Interview with Aliya Caler and Kara Schamell, founders of Birthing Adventures Midwifery, on their experiences supporting families through the homebirth midwifery model of care.
By Lee Burgess, President, Natural Resources Board of Directors
Welcome to the “Listen and Learn” Interview Series...part of our “It Takes a Village” Fundraising & Awareness Campaign!
Some expecting parents know from the get-go, and others realize at some point during pregnancy, that they want a different kind of birth experience — one that happens in their own homes. For a healthy, low-risk pregnancy, some birthing families opt to be surrounded by people they know and trust, in an environment that feels...well, like home!
This desire became even more prevalent when the COVID-19 pandemic hit and restrictions were placed on birthing people delivering in hospitals. More expecting families began to turn to the homebirth model of care.
We’re excited to talk to two homebirth midwives, Aliya Caler and Kara Schamell, who came together during the pandemic to support expecting families through Birthing Adventures Midwifery. They are shining a light on the homebirth midwifery model of care and the benefits available to expecting families.
In this episode, we discuss:
- Kara and Aliya’s backgrounds, work and creation of Birthing Adventures.
- Homebirth midwifery model of care vs. hospital births..
- The importance of postpartum care.
- Three things new and expecting families should know.
- Words to describe the homebirth experience.
- Learn more about homebirth options.
- How to connect with Kara and Aliya.
Lee Burgess: Welcome to the Natural Resources' It Takes a Village interview series. We are speaking to contributing members of the parenting and birth community here in San Francisco. Thank you so much for being with us, and for supporting Natural Resources as a community nonprofit, supporting new and expecting families.
My name is Lee Burgess, and I'm the president of the board of directors at Natural Resources. And we're talking with midwives. Yay. My favorite people. Some of my favorite people. And it is my pleasure to welcome Kara Schamell and Aliya Caler, two home birth midwives in the Bay Area. This is a topic so near and dear to my heart, because I had both of my children at home in San Francisco. So welcome, guys. Thanks for sharing some time with me today.
Kara Schamell: Thanks for having us.
Kara and Aliya’s Backgrounds, Work and Creation of Birthing Adventures.
Lee Burgess: So to get things kicked off, could you share a bit about your journeys to become midwives and start your practice, Birthing Adventures?
Aliya Caler: Yeah. Kara, do you want to start?
Kara Schamell: I'll kick us off. Yeah. So my journey to midwifery is quite winding, like many midwives will tell you when you ask them, "How did you get to be a midwife?" The seed was planted for me, probably when I was a kiddo. My mom always told me about my own birth story and my brother's birth story. And I was always interested in births. And I actually went into music, after graduating from college with an anthropology degree.
And it was through my first gig post-college. I was reading a book for fun, historical nonfiction, called The Red Tent. And I can't tell you what that book was about. I can only tell you that it talked about midwives. And I was like, "Wait, what? Midwives, who are they? Are they extinct? Do they even exist anymore?" And so that book was really the impetus for me to deep-dive on a total research journey with wanting to understand the nuts and bolts of the maternity care system in the US.
And once I became educated on that big whopper, I was like, "Doesn't sound like we're doing too well with maternity care outcomes in the US. And I can't just go on with my life, playing music and working in the nonprofit world. I've got to do something." And so that was the impetus for me to become a doula.
So I started doulaing in 2010 and working in the hospitals mostly, as a doula. And it was really through the experience of working in the hospital setting that I was like, "Okay, I want to do more. I want to be more than just an emotional support. I want to be a provider."
And I decided on home birth midwifery as my track, because again, doula experience, I saw that advocacy in the hospital setting was an uphill battle. And I wanted to work in a practice model where my clients had a voice, and they didn't have to fight to have a voice in that space. And it would be a relationship-based care model. So yeah, big story there, but that's the long and short of it, in a nutshell.
Lee Burgess: That's great. Aliya, what about you?
Aliya Caler: Well, I share a little bit about this on our Instagram page, but my journey to midwifery was largely about letting go about what I had thought my career was going to be like, and opening my heart to what the universe had in store for me.
I started my career out in the field of health disparities, disease prevention, health promotion. I got a Master's in Public Health. I was writing public health law in Massachusetts. And really felt that calling that you hear people talk about, and was definitely scared of it, but really had been searching for the past eight years to find that love of my work. And it just wasn't there. And I kept being in roles where I had to cut my heart off from my head, in order to survive in the work and be successful.
And so I just had this feeling that I was supposed to be a midwife. Like Kara, interestingly, I was in Massachusetts at the time, which is where Kara was when she became a doula. I left my role in the Massachusetts state legislature, became a doula, started attending births.
And when I attended my first home birth in Harlem, I was like, "Yep, this is it." I'm in a kitchen with a couple I've never met before. A home birth midwife had just called me and said, "Can you help support this couple? They need a doula."
They're in their birth tub in the kitchen, and I'm alone with them. I literally felt at home. And so I had been dancing around the idea of like, am I really going to go back to school and do this? And at that night, I knew I was. And I decided to become a nurse midwife, because I also wanted to provide abortion care.
So even though I knew I wanted to be a home birth midwife, then I had to really say, "Oh God, I'm going to go learn how to be a midwife in the hospital setting, so I can have this credential that will allow me to legally provide abortion in the United States." So that was my journey, very winding.
And then Kara and I met in the pandemic, and my soul had been putting out there that I wanted to find a partner. And we met early on in the pandemic, and started attending births together. And it just clicked. It worked. And so we started working together a year ago, and it's just been a great joy, one of the many joys of my life.
Kara Schamell: That's awesome.
Lee Burgess: Yay for joining in the pandemic.
Kara Schamell: Yeah.
Lee Burgess: Because people kept having babies.
Kara Schamell: People never stop having babies, which was one of the reasons to move to midwifery, because being in the nonprofit arts world before midwifing, I was like, "Wait, this funding gets cut and nonprofit arts gets deprioritized, but people always have babies." Truly.
Yeah, I had previously practiced in a home birth practice in the Boston area with the partner. And when I came to San Francisco, I actually took a break from on-call work to help launch a telehealth practice for women's midlife health. And that was really fun.
And then I came back to birth work at the start of the pandemic, when it just was very clear that unprecedented numbers of families were looking to birth in the community, in their homes, in free-standing birth centers outside of the hospital. So that felt just like getting called back in onto the front lines, to serve people who didn't want to go into the hospitals.
Homebirth Midwifery Model of Care vs. Hospital Births
Lee Burgess: All right. I want to dive into talking a little bit about home birth. So what does care with a home birth midwife, how does it compare with what happens in the hospital? Since I know, you both have also worked in a hospital setting.
Aliya Caler: I'll say a little bit, Kara, and then you can chime in, because there's so many differences and there's some similarities as well. So you really want to think about a pregnancy, preconception, actually what does care look like during the pregnancy? What does care look like when you're having the baby? And then what does care look like in the postpartum period?
And I'd say, just broad strokes in care, you can get into the nitty gritty, but how the care compares is care with a midwife, a home birth midwife specifically, is really centered on you as an individual, first and foremost.
So most of us care for you inside your own home. And the prenatal visits, while on the same schedule as any care provider you'll find in the United States, in terms of frequency of visits, they're much longer. So they're anywhere from 45 minutes to an hour and 15, an hour and a half, depending on what's going on with you. So there's a lot more face time.
There's a lot more education, or what a lot of people like to call informed consent. But what we like to call is just giving you all the facts about whatever decision is being made about your care in the prenatal period, to allow you and your partner to make decisions that actually feel good for you.
And then really honoring you as a whole person, heart and mind. And really, midwifery care is also looking at you and baby as one. We don't separate the two of you. So I'd say those are some of the differences.
Kara Schamell: Yeah. Things that I like to highlight, in terms of the midwifery model of care, specifically home birth versus the hospital, is that our model is based entirely on collaborative decision making.
So it's not like you're just being moved through this system where they're like, "Oh, okay, you're 28 weeks, this is what we're doing. You're 36 weeks, this is what we're doing." Everything with us is, "Hey, you're approaching 28 weeks. These are your options for what we can do. Let's talk about it, give you an opportunity to ask questions, discuss it as a group, and you make the choice."
So it's a whole different dynamic with the way we make decisions. And in that spirit, I'd say it's a much more empowering model of care, where people are active participants and they're not simply along for the ride. And then the other thing I'd call out, that's a big difference between hospital-based care and home birth care, it's so deeply relationship built. The entire cornerstone is pinned on the relationship you have with your care providers.
Come your birthing day, you will know who is walking into your home to receive your baby and to support you. And I don't know if many people can say that about their hospital experiences, walking in, in labor, and actually recognizing the care provider who's going to take care of you that day.
The Importance of Postpartum Care.
Lee Burgess: Home birth midwives provide a different model of care postpartum than the typical Western medical model. So can you share a little bit about what postpartum care is like with a home birth midwife? And do you think it leads to better maternal outcomes?
Kara Schamell: I would love to take this one, because this is actually my passion in midwifery care, absolute passion. So I always say, when we're meeting with families who are exploring home birth, postpartum care is where home birth midwives shine. It is the biggest part of the offering that's also not acknowledged. There's so much emphasis on baby arriving, that we don't tend to think in our culture about, well, what happens after baby is here?
In the home birth model, it's actual comprehensive postpartum care. So in a hospital, you're there being observed for a couple days, and then they send you home. That's it. They're like, "Good luck. Your baby's going to be seen by the pediatrician, but call us and maybe get through to us, if something is wrong." I wouldn't consider that postpartum care at all, just 48 hours of observing and interrupted sleep in a clinical, loud, bright lights scenario.
Versus home birth, where your midwives stay for four to six hours after the baby is born, to make sure that everyone is stable and healthy and normal. And then we tuck you into bed, and we come back the very next day. We prep you with a sheet of instructions for like, this is everything that's healthy and normal in the first 24 hours with your little one. We'll be back in a day. We run the standard tests at the day one visit. We do a screen for cardiac anomalies, and we do the newborn metabolic screen on day one to make sure that baby's okay.
We return on day three. And then again, either day five, six or seven. So we're looking at a minimum of three comprehensive checkups, just in the first week. And this is usually the timeframe when new families have the majority of their questions. The folks who had no questions prenatally, blow up our phones in the postpartum. Every midwife knows. But yeah, minimum three visits in the first week.
A lot of what we're doing in that first week is breastfeeding support as well. So I like to include, in terms of talking about maternal outcomes, I think that a measure that is not paid attention to enough in the mainstream is breastfeeding success outcomes. And we know it just firsthand, as home birth midwives, the vast majority, 99% of our clients are successfully breastfeeding at six months and up. So that's a huge, huge, huge improvement in maternal outcomes.
But yeah, every visit, so we have the first three visits in the first week. And then we see you again, week two, week four, and week six. It's at least an hour, each of those visits. We're checking in on mom's bleeding, making sure that her uterus is coming down nicely, and her blood pressure is healthy.
Again, in terms of monitoring for postnatal complications, the fact that we are coming to your home and taking your blood pressure, and your pulse, and your temp, and checking in on you, and that's not happening in the hospital-based model when women are at a high risk of postnatal complications, that is a disservice to all birthing people.
The fact that you would just be on your own, and have to reach out to them to say, "I'm not feeling quite well." And then have to go into a clinical setting to get your blood pressure checked. I don't understand why home-based care isn't the gold standard of care, where someone's just coming and proactively checking your blood pressure.
Aliya Caler: In other countries, it is.
Kara Schamell: It is. Yeah. That's a good point, Aliya.
Lee Burgess: Yeah. And I think there's that also, if you have a relationship with someone, and I know other midwives have shared this with me too, if you don't look like you're okay, then I think there's that gut reaction of like, "You look pale, your eyes are bloodshot."
Aliya Caler: I mean, I'd say that as home birth midwives, we're always continually assessing you in the prenatal period, at birth, and in the postpartum, are you still a good candidate for home care?
And most of the negative maternal outcomes we see in the United States are occurring in the postpartum period. That's when we're losing moms in this country, because nobody's there to monitor them.
But another piece, I think, about postpartum care is the fact that home birth clients feel held. The transition after having a baby, the fourth trimester we've started to hear about, that's really true. And so you're having somebody that's still with you. You aren't just being cast out after you've just gone through.
You've been totally cracked open emotionally, and spiritually, and physically, but to still feel cared for, even mamas that transfer, that get to come home and still feel cared for by the same people, that's changing their relationship to this huge change in their life. And that's why we aren't seeing the rates of postpartum depression in the home birth community, postpartum anxiety, because you're still being held in that same way that you were being emotionally held in the prenatal period.
Words to Describe the Homebirth Experience
Lee Burgess: So I would describe my home birth experiences as safe, serious, and joyful. What were some words you guys would use to describe home births that you see are some typical outcomes for your clients?
Aliya Caler: Words that I would use would be self-empowering, rights of passage, and sacred, I think.
Lee Burgess: I love that.
Aliya Caler: Yeah. And maybe a little bit of surprise, or something like that. Surprise.
Kara Schamell: I mean, it's no coincidence that our practice is called Birthing Adventures. So I think adventure is a word that comes to mind. For me also, the words, the big ones are intuitive and physiologic. It's just something your body intuitively knows what to do. And also empowering. I'm going to second Aliya's self-empowering.
Learn More about Homebirth Options
Lee Burgess: So if someone is interested in home birth, what would be the best way you would recommend that they educate themselves about their birth options generally, and then meeting different providers?
Kara Schamell: Living in the age of the internet is an incredible gift. There are so many things to access online. I think a great place is to start would honestly be, if you're coming at this with very little knowledge, which most people in the US are, once they get pregnant, then it's like, "Oh, what now?"
Go to doulas and midwives' websites and visit their resources page. Most doulas and midwives have extensive resources pages with books, and movies, and articles, and other websites where you can educate yourself. I think that's always a good starting point.
And then to call out some specific things, obviously Natural Resources. Incredible offerings, incredible classes. The Meet the Midwives whole format of getting to actually have a meeting with a midwife, to learn about home birth in particular. That's always helpful.
And also Evidence Based Birth is a good resource too, that everyone should know about. It's run by Rebecca Dekker, who's a nurse and a PhD researcher who just knows everything about perinatal, everything.
Aliya Caler: Home Birth Midwives in San Francisco offer 40-minute free consults, where you can pick their brains about what their home birth practice looks like.
Kara Schamell: And childbirth education classes, even on the early side of pregnancy, can be helpful. Once you're into the second trimester, taking a childbirth education course to learn about the process of what's happening in your body in pregnancy and birth, that will create a more rich landscape to explore. You’ll get to ask yourself, “Who do I trust most to support me in this process?” Versus if it's totally unknown, you don't really know what you're looking for in a provider.
Lee Burgess: And I think that's a good point is that you don't always have to know, you could switch providers. I think a lot of people don't even realize that that's an option.
Kara Schamell: You can change at any point.
Aliya Caler: I think also looking at what's going on in other countries. If you're a healthy person giving birth in Canada or England, you're automatically seen by a midwife. And then if something occurs in your pregnancy, you are referred to an OB-GYN, OB-GYN or a maternal fetal medicine doctor.
But just do a little bit of research about what's happening. There's plenty of documentaries, Why Not Home? The Business of Being Born. There's The Farm in the United States, while controversial for a lot of different reasons, does provide you a different framework for what's happening, what birth can be like. And there's so many podcasts and there's so many books. The woman that wrote Cribsheet.
Lee Burgess: Emily Oster.
Aliya Caler: Yeah, she's great. She has a few books out that highlight different points of childhood. Ones for pregnancy, ones for the little guys, and then ones for school-aged kids.
Lee Burgess: She didn't love home birth in her Expecting Better book, which I read when I was pregnant.
Aliya Caler: Most people don't. Let's be honest. ACOG, for example, doesn't support home birth outright. So the OB-GYNs in the United States aren't willing to get behind home birth. And there's only about 2% of folks in the United States that are giving birth at home. And there's a long history to explain why that is, which we probably don't have time for in this interview.
There's plenty of doctors in San Francisco that are supportive though, which is one of the unique things about the San Francisco, Bay Area. Is that the community midwives, we have a good relationship with hospitals and providers here, in comparison to many other places in the country.
Lee Burgess: I think it's just really about being able to listen to your gut, and who do you want guiding you through this really sticky, crazy experience? Because you're going to have moments where you're not sure what to do, and you’ve got to look into somebody's face and have them talk to you about it.
To me, that was kind of it. I was like, "Other than my partner who doesn't have much more information than I do, who am I going to look to for guidance?" And these midwifery relationships, I just can't say enough about how important they have been in my life, and continue to be, even though I'm done having babies. But it is unlike any other relationship I've had.
How to Connect with Kara and Aliya.
Lee Burgess: If folks want to know more about your practice, how can they learn more about you and what you do?
Kara Schamell: So you can visit our website, birthingadventures.com. There's a very clear button that says "Schedule," where you can submit a form with your information, if you want to schedule, as Aliya said, a free consultation to learn more about us. And there's also just lots of information on our website as well.
Aliya Caler: We have a collection of midwives. We have the San Francisco Home Birth Collective. We have a web page also, where you can see the different practitioners. And I think Instagram is nice if you do use that app, because it allows you to see the story of what our practice is.
Lee Burgess: Well, thank you guys for taking time today to meet with me, and thank you to everyone who has been watching and attending this installment of the It Takes a Village interview series by Natural Resources. You can find this and additional information on our website at naturalresources-sf.com.
And we hope you'll learn more and support. We'll see you next time.