated person, and was very much in control of how I was navigating my pregnancy, that stuff would have gone out the window if I had transferred potentially. And that’s the stuff that I was afraid of really.

Rebecca Dekker:

And also we don’t want to happen. I know there are hospitals where there are smooth home transports and that’s what we need to work towards. We’ll talk about that in a little bit. I did want to mention that we’re finishing up our article about Pitocin and the third stage of labor and I just have to share that. I did not know this until recently that there was a study that came out in 2018 about postpartum hemorrhage, and it had more than 360,000 participants who experienced postpartum hemorrhage in the US, in hospitals. And they found that non Hispanic black women were at the highest risk of having severe illness from postpartum hemorrhage and at five times higher risk for death compared to-

Isis Rose:

Wow.

Rebecca Dekker:

… black women due to postpartum hemorrhage. And the thought is that because of implicit bias or racism, there’s actually racism in postpartum hemorrhage assessment. That they don’t recognize postpartum hemorrhage as quickly, or they quantify the blood loss as less. They say, “Oh, you weren’t losing that much blood.”

Isis Rose:

Wow.

Rebecca Dekker:

Yeah. So that’s and I think it’s really important for health care workers to recognize that that is a concern and a problem in the US that there’s racism in terms of estimating blood loss after a birth.

Isis Rose:

As awful as that is, it’s also not surprising. One thing I will say is that I know that I’m anemic. And so during my prenatal counseling with my midwife, we talked about nutrition and we talked about how do I build up my blood volume and how do I supplement my hemoglobin levels and things that I don’t have a lot of training or knowledge in, but I’m trying to remember the word she used, right? But there were those conversations about food and nutrition and one of the reasons why black women especially, but birth workers in general, one of the reasons why we are doing the work that we do is to really see the individual birthing person for who they are, and provide them with information that they’re not really given the space to receive in their appointments with their providers in the hospital or the clinic. It’s very likely that your OB won’t be doing nutritional counseling with you.

Rebecca Dekker:

Right.

Isis Rose:

And so much of that will dictate how your birth goes. And we didn’t really foresee the hemorrhage happening, but we did know that I had anemia issues and hemoglobin level issues. And so I think, maybe she didn’t tell me that she was anticipating a hemorrhage, but she was fully prepared for one and she brought all of her necessary equipment to handle one. And so I think possibly, one of the reasons why black women aren’t being treated for hemorrhage or counseled in preparation for blood loss is because there’s a lack of acknowledgement of the fact that we don’t have nutritional counseling and a lot of times when we talk about nutrition and pregnancy for black women, it’s just written off as, “Oh, well, they don’t have high quality food access or they live in a food desert. And that’s not my problem. That’s some other institutions problem so-

Rebecca Dekker:

Or they might assume that you live in a food desert-

Isis Rose:

Exactly.

Rebecca Dekker:

… and they don’t bother telling you what to eat.

Isis Rose:

Mm-hmm (affirmative) right.

Rebecca Dekker:

And I think it’s a good point that-

Isis Rose:

Right, there’s a lot of assumptions made.

Rebecca Dekker:

Yeah. That your prenatal care may have played a role in helping you recover from the postpartum hemorrhage because your anemia was being treated and you were being counseled about nutrition.

Isis Rose:

Mm-hmm (affirmative).

Rebecca Dekker:

It’s interesting. So tell us about the home birth climate in Illinois. Why is it that CPMs can’t practice legally and you had to hire someone underground?

Isis Rose:

So for the past 30 or 40 years, midwives have been advocating to be regulated by the state, or what that looks like is being granted a medical license, a license to practice medicine. And year after year, it just does not happen. And I think this past year, 2019, there was significant headway made because there was a Legislative Study Committee formed. And that committee was called The Home Birth Maternity Care Crisis Committee. And basically, the purpose of this committee was to finally acknowledge that there is a home birth maternity care crisis in Illinois because we don’t have enough home birth providers.

And so in the state of Illinois, nurse midwives are granted the license to practice medicine and attend home birth, but Certified Professional Midwives are not. And the licensed home birth practices that currently exist in Illinois, there are 11 of them. And those 11 practices are spread across nine counties out of the 102 counties in Illinois. And of those nine, most of those practices are concentrated in Cook County, which is the Chicago area. And so when we’re talking about midwives practicing legally, we’re talking about Certified Professional Midwives. And the Certified Professional Midwife is the only midwife in the only US-based birth provider who received specialized clinical training in managing out of hospital births. And that’s a condition of their national certification.

But despite that, they’re still not recognized as a profession that should be regulated by the current powers that be. However, circling back to The Home Birth Maternity Care Crisis Committee, the committee that was formed unanimously decided or unanimously recommended that licensing and regulating Certified Professional Midwives is necessary to address the gap in coverage in home birth maternity care. And I actually was one of the consumers who testified back in August 2019. And so the committee that was formed heard my testimony, and I talked about being a consumer of home birth in Illinois and how as a black woman, I was basically terrified of giving birth in the hospital. And it wasn’t fair for me to have to seek a midwife who is practicing underground because like I mentioned before, when you are forced to practice underground, you don’t have access to insurance reimbursement. You don’t always have access to the medicines that you might need to treat a hemorrhage for example. And so it’s just been a constant battle to-

Rebecca Dekker:

Yeah, the underground midwives often… Or the midwives who are practicing without a license often have to get friends to give them oxygen and medications. They can’t get them through legal channels.

Isis Rose:

Exactly.

Rebecca Dekker:

Yeah. To manage postpartum hemorrhage.

Isis Rose:

Mm-hmm (affirmative).

Rebecca Dekker:

So you testified and what happened to the legislation? You said you made headway, did it get halfway through the process? Or where did it get stalled?

Isis Rose:

So in terms of where it got stalled, so when I say it made headway, I think that the headway is the fact that they actually formed a committee to investigate the fact that this is happening.

Rebecca Dekker:

Okay.

Isis Rose:

But there’s a bill. There’s currently a bill called The Midwives Practice Act that is temporarily, well, what am I trying to say? The Midwives Practice Act was established post the committee and their recommendation and so The Midwives Practice Act as of April the last month, this was something that we were hoping to advance and push through the legislation in light of COVID-19. However, that didn’t happen. So we were really urging governor J. B. Pritzker to enact emergency licensure for midwives, Certified Professional Midwives, and using The Midwives Practice Act as a basis for that licensure, however, there was no action made on his behalf.

And so it’s just really unfortunate that even though we have perfectly healthy women and babies, for us to give birth in places that are not healthy, where sick people are congregating, our governor still is not willing to, excuse me, our governor is still not willing to grant emergency licensure for Certified Professional Midwives. And so because our courts and our legislators are not meeting right now, things are on hiatus until the summertime. And so we’re just playing the waiting game trying to see if emergency licensure will be granted, and if not, how do we get something on the books so that we can move forward with licensure post COVID?

So, yeah, it’s just been a really interesting couple of months. And as awful as the pandemic is, I really do think that it’s putting home birth on the map and I think people are seeing that home birth is a viable alternative to the hospital birth.

Rebecca Dekker:

Well, it’s great that you’ve been able to be involved in that process as a consumer. Tell us about starting your podcasts. Why did you start the podcast about birth while black?

Isis Rose:

Yes, yes. So I gave birth to my daughter in January 2018. And it was a beautiful experience. It was amazing. And it suddenly dawned on me that when I was pregnant, I didn’t really hear that many stories of black families who are birthing at home. And I heard a couple here and there but I realized that the black home birth community is so much bigger than the average person even really knows about. And so, based on the connections that I had already made with folks while I was doing research, I just started putting my feelers out and saying, “Hey, I know you’ve had a home birth, would you want to be interviewed on my podcast that I’m starting?”

And so I was able to find a couple of interested people and then my cohost, Chae Pounds, she and I actually met at Nicole’s doula training. And so once I got her on board, and it felt like a real thing, we launched the show in September 2018. And it’s been great ever since. And I really just felt like I wanted to address the gap in media representation around home birth and home birth already seems like this very fringe hippie, crunchy thing. And the amount of people who home birth are in the minority. And then black women or black birthing people are an even greater minority in this already, alternative space. And so I really wanted to just have greater representation and it’s just been really fun ever since.

Rebecca Dekker:

Yeah, I’d love to encourage our listeners to check out the Homecoming Podcast. Do you have any episodes that you recommend in terms of getting started listening to your podcasts? Do you have any favorite interviews that you’ve done?

Isis Rose:

Oh, yeah. I have several favorites. I think one of my favorites is actually episode three. And that’s when we interviewed Roxanne. Roxanne is an awesome, awesome person. She ended up having a 27 week old premature baby via emergency C-section for her first birth. And that was a very traumatic experience for her and she ended up struggling with breastfeeding, and she took that experience and went on to become a breastfeeding advocate. She went on to become a babywearing advocate. And when she became pregnant with her second child, her son, Zion, and that’s the story that you’ll hear, she decided, “You know what? I’m going to have a home birth.”

And home birth meant something a little bit different for Roxanne because she’s a woman who identifies as a fat black woman. And she talked about the discrimination that she felt and she wanted to have a natural birth, a water birth and this is basically a VBAC. So her doctors shut her down, they were like, “No, you can’t have a VBAC because of the risks.” And then she said, “Okay, whatever, I want to have a water birth. I don’t care what you’re talking about.” They were like, “No, you can’t have a water birth, you’re too fat.” And she was like, “Oh, okay, well, I’m just going to not do any of this. And I’m going to find a midwife and I’m going to have a home birth.”

And she had a home birth, she had a home birth after cesarean, and at the time that her son was born, she said that she weighed almost 300 pounds. And despite all of the risks that people were confronting her with, and risks that she didn’t take seriously because, as an educated person, she realized that the risks did not outweigh the benefits. She took risk on herself, and decided, like, “Okay, well, I understand that this could happen, but I know what will happen.” And so she just had a very empowered story. And she represents somebody that you don’t really see in traditional home birth stories. You always see the perfect lighting and the woman with the small frame and the big belly and, you know what I’m saying? There’s certain representations of birth that you see.

Rebecca Dekker:

Yeah.

Isis Rose:

And I really felt like her story was really powerful and really needed and a disruption in your average birth story. So yeah, it was great. And I think another story that I found to be very powerful was, I interviewed a woman named Nuola. And Nuola, she felt that she was coerced into having a D&C with her first pregnancy. She was told that she had growth restriction, but then in hindsight, she realized that as an unmarried black woman, she was probably not given the best care that she deserved. And then her second pregnancy resulted in a stillbirth.

And despite the loss, she continued to build her family, she ended up having two healthy term children. Both were born in the hospital. One was an OB, one was a nurse midwife. But then when she became pregnant a third time, or with her third child, she decided to have a home birth. She was just done with the trauma and the medical system. And she just decided, “You know what? I’ve already experienced these other types of births and birth situations, I’m ready to give birth in my home, with my kids present, with my husband present.” And she also had just a really beautiful, empowered experience after what was really devastating for her.

Rebecca Dekker:

Yeah.

Isis Rose:

And I think that there’s so much triumph and healing that happens in the stories of the families that we interview, and I definitely identify with that.

Rebecca Dekker:

So after interviewing so many families, why do you think black families in particular are being attracted to home births in greater numbers?

Isis Rose:

Well, I mean, I think that we just continue to learn about the disparities in the healthcare system. Disparities in treatment, disparities in birth outcome. I think about people like Lashonda Hazard she was texting her friend saying, “I think something’s wrong with me. No one’s listening to me or taking me seriously.” And then she died. Or Kira Johnson, her husband’s that advocating for her since she died from internal bleeding based on a botched cesarean. And so I think there’s a lot of really dire statistics and a lot of really unfortunate stories that we hear on a regular basis.

And I think that’s another reason why I started the podcast because it’s unfortunately for black women, you can hear negative birth stories. However, you don’t hear as many beautiful birth stories. And so I think we have to be really intentional about the type of information that we’re putting out there. And the type of… I think it’s important that we manifest the types of births that we want to have as a collective. I think that even though we do see that there are issues in these dominant systems, we as birth workers, we as midwives, as doulas, as parents, we also recognize that there are solutions to the problems that we see. And I think, speaking for myself, I do see that home birth is a solution to the issue of institutional racism, because once you get away from that institution, you’re starting to have a different perspective of your health and your birth and I think people really just want to take their birth and their power back.

Rebecca Dekker:

How do you think people such as yourself who are trained in birth work can help alleviate anxiety in terms of the discussion of the dire statistics, but a lot of black women still have to go to the hospital for whatever reason. Maybe they’re high risk, or they can’t afford a home birth midwife.

Isis Rose:

Right, right. Well, I think that information is definitely one of the best ways to address anxiety. And I think that’s why your podcast is so important. Because we live in this culture of information overload, and especially when it comes to pregnancy. And so I think it’s really important that, we as birth workers, but also as friends of people who are pregnant start to become a little bit more discerning about what kinds of things we share with new parents. And I think that yeah, I think we need to be cognizant of the type of information that we’re disseminating, but also, giving people alternatives to what might be the normal narrative that they’re hearing. So that’s a really good question. Let me think on that some more-

Rebecca Dekker:

Yeah, I think you’re right-

Isis Rose:

… anxiety.

Rebecca Dekker:

… though about information being power. And we talked about that with Michelle Gabriel Caldwell, who came on the podcast and talked about how she as a black woman empowers her black clients and how education is a big part of it. Knowing that these don’t have to be your outcomes, we can-

Isis Rose:

Right, right.

Rebecca Dekker:

… you can empower yourself and you can find the right people to support you. And you don’t have to be a statistic.

Isis Rose:

Exactly. And now my, the doulas’ attorney. I think anxiety is just another way of saying fear, and it’s fear of the unknown. But once you are aware of what could happen or what will happen or what might happen, a lot of those fears and anxieties start to go away or at least become more manageable. And so yeah, you can start to release that. You can start to release the fear and the tension once you have more information, and you have other perspective.

And I think what I was saying before as far as being more discerning about the types of things that you share with new parents, when I was pregnant, I was very intentional about not receiving everything people were telling me or feeling obligated to share. As pregnant people, you feel like you’re under the microscope, like, “Oh, who’s your provider? Where are you giving birth? What’s the sex? What’s the name?” And it’s like, you don’t really have to always share and you don’t always have to accept or receive the things that people are telling you, especially if they’re trying to project onto you their own traumatic birth experience. That doesn’t have to color your experience of your pregnancy or your birth, but sometimes it feels like we have no boundaries as pregnant people. And I really think that in addition to information, we also have to be real about our boundaries and not allow people from the peanut gallery including our mother-in-law’s cousin or whoever to dictate to us how we should experience these really life changing events.

Rebecca Dekker:

Yeah, for sure. So Isis, we probably have time for you to ask me one question, if there’s anything I can help you with.

Isis Rose:

Yes, yes. So I do have a question for you. And I’m going to preface that by saying, as it relates to the podcast at Homecoming, we address two myths. And one of those myths is that hospitals are the safest place to give birth. And the other myth is that black families don’t birth at home. And so I would like to ask you to speak to the safety of home birth and the fact that for some folks, maybe home birth is the safest option.

Rebecca Dekker:

Yeah. So the number of families who choose home birth, which is now starting to be called, when you talk about home birth, so freestanding birth centers, community birth, it’s small in the US, but it’s growing and it’s definitely growing among people of color, they’re choosing home birth, as you know in a way to birth outside the traditional healthcare system. And people choose home birth for many reasons. One of the top reasons in one study that was carried about 10 years ago, was a belief that community birth is safer and desire to avoid unnecessary interventions and previous negative hospital birth experiences. So those might resonate with you in terms of the people you talk with.

So whether or not home birth is actually safer than the hospital, actually depends quite a bit on where you live. So in Canada, in some other European countries, we have a lot of research on home birth outcomes showing that for low risk people, home birth is very safe. In some studies, they found it safer for experienced moms than for first time parents. But in other countries, they’ve not seen that difference. So it depends on where you live. So in the US, it’s a little bit harder to study, compare home versus hospital birth.

One of the main reasons is that the people in the US who tend to choose home birth have higher cultural tendencies to decline prenatal testing, such as genetic testing. They decline termination for genetic problems, and they declined autopsy. So say somebody was having a home birth and they experienced an infant death or stillbirth, they’re much more likely to decline an autopsy. And so the cause of that death would then be unknown. When it could have been due to a congenital anomaly. So it’s difficult to compare those kinds of people to people who give birth in hospitals, if that makes sense.

Probably the best quality study we have on midwife-led home births in the US was by Cheyney et al, published in 2014. They included nearly 17,000 people who were planning home birth at the start of labor. So unfortunately we cannot compare their findings to a comparison group in the hospital. But we do know the absolute risks. We know that when they excluded known lethal congenital anomalies, the rate of intrapartum stillbirth was 1.3 per 1000 births. And the rate of newborn death was about 0.76 per 1000 births. When they took higher risk women out of the sample, the rate of an intrapartum stillbirth, which was previously 1.3 per 1000, dropped to 0.85 per 1000. And when they only looked at people who were having a subsequent birth, a second, third or fourth baby vaginally, and they only had vaginal births before, the rate went down even lower. So it did show that if you’ve had a vaginal birth before, no prior caesarians, no other risk factors that the rates of intrapartum stillbirth, meaning having a stillbirth during labor were very low.

One of the reasons we can’t compare that to any hospital data is because hospitals in the US actually do not track intrapartum stillbirth. So we actually do not know what percentage of babies in a hospital birth die during labor Which is shocking that we don’t track that. But it’s when they mark a stillbirth on the certificate, the birth certificate, they’re not telling you if it was a stillbirth that happened weeks ago or a few days ago or during labor. So we can’t compare the home birth outcomes to the hospital outcomes.

There was a study in 2015 that a lot of people talked about when it came out by Snowden et al. And they found that when they combined stillbirths and newborn deaths from home births in Oregon, that the rate was three times higher than what they see in Ontario, Canada. So there is a consensus I would say, among researchers that home birth in the US is comparatively not as safe as Canada and other countries. And they think there’s three potential reasons for that. One is because the community birth system is not as well integrated with the healthcare system, as you said. For example, in Canada, midwives are trained in both hospital and home birth, and they’re actually required to do both.

So if you’re having a home birth with a midwife in Canada, and you need to transfer to the hospital because of postpartum hemorrhage, your midwife simply goes with you, admits you to the hospital and then continues caring for you in the hospital. So it’s more of a seamless transition rather than this upheaval where we have to go to the hospital, they don’t know I’m coming. They don’t know who I am. They don’t have my records. They don’t know who my midwife is. So there’s a lot more potential for difficulties with that transition from home to hospital in the US. Also in the US, we have more variation in the qualifications of birth attendants. So there’s no real consistency across the nation in terms of Certified Professional Midwives. So there’s some discussion about that. And more people in the US with higher risk factors tend to choose out of hospital births.

So you may have seen this as well, some people who are afraid of the hospitals in the US may choose home birth when they’re actually not the best candidates for home birth. So really, the safety when… Safe is a subjective word. But when we’re talking about safety in general, it depends on those three main things, what are your individual risk factors? Are you a good candidate for out of hospital birth? The person who’s going to be the best candidate is a healthy person who has never had a caesarian before, who’s having a subsequent vaginal birth, they’ve already had a vaginal birth, and their baby is a single baby and head first position at term. The risks are going to be slightly higher, if it’s your first baby.

And then the second thing that has to do with the safety is the qualification of the birth attendant. How was your midwife or birth attendant trained? What was their education like? And then third is how well is community birth integrated with your local hospital system? How easy is it to transfer to the hospital? Are there transfer guidelines in place that the hospital follows and that the midwives follow? How easy is it to get a physician referral at the end of pregnancy or during labor?

So those are the main things having to do with safety I would definitely recommend people check out homebirthsummit.org. This is a multidisciplinary group that met multiple times over the years and developed best practice guidelines for transfer from planned home birth to hospital and they have a model blueprint, it was a unique collaboration from physicians, midwives, nurses and consumers and you can obtain the guidelines for free, you just have to enter your email address. And they also have model transfer forms. So a form that a hospital could use when they’re receiving a transfer.

So one of the things I hope, as your state moves towards licensing, and hopefully eventually passes a bill to license Certified Professional Midwives is that they include something related to home transfers, the transfer process in the bill. So in Kentucky, we finally passed our bill in 2019, after many decades of advocacy, and it was really nice to see that basically, part of the bill, if I’m speaking correctly, had to do with creating a working group to decide on transfer guidelines so that everybody could be clear. The hospitals could be clear on what their responsibilities were, and the midwives would be clear on what their responsibilities were. So that is definitely a key part to increasing the safety.

Isis Rose:

Definitely, 100%.

Rebecca Dekker:

Well, Isis, thank you so much for coming on the podcast, sharing your story and for the advocacy work that you’re doing, and the podcasting that you’re doing. We really appreciate everything you’re doing to help families.

Isis Rose:

Thank you. Yes, I really appreciate you and this was really an honor, truly.

Rebecca Dekker:

And people can look for your podcast, the Homecoming Podcast, how else can they follow you on social media?

Isis Rose:

Sure. My Facebook, my personal doula Facebook is Isis, A as an apple, Rose, doula. And that’s where I’ll be advertising my services. So if you need a doula, I offer virtual services now. And yeah, I’m also on Instagram @homecomingpodcast.com and @isisarose_doula.

Rebecca Dekker:

Awesome. Thank you Isis so much for-

Isis Rose:

Thank you.

Rebecca Dekker:

… helping us.

Isis Rose:

Thank you. And can I also just add real quick?

Rebecca Dekker:

Yeah, go ahead.

Isis Rose:

I’m sorry. If you’re interested in being more involved in advocacy around licensure for Certified Professional Midwives, please follow ILFOM, Illinois Friends of Midwives on Facebook and you can also get more information at illinoismidwifery.org.

Rebecca Dekker:

Awesome. Thank you, Isis.

Isis Rose:

Thank you.

Rebecca Dekker:

Today’s podcast was brought to you by the community inside The Evidence Based Birth® professional membership. The free info that we provide to the public at evidencebasedbirth.com is supported by our professional membership program. Our members have access to a closed Facebook group and private community forums. I’m proud to say that this is an interprofessional group that includes doulas, childbirth educators, nurses, midwives, physicians, and other professionals from across the world. Each week I do a private Facebook Live with our members, where we dive into more discussion and I answer their questions about these podcast episodes. I’m in our private community every weekday answering questions and helping members brainstorm solutions to problems. To join our professional membership, visit ebbirth.com/membership.