Birth Matters Podcast, Ep 117 - Is Homebirth Safe? w/ Sorayya Kassamali Rickicki

Our guest today is Sorayya Kassamali Rickicki, a New York City-based home birth midwife whose practice is called Taarab Midwifery. Sorayya shares her journey from being a birth doula to becoming a midwife, inspired by her own physiologic, unmedicated births. The conversation emphasizes the importance of respectful care, the role of midwives in providing individualized and consent-based care, and debunks common misconceptions about the safety and financial accessibility of home births. Sorayya also highlights the differences between home and hospital births, particularly focusing on maternal and neonatal safety, and the benefits of having midwife-led postpartum care. Finally, she touches upon her plans to contribute to maternal health in Tanzania through volunteering at a health clinic.

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Episode Topics:

  • Introduction and Guest Welcome

  • Journey to Midwifery

  • Home Birth Praise and Client Experiences

  • Challenges and Misconceptions of Home Birth

  • Safety of Home Birth

  • Handling Emergencies During Home Birth

  • Postpartum Care and Support

  • Trauma-Informed and Collaborative Care

  • Personal Stories and Practice Philosophy

  • International Work and Future Plans

  • Final Thoughts and How to Get in Touch with Sorayya

Interview Transcript

Lisa: Welcome. Sorayya it's so good to meet with you. 

Sorayya: Thank you. It's really lovely to be here. 

Lisa: So would you please first just share a little bit about yourself, about what brought you to this work? 

Sorayya: Yeah, that's a big question. 

Lisa: It's a very big question. And I can break it down if that's helpful. What brought you to this work, maybe? 

Journey to Midwifery

Sorayya: Yeah, that sounds easier. So what brought me to this work? Definitely the births of my babies. So I have three children and they were all natural,unmedicated births, and really they were the impetus to bring me to birth work, and then eventually midwifery. I started as a birth doula, and I saw a lot of birth, not as a clinician, but as someone who just supported people through the process. And, I felt like I really wanted to support people in the postpartum period as well.

So I decided to go on to do my lactation consultant certification, so I could support people through pregnancy and then postpartum and lactation. And then through that journey, I really just, I got the calling and I really felt drawn to becoming a midwife, and taking on that clinical responsibility and really, serving people throughout the city, through conception, pregnancy, birth and postpartum. 

So I went to midwifery school, graduated in 2019 and just basically went straight into home birth. I thought, the trajectory for so many midwives is to work in a hospital first and then go into the home birth, but my heart was really in home birth. I had home births myself and I just felt like in terms of supporting people, that was the only way that I could do it with full autonomy and not having to answer to a system that is kind of broken.

So that's what happened. I jumped right into it and just really love the work that I do. 

Home Birth Praise and Client Experiences

Lisa: And I'll just mention that you have been praised before on my podcast, as listeners, depending on what they've listened to might or might not know, Hannah shared about her beautiful home birth with you, episode 92.

And then Sheyda, at the time we're recording this, that hasn't aired yet, so I can't say what episode it is. Although when I record the intro outro, maybe I'll be able to mention that. And hopefully they'll be back to back, but it's always so wonderful to learn about really respectful care providers, who are really improving outcomes.

through the power of storytelling. So it's been really encouraging to get to know you a little bit through those clients of mine who just were over the moon about their birth experiences. 

Sorayya: Yeah. that's so nice to hear and I just, I feel like people are really thirsty for that kind of care, you know?

Lisa: Absolutely. 

Sorayya: It's really lacking in our system and that's why I became a midwife, a home birth midwife, and I think that's why people come to home birth because they really want to have some more agency in their healthcare.

Challenges and Misconceptions of Home Birth

Lisa: Yeah. And it's all too uncommon when it's someone's first time, at least that's been in my experience, in doing this work that, because we grow up well, for those of us who've grown up in this culture, we've grown up in this doctor knows best, like everybody gives birth in a hospital, what, why would we think about anything else?

And so there's this fear of the unknown, I think, a lot. And so it's been encouraging for the few of my clients who have chosen home birth for their first, without that fear, I mean, not that there's none, but, just really being so convinced, which you need to be in order for home birth to be a safe choice. It's been encouraging to see for those clients,just how amazing it can be.

A lot of people, on the other hand, learn that the hard way through their first about that system and all the challenges that we face, especially people of color, even more so. But yeah, a lot of people after they've gone through it, then are like, okay, now I see, and now I think I'm definitely going to explore home birth.

Do you find that a lot of the people you work with are? Not primips? 

Sorayya: Not necessarily. That's interesting because I definitely get a lot of 1st time or 2nd time, 3rd time, so I don't feel like there's an imbalance in that way. I find that people who are coming to me are already very knowledgeable about their choices and the system.

It would be so nice to find the people who aren't knowledgeable about it so that they can understand that there are options in birth and birth setting. And I think that it's the ones who are basically like, Oh, I'm pregnant, let me go to the obstetrician, get a sonogram, get all these tests, then keep going.

The obstetrician doesn't really care about me or really ask me many questions, but I'll keep going to that person. And those are the people that I feel like are lost in this and I wish that we could, be like, no, this is an option too. I think people think also there's a barrier for home birth in terms of payment, like, how much you have to pay for it. Many people come to me think that home birth is basically out of pocket. But the reality is we do accept health insurance and it definitely depends on your plan and on your deductible and all the other stuff, but, for the most part, home birth is something that is accessible to even people with Medicaid. So it would be really wonderful to find, those people and reach out to them and let them know that this is an option, especially the black and brown women who are, rightfully so, afraid of this system and who want to step outside of that system and find someone who's really going to care for them.

Lisa: Absolutely. Thank you so much for bringing up the financial aspect because you're absolutely right. That and safety are the two arguments I hear against the whole idea of home birth, but I would also point out that so many people who have a hospital birth get these unexpected bills that often end up adding up to more than a home birth would have cost, even if the home birth had to be out of pocket. So check with your insurance, be sure you understand the coverage, what the coverage includes, no matter where you're giving birth and just to know that aspect. 

Sorayya: And if you have a deductible, you probably have that for hospital based care as well. it just depends. I think it depends on everyone's priorities, as long as they have the knowledge about home birth, then I think it becomes more about choice. And, always speaking with a home birth midwife, even if you're not completely sold on the idea, just having an idea of what the care looks like and speaking to their biller. And, I think it could just be like another one of those interviews that you do with your healthcare provider. 

Safety of Home Birth

Lisa: Yeah, absolutely. So since we're on the track of objections to home birth, can you talk a little bit about the whole topic, when somebody asks you, is home birth safe? What would you say to them?

Sorayya: Yeah, I've thought about that question. I've definitely been asked it many times before. And I just, I feel like it's the wrong question to ask. We never say, is hospital birth safe? It just doesn't come up. The default is that it is, right? But that's not the whole truth.I think hospital birth is safe for some people, and not for others, and I think the same of home birth. Obviously there are statistics showing the safety of home birth. They're not so great, those statistics. But the studies are very flawed. There are no real large scale studies. I think that we need to do more investigation about that, especially with licensed providers who have experience at home. Weeding that out from maybe more lay midwives or unassisted births or things like that. So is home birth safe? I think it's more, is home birth safe for you? Is it safe for you and your family? And that's definitely something that I go over in a consultation. I am constantly assessing the safety of home birth for you and your baby throughout the pregnancy in the labor process. It's just a constant reevaluation of the safety of home birth for you because it's important for me as a midwife to participate in a low risk pregnancy and a low risk labor and birth.

Obviously, there are some people who have high risk features who are adamant about having a home birth or who would not go to a hospital, even if they were given the choice. Those are kind of things that we, as home birth midwives, we evaluate individually, but for the most part, our births are low risk.

And,if it's your 1st time, there's a little bit more risk in the process, both home and hospital. And, another thing I always say to people in consultations is, what risks are you willing to take because each setting comes with their own set of risks. Walking into a hospital, right away, you're getting surveillance that is actually not evidence based. Continuous fetal monitoring is not something that ACOG recommends for low risk pregnancies. So already, you're in the system where medicine and liability are like, the lines are blurred. So is it safe? That shows that you have a higher risk of surgical birth.

So I think it's a different set of risks. It's not safe or not safe. It's more, what is the right place for you in that moment in time. And the good thing about it is that you can change your mind. If things kind of change or your health takes a turn or the health of the baby takes a turn, a transfer can be done.

So I guess I'd love to see that question kind of, more individualized, like it's more about how home birth can serve you. 

Handling Emergencies During Home Birth

Lisa: I love your answer. That was so interesting and different from any answer I've ever heard. So if someone is saying, I'm low risk, but if something arises, isn't everything an emergency? What would be the things you'd share on that?

Sorayya: No, and there's a difference between pregnancy, labor, and after birth, but most things that we encounter are not true emergencies. So most transfers to a hospital are not true emergencies. They are definitely times where we see interesting or ominous clinical signs compounding on each other, and we want more information. Maybe because these things are happening, we do need a continuous fetal monitoring or, maybe your blood pressure is creeping up, and we do need labs to see if there's any risk of preeclampsia. So there are things that we have to take into account to keep you safe and low risk, but most things are not true emergencies. 

Lisa: Yeah. Yeah. And I think, just to echo what you're saying, if I'm hearing you correctly, is someone else framed it like this, that the baby and the mother, the parent are telling us a story.

We're getting a narrative in the different things that we're monitoring, whether that's in pregnancy or in labor, and because we have that narrative, we have ways of almost always knowing way before it becomes a dire emergency that, okay, maybe something's up here that we need to address.

And I just found that really reassuring when I was choosing home birth with my second baby, just to realize, to sit with that idea that whenever there is a home birth transfer, it's almost never an emergency emergency, like we have plenty of time. And here in New York City, I know this is not true everywhere, but in New York City, We have hospitals everywhere.

So we can get somewhere if we really need to in an emergency quite quickly. 

Sorayya: Yeah. And, it's very true. That's why we're there, right? Otherwise you could just have your baby on your own, but to have someone, a clinical person watching what's going on and seeing if anything deviates from normal,is just a security net for you. Usually birth works, right?

So the best birth is just sitting back as a midwife and watching it all unfold, and it's not textbook and it's not necessarily what they want to see in the hospital, but it is an unfolding of process. 

Lisa: So then I do want to linger if it's okay with you a little bit longer on the safety thing, just because it's a big question for people who are considering home birth and whether or not they're familiar with it. So in pregnancy, what are some of the things that would cause someone to risk out and need a different kind of birth setting and care, would need hospital care, OB care? 

Sorayya: Yeah. Probably the biggest thing is high blood pressure. So if you are normally normotensive, and then your blood pressure really gets into abnormal ranges, and it's chronic, it's something that's continuing to happen, it's not like, oh, you were nervous one day or something. That's not something you want to deal with at home because it's a risk to you and also to the baby. So I would say high blood pressure, preeclampsia, 

Things like diabetes that needs insulin. So I have a lot of gestational diabetics in my practice, but if they're managed with diet and exercise, then your risks of the obstetric risk factors are pretty much non-existent. But if you do need insulin, that is something that's much better managed in the hospital setting. Things like cholestasis, which is something that can really be detrimental for the baby.

There's so many things in birth, like going through midwifery school and reading papers and articles and studies on things, you can really get into all of the nitty gritty of the things that can happen. The things that are happening to your body, the increased blood, like all this stuff changes your body and can create problems.

So pregnancy, birth, it's not without risk in and of itself, there are changes that happen. A lot of things can happen, but they're more rare, I would say that these kinds of things that I just brought up are a little bit more common. Most people that start off low risk, in my practice, stay low risk.

Sometimes in the delivery or labor things can shift around. But in terms of prenatally, I would say most people stay low risk.

Lisa: Thank you so much. Yeah, I definitely wanted to bring up the gestational diabetes thing because I'm in discussion with a client who's giving birth in a hospital setting right now. And so many providers, even with a well managed case where they don't have to be on insulin, they'll start to talk about induction.

And it's not always evidence based, especially like you're saying, if they don't have to be on insulin. But it's just challenging to help clients navigate that with their provider.

Sorayya: It is. 

Lisa: They're like, what, why are you talking about induction suddenly? Like it totally blind sided them, and they had just been told a week before that it was well managed, that it's no concern whatsoever. And then the OB was like, what are you talking about? We have to be on insulin. It was like, wait, what? And you have to be induced. Yeah, that's challenging. 

Sorayya: The lack of communication and transparency in that whole process, I think it is really harmful.

That also happened to a client who risked out of the care, the baby had some issues, so wanted to go with an OB practice, but then when she was with the OB practice, she realized that this issue was not necessarily harmful, she could continue a home birth, but she noticed the care in the hospital was just so poor that when she got gestational diabetes, they never even told her.

She saw it on her own, on her lab portal, but they never even told her about it. And so she just came back to the practice and we managed the gestational diabetes with diet and exercise.But she was just so confused as to why they wouldn't even say that she had it, let alone manage it, so there's a lot of stories like that that are really, in this country that has so much money and it's so developed, but the care, maternal care is really, it's not very good. 

Lisa: Blaming it on the patriarchy. Yeah.

Sorayya: But there are other places, I did some training observation in the UK during my midwifery studies and they have problems, obviously, but the NHS has, like a cohesive community and hospital birth system that, it works, it functions in a way that ours really just doesn't.

Lisa: That's a great point, yeah. Excellent point. Ah, so much work to do And you're doing it and thank you so much that you're doing it and you're being part of the change.

So then in pregnancy, when you're attending a birth that's in someone's home, what are some of the things that can happen that might be otherwise perceived as scary, but that you as an expert midwife are very equipped to handle? Because a lot of people are like, oh, if there's any emergency, they're like, oh, no, but I know that I know.

And I would love for you to share what are those different safety, I don't know, equipment or things that can arise. Just any of those details would be really helpful. 

Sorayya: Yeah. And you're talking about the delivery, right? 

Lisa: During the labor, yep. And the delivery, after birth. 

Sorayya: Yeah. Like I said, there's so many obstetric complications that can come up and, are rare and whatever, I would say the three bigger, more common obstetric complications that we see in home birth and in birth in general, are, postpartum hemorrhage, shoulder dystocia and,neonatal resuscitation, the need for that. So all of those things are definitely something that we're trained in and come equipped to handle. 

In the case of postpartum hemorrhage, which is, especially for people, multips, who have had 3 or 4 or 5 babies, that can be a real risk factor for them to have a hemorrhage. As a home birth midwife, I come with many different medications and they are the same medications that you would get in the hospital. Not only techniques like excavating the uterus and getting clots out, or, compression of the uterus to make sure the bleeding stops, there are definitely techniques we can do with our hands, but also medication. Pitocin is like the go to medication, cytotec or misoprostol, methergine is another one. We have some medications to put in IVs, IV fluids are always available. I always, if someone's at a higher risk, we might even put access or Hep Lock in just to have access to that postpartum if that's what the client desires.

But usually one of those medications helps with the hemorrhage and everybody's okay to stay at home. It's very rare if that turns into an emergency to go to the hospital. And if it does, it's usually because the client feels weak or feels like they want blood. Because if you lose a lot of blood, you can feel really weak and not be able to hold a baby as well as you would like to. So some clients might opt for a hospital transfer to get some blood. But most of the cases are just managed at home. 

For shoulder dystocia, that's one of the risks for gestational diabetes that's untreated. A big baby or a baby who's developing fat along the shoulder area, so that when the baby is navigating the pelvis, the shoulder gets stuck and in the hospital, it's like this huge, everybody comes in and it's this huge emergency and it's very dramatic. It is an emergency for sure. It's a true emergency. But at home, I will say that we see a bit less of that. The reason for that is that at home, people when they're pushing their babies out, they're able to be in whatever position they want to be in.

So if you're stuck on a bed in a supine laying down position and your pelvis is smushed up and your legs are up and the pelvis is not able to open at its full capacity, then that's what we call bed dystocia. And that happens much more often in a hospital because they're not allowed to necessarily move around, especially if there's an epidural.

I would say that we see that a little bit less, but there are definitely maneuvers that we are trained to do right away to manage whatever issue is happening in terms of the shoulder being stuck. I will say that most of the time if that's happening, you just get on your hands and knees, or you just bring 1 knee forward.

Lisa: And I was going to ask about the Gaskin maneuver, yeah. 

Sorayya: Yeah, yeah. And then that's it, and it's pretty unusual to have to do a series of maneuvers and not being successful at that. That's another thing that we're trained in managing. 

And then for neonatal resuscitation, it's actually a certification that we have to get every couple of years. So we're constantly training. And even within those 2 years, lots of us will do drills and make sure that we're keeping our skills nice and honed so that when a baby does need some breath, we know how to do that. I've definitely given babies breath, like usually it's just a few breaths that they need to kind of clear their lungs and open up.

Especially at home, the transition can be very subtle for babies. It's not super dramatic or cold, especially in the water. If you're having a water birth, that transition can be very seamless for the baby where you're just kind of like, no, no, you have to breathe now. 

Lisa: I'm out already? It was so gentle. Yeah. Not expecting that cry immediately. 

Sorayya: Yeah, I think that plays into it a lot too. And, if you see a baby who needs help, you just give breath and that usually does the trick. There are some cases where maybe, there were complications in the labor that caused a little bit more issues, where more breaths need to be given for a longer period of time.

But again, this is something that we're trained to do. It's not super unusual. And it's something I definitely go over in the final prenatal visits with my families so that they can see like the ambu bag, they can see the setup, they understand that this might just be normal, right? 

Lisa: Yeah, a bunch of the doulas in my collective and I did the neonatal resuscitation training with Karen Strange. Is that who you have trained with? I just love the vast difference between that and just the beauty and expertise that midwives have in observing the range of normal in baby adjusting to life outside the womb in those moments, versus being so super fast in hospitals, so much to intervene when that could actually cause harm, and often isn't necessary. So I just really love that. 

Sorayya: She's so special in that way. She talks about how babies are feeling, talking to babies, they're real. 

Lisa: Treat them like a human,

Sorayya: They're real humans, they have feelings. 

So she's just so amazing at doing that. But yeah, I think, that whole culture of get the towel on, stimulate the baby, get the baby crying. Like it can be pretty traumatizing for the baby. 

Lisa: Yeah, absolutely. And, I heard a midwife one time, I think on a podcast say that she talks to her clients prenatally about the possibility of needing a few breaths to help baby with that, because in her experience, it was like one in 10 babies needs that.

I don't know if that's been your experience or not. I didn't look up the statistic or if it was just her anecdotal experience, but I thought that was really interesting. Do you have any thoughts on striking the balance with your clients? And maybe it's very individualized and that would be beautiful, if so, but striking that balance between, like, how much fear are we causing this person by telling them things that are perceived as scary versus not giving them that anticipatory guidance. Do you have any thoughts that you would want to share on that?

Sorayya: For that particular issue, I think it's actually very beneficial. I've never had anyone say, I wish you didn't tell me about that, cause now I'm scared. No, I've never had that. Maybe it's the way you present it, and I think that is reassuring. It's kind of like, there's not really a problem, especially for just inhalation breaths.

It's not really a problem, it's just assisting baby, right? Baby will probably come around. Most of those babies, not all of them, but most of them will come around, but we're helping them. So I think giving that reassurance is good. And then the ones who have gotten that reassurance and then see it in the actual delivery are very grateful because they're like, I would have been really freaked out if you didn't tell me about that. 

Lisa: Yeah, to me, to my thinking, anticipatory guidance is so valuable. And, when I'm teaching birth class and most of my clients are giving birth in a hospital setting, just talking about the benefit of having a doula there with you, because they have a really good sense of what's about to go down, and okay, that doctor's about to come in and they can explain to them, okay, I think this is probably what they're going to come in and say to help them feel a little more prepared on how they'd like to respond and, thinking through things that, they might feel too pressured once they're in the room. That makes so much sense that you've had clients who are like, Oh, that, that was much less scary, cause I already knew that was a possibility. 

Sorayya: Yeah. And then, it's a very emotional time. I find that partners are a little bit more anxious, obviously before the birth, but even during the birth in a way that the birthing person is really just chilled out. If the baby needs breath, okay, the baby needs breath. I'm here for it. And it's the partner that's just a little bit more riled up. So, I think education is key in the grand scheme of things. So I think the more information you get, I think, the better it is, especially if it's coming from a provider that you trust.

Lisa: Thank you. Is there anything more on the safety topic for during labor,and in the immediate right after, before I ask him a little bit about postpartum? 

Sorayya: I think it's really important to have a birth team, and I'm talking about more family members, partners, obviously your doula's on board, but, having a birth team that really supports home birth. Because if you have anyone in there who's doubting it or doubting your abilities, it can really change the dynamic in the process, but it can also influence how your labor is going to play out. Because if I have people who are very fearful of birth, then, I've had people who want to transfer when something is very not risky. It just, for the provider, it just makes you feel like, okay, these people have a very low tolerance for how birth is going to play out. So for people who are choosing home birth, only having people in the room who support that and that you feel that this is the right choice for you, that really plays into the whole safety piece too. 

Lisa: I'm so glad you shared that, yeah. Yeah, choice of birth team in any birth setting, super, super important. Need Zen in the room or else it will slow down our labor and possibly stop it. 

Can just create a negative dynamic, too. Yeah. Who wants that? No, thanks. Not on this day of becoming a parent or growing our family. Can you explain a little bit about,what is your standard of care in postpartum in terms of how frequently are you in touch? What does that look like? Because I love to always highlight this compared to the atrocious model of hospital care where they're like, bye one to three days after. And they're like, see you in six weeks. Like, really? 

Sorayya: Yeah, that's awful. That is such a gap in our system, and it's something I had thought about in my doula days and why I wanted to get into like lactation and wanted to fill that gap in some way. This observation training that I had in the UK during my midwifery studies was really profound because it opened the door to the different ways of doing things.

And there they are visited by midwives, community workers, nurses, like they're constantly being cared for throughout that six weeks. 

Lisa: As it should be. 

Sorayya: As it should be. 

Lisa: Beautiful. 

Postpartum Care and Support

Sorayya: And it's so important. Postpartum is like a big passion of mine. I see you on day 2, obviously that day is about some exams that we do for the baby, making sure you're recovering, if you had sutures looking at those, and then, day 4, I want to see you again. 2 weeks after the birth, 4 weeks, and then finally at 6 weeks. So I do have a lot of visits built in postpartum to wean you off of the care. I mean, we've seen each other so much prenatally, and at the end, we're seeing either once a week or biweekly.

So throughout all of that, you can call me 24 hours a day. It's just, you have access to your provider when you have questions and some people start obviously with a lot of lactation issues, if that's their journey, mental health issues definitely pop up throughout that time period.

Just basic newborn care, 1st time parents not knowing if their baby's breathing and just having access to your provider, I think is just so invaluable in that time period. 

Lisa: Yeah, and different from the kind of support we're getting from a pediatrician, right? Because they didn't see how things went down in labor, and that's a big difference. Being able to have all those extra details that inform what an answer might be to a question that they have in the middle of the night or whenever. 

Right. And you can always have multiple providers on board if that's something, I wish they had pediatricians that you had that kind of access to, too. That too, that's a great point. You don't have 24 access to most of them, you have to go to urgent care if there's a concern in the middle of the night. 

Sorayya: Exactly. So, I think that's really important to distinguish that the care that we provide is very personalized.

So you're not just another number in a big, large practice, especially for providers like me, who only take about two to three births a month. Your birth, your baby, all that is very important to me in my practice. 

Trauma-Informed and Collaborative Care

Lisa: Any thoughts on the idea of trauma informed care, and the differences between, your practice, home birth generally, and hospital birth on that front? 

Sorayya: We approach every patient as having had some kind of trauma, even if they didn't. That's just the kind of atmosphere we create.

Anything that I do is consent based, so I don't just do things to you without your consent. It's so so important to me and very different from the hospital system. I've heard people have really traumatic experiences with their 1st visit with their OB and just feeling unheard and unseen, and then being pregnant is a very personal thing. And, if you've had any kind of trauma, it can trigger feelings and reactions and so we're very careful. I'm very careful at seeing you as a whole person who may have had a history of that. Sometimes I never do a cervical exam,from the beginning to the end, I never see your cervix. That's because it's not necessarily important. Maybe you just didn't need a pap smear, you already had 1, or maybe your birth never needed any cervical checks because it wasn't going to change the management of how the birth was progressing, I never did it then. So, you know, vaginal exams are not something that happen every prenatal visit and every couple of hours in birth. I don't believe in that. And, I think limiting that is really helpful for people who have experienced trauma. 

And then I always ask at the initiation of care, about any of those experiences that may have come up. So people can be honest with me, maybe they're not, maybe opens up a little bit later as they rebuild rapport and as they feel more comfortable.

But I think when you have that kind of closer relationship with a provider, it's easy for the provider to see those things in you and for you to expose yourself to them. And that dynamic, I don't think would ever happen in a hospital based setting. 

Lisa: Yeah, so much less common. Yeah, it is something we talk about in birth class because again, most of my clients are giving birth in a hospital setting, and I talk about like cervical checks are so much more standard with hospital providers, much more so with hospital OBs, and it's unnecessary surveillance in the vast majority of cases. And you can just keep your pants on. You can just say, Nope, not doing that today if you don't want. And I always point out that, you know, midwives, on average, especially home birth midwives, tend to do those much less, if at all. And in some cases only if the patient asks for that. Yeah. Thank you. 

Big, huge. Everybody, listeners, just know that this is a major difference in care, generally speaking, is just this very trauma informed, consent based model and really individualizing care and personalizing care that everybody deserves, but most of us aren't getting in a hospital setting. 

Sorayya: And also to add to that, collaborative care. This is your body, your baby, your birth. You don't want something, you don't have to have it. I'm there to guide you. I'm there to give you recommendations. There are definitely some tests and some procedures that I find are important.

And then there are some that you feel you really don't want, and that's something that we collaborate on together. Nothing in my practice is required, as long as you have all the information, then I'm happy to serve you in the birth that you envision. 

Lisa: So much gratitude for that. So much beauty in that. Oh, it just makes my heart sing. And I'm sure some people are listening right now and they're like, this resonates with me a lot. So thank you for sharing. 

Sorayya: Some partners tend to have more questions about the safety and all of that, but sometimes it really does speak to the person who's going to have this baby and it just feels very right to them.

And then I think that there are other people who really want to be told what to do and to be cared for in a medical, clinical environment and that's fine. As long as there are choices, I'm all for them. 

Lisa: Agreed.

Personal Stories and Practice Philosophy

Lisa: All right, I feel like we spent so much time on the worst case scenario, safety stuff. Is there anything you would like to share? I don't know, it could be an anecdote in terms of a birth that just really stuck with you that you were like, that was so beautiful and so empowering for them and just life giving for you.

Sorayya: Oh my god, there's just so many and it's like every time you go to a birth, you know that it's not going to be the same, that it's going to be a completely different experience. That's why I love my job because every time I'm on my way to a birth, I'm like, okay, this is going to be vastly different from the one before.

That's a gift to see how differently it impacts people and how this kind of dance between the birthing person and the baby and the family and everybody's just organic in this kind of, metamorphosis, right, into parenthood. I'm trying to think of ones that are really shocking, but it's actually the ones that are not, that are super uneventful.

Lisa: That sounds great. Uneventful. Give us that. 

Sorayya: Exactly. That's what you want. You want a low key one that everybody's just feeling happy about it. And yes, it's an intense experience.

So like I love to think of it as a dance because it's just like figuring out the movements of yourself, of the baby, of your partner, it's just this blossoming and, I think people become empowered through that and when they're tucked in after the baby's done the newborn exam and the baby, is ready to latch, you just tucked into your bed, that's just like such a beautiful moment for me where it's like, okay, they're good. Everybody's good. Everybody did this. 

Lisa: Got chills. 

Sorayya: Yeah! And now I can leave and I've done my job. That's the best kind of birth, yeah. 

Lisa: I love that. As you brought up the dance, that was actually the word that was coming to my mind too, that brought up for me the name of your practice. Would you like to share a little bit about how you chose the name for the practice? Because I adored reading about that on your website. 

Sorayya: You know, it just came to me.

It's a little bit personal. I was in partnership with another midwife, and my father got really ill in August. And, while I was in the hospital with him day and night and, then in hospice, and then as he passed, like that relationship, that partnership, just, I don't think she was able to deal with all of that grief.

And in that breaking up of that business, and, in this kind of acute, deep kind of grief, I just, I knew I had to honor my father in some way. If I was going to carry on as a midwife and if I was gonna do this on my own and find a place for myself as a sole provider. And, my father, so Taarab is actually, a musical genre in East Africa and Swahili culture.

And it's a kind of a fusion of Arabic and, and African and European and, Indian sounds. It's a very beautiful, very distinct kind of music, and my father was a singer of Taarab in his country in Tanzania. And, it was the sound of my childhood. It's very personal, Taarab music. And when I figured out what the name was from its Arabic, I was just like, Oh, wow, this is what labor is to me.

There's no word in English that is equivalent, but it's a kind of a mixing or stirring up of an ecstatic feeling through dance. And I just as someone who had labors and who sees a lot of labors, that's what it evoked for me. This kind of dance between the birthing person, the baby and maybe there's music there and maybe it's silent, but it's definitely this dance.

So Taarab has many layers, has many meanings for me, but it just was like, okay, that's what my business is going to be called. That's what my practice is going to be called Taarab Birth, yeah. 

Lisa: Thank you so much, Sorayya, for sharing that, and I'm so sorry for your loss. What a beautiful tribute.

And now I want to look up that kind of music. 

Sorayya: Yeah, it's hard to find the real traditional Taarab from that time on YouTube. There's some like more modern versions, but, yeah, the kind of my dad sung from the 1960s is very, it's like a more older vintage, but, yeah, and just, with that name and also with this almost rebirth of me and my midwifery practice and all that, I knew I wanted to honor him in that way and also honor him in the community that he was raised in and was very much a part of, with my international work.

Lisa: I'll just mention that, I'm identifying a lot with you in both the music part, I come from a musician family, singer, parents as well, and then we lost my father in law last year, deeply beloved. And so I just, I really identify with you with so much on those two levels and also applying the musical to birth itself and that metamorphosis.

I just, I love that. I love that. 

Sorayya: Yeah, and that vision, I don't know if you looked at the cover of my website, just knew I needed that to just tie it all together. 

Lisa: It just feels really sacred. 

Sorayya: It's yeah, very personal, this practice for me. 

Lisa: Yeah. On the topic of grief, briefly, I don't know if you've read this book, The Wild Edge of Sorrow.

If you have not, I highly recommend it, by Francis Weller. My prenatal yoga teacher, trainer recommended it. She said it's like her sacred go to book. So I immediately got my hands on a copy and now I feel the same way. I'm like, I will read that over and over. And so if you read it, let me know what you think, Sorayya or listeners.

But I thought that was really just therapeutic in different kinds of loss too. It explores so many levels of grief and ways that we can grieve in life including, but not limited to loss of loved ones. 

Sorayya: Yeah. It's hard to lose a parent. It's not like anything else. I'm sure losing a child too, it's not like anything else. 

A part of you that just dies with them. It was so important to me to keep him alive, to keep him alive through my work and through me, you know, 

Lisa: Well, thank you for that. Now, you just mentioned your international work.

International Work and Future Plans

I would love to hear more about that. As I understand it, you spend most of the year here in New York City attending home births and then part of the year in Tanzania. Is that correct? 

Sorayya: Yeah, so that's something that is, you know, this 2024 is happening, so I have a few contacts with midwives in Tanzania, but the most exciting one that I hope really becomes a collaboration, is in Zanzibar.

And it's a clinic called Wajamama, and it's actually more than just a health clinic, it's really an educational space for women. It's a lifestyle kind of support, for exercise and other things. In Tanzania, they have one of the worst maternal mortality rates in the world, and a lot of that has to do with access to technology and also for people not having the education that they need to have a safe birth.

This kind of a space in whatever capacity throughout the country, I think this kind of a space is very deeply needed. And if I can volunteer my services there, and midwifery services are really important, if I can volunteer that for the people in the organizations there, that was really fulfilling for me and in another way of honoring my father too. The work speaks to me on many different levels, but, yeah, I'm really excited for this next chapter of my career and of my life. 

Lisa: And I will be sure to get from you any links, if there are ways that people would like to support the work that you're doing there, I'm sure people will want to do that. So I'll get that after from you and I'll be sure to include it in the show notes for this episode. 

All right. Well, is there anything else that you were hoping to share about home birth that you think would benefit listeners?

Sorayya: Yeah, just that I think it's important to understand that there are options for you as a person who's newly pregnant or who's had a birth and didn't like the way their birth was the first time around that, even just a quick consultation with a home birth midwife might change your mind or it might make you feel like, Oh no, hospital birth is right for me.

I just think that having the exposure to all the different types of settings is super important. I wish we could maintain a birth center. 

Lisa: Yeah. 

Sorayya: I think that's another good option for people who are not committing to home.

But, birth centers, as of now, birth centers in New York, freestanding, it's just like giving birth at home. There's no real difference unless you have a birth center attached to a hospital, you might as well have it at home and not go anywhere. So understanding those different pieces of this puzzle and not feeling super overwhelmed by it, I find that it's like preaching to the choir a lot of times because I get people who already know these things, and I wish there was more advocacy outside of those circles and to more underserved communities. 

Lisa: Yeah, I'm thinking about, maybe we could sometime think about doing a workshop for people who are just like, even just trying to conceive or earlier in pregnancy. I do a workshop that's similar, but it's not exactly the same thing about really going over the details and the differences between the different options of birth setting and different kinds of providers.

It seems like that would be a great touch point to help people start that education early on when they're needing to make some of those decisions. Although I will also say that I switched to home birth at 34 weeks in my second pregnancy. So it's almost never too late depending on the provider and their style and what they're okay with.

 But the earlier, the better, cause then you're really being able to develop rapport with whoever your provider is. 

Sorayya: And I do home visits, so I'm able to see you in your natural space and your partner and your family members. And so I think that really gives me a good insight into how you live and those unspoken kind of things about people that you can't really tap into in a clinical setting, that I think really flourish in home birth, especially when you're doing home visits.

Final Thoughts and How to Get in Touch with Sorayya

Lisa: Yes. Thank you so much, Sorayya. So if people would like to get in touch with you, can you, for those who might not visit the show notes for that, can you just share how they can get in touch with you, please? 

Sorayya: Yes. So you can email me at sorayya@Taarabbirthmidwifery.Com. 

Lisa: Could you maybe spell that out just for good measure?

Sorayya: Yeah. Okay. Sorayya is S O R A Y Y A at Taarab, T A A R A B, birth, B I R T H, midwifery, M I D W I F E R Y. com. That's my email and then my www.taarabbirthmidwifery.Com. So yeah, you can even just go onto the website and there's like a connect button and you can just send me an inquiry there.

I also have my website in Spanish. So if people don't speak English, then they can toggle on to the Spanish version. A lot of Spanish speaking families that I work with. And I guess those are all my contacts. I don't have Instagram and all this stuff. 

Lisa: Good for you.

Sorayya: As a person, I just can't, with social media, it's like not my thing.

So it's really hard to maintain it as a business. I'm sure one day I should do that, but yeah. For now, those are the places you can get in touch. 

Lisa: Thank you so much, Sorayya. What a pleasure and honor to get to share space with you and to hear all about the work that you do. Thank you so much for that important work.

And I hope that, people who have now heard all of this information and are really curious to learn more or are like, yeah, I want a home birth. I hope that they will reach out to you. 

Sorayya: Thank you, thank you, Lisa. It was really nice speaking with you.