Ep. 97 - Preparing for a Positive Cesarean Birth with Nicole Heidbreder and Amir Niroumand

Debra Pascali-Bonaro: Have you thought about preparing for birth in every situation so your voice and choice can be heard and honored? What if to safely give birth, you or your baby need a cesarean birth? I believe that every birth can, and should be gentle, sacred and have elements of pleasure and love. That’s why we’re doing a mini series right now about cesarean birth. So that no matter what birth asks of you, you are positively prepared to have a gentle loving birth in any setting. My guests today are joining us to talk about the magnificent cesarean birth. 

Hi, I’m Debra Pascali-Bonaro, Founder and Director of Orgasmic Birth, and host of the Orgasmic Birth Podcast. My guest today is Nicole Heidbreder and Amir Niromand. They are really dear to me. Nicole has been a longtime friend and colleague. She’s worked as a labor and delivery nurse in various capacities for the last 13 years in Washington DC, and has been attending births as a doula for over 17 years. That’s how we connected so long ago. She’s worked in DC, New York City, San Francisco, Sumatra, Bali and Uganda. And she’s also spent the last 10 years as a doula international approved birth doula trainer, and is a doula international train birth and postpartum doula. Among other things that I’ll have Nicole tell about herself and introduce Amir, but I just want to say personally, having you both here today is just near and dear to my heart. Because we knew each other way back, as you were beginning your doula career, we now share our passion for helping to advocate for all people for all doulas and to make choices. And so having you both here to share your journey, just wow. Thank you. Thank you for joining me today.

Nicole Heidbreder: Thank you, Debra, for having us. And it’s very poignant and very special for me. As you said, you were part of my initiation into the birth world, part of my entrance into that career. And now that I’m on the other side of the coin, it’s been really meaningful for me to share all these months and share the journey. I feel very tender in my heart just saying that. I’ve worked in birth as a doula, as a nurse, as a birth doula trainer, also taught at John Hopkins Nursing School for a while, and a wild twist of fate. Now, after all those years, now I’m on the other side of the coin as the pregnant person, and I’m really trying to honor that, to feel into the experience. Not from an intellectual knowledge base, but really from my heart, from my body. I would say, that’s also my bio where I’m at right now. But yeah, and I want my partner to also be known.

Amir Niromand: Yeah. Hello. First and foremost, I would say students now of the birthing world, tutor at home that is teaching me everything all the time, so that’s wonderful. In my own life, my career, I’m a fuel cell scientist. And then my passion and hobby is community farming. I have a community farm, and it’s a lot about healing ourselves, building community, growing food, and using food as a means for healing and community work. So I think those pieces also somehow come into for us into the family part, and into the birthing part, and the container that’s holding us.

Debra Pascali-Bonaro: So beautiful. And thank you both for sharing. We often say, and Nicole, you probably have used it too, that we are born the way we live. Bringing who we are in every aspect of who we are is really important in how we begin to view birth and prepare for birth. So knowing a little bit about each of you, and now your own personal journey being pregnant, do you want to share a bit about your journey and where you’re at?

Nicole Heidbreder: Well, at the present moment, I’m 28 weeks. In fact, actually this weekend, I both entered the third trimester and turned 44 on the same day. So that was a little bit of a wild and wonderful birthday present. Amir and I have been trying for about a year and a half to conceive and had an experience where I was very fertile. I kept getting pregnant very easily, but then having miscarriages. So none of those pregnancies made it this far. So it was a beautiful birthday gift to just be feeling very healthy and very strong in my heart, strong in my body, and entering the third trimester for the first time for me.

Debra Pascali-Bonaro: And how are you feeling Amir?

Amir Niromand: I feel very good. And that fertility is also a testament to my power. So I just wanted that to be known, for sure. I’m really grateful. We had a couple of miscarriages, and we’ve known each other for the same time, same duration, a year and a half. And that’s been a big journey of also getting to know each other more than the ups and downs. It’s really difficult, and a good lesson. And we are very grateful that we have amazing support with our community, with our therapist. And yeah, that has brought us a lot closer and feeling a lot more solid together. So that really feels good. Feels like we’re on really solid grounds. I’m really grateful about that. So yes, everything about the pregnancy and about our connection feels really good.

Nicole Heidbreder: I think neither of us take it for granted that we went through such a fertility journey, and it just brought us closer together. Because we both know that there, for some couples, that’s not the case. Repeated loss, having decencies, having even more invasive surgeries that are hard, it’s hard on a union, in addition to having its own individual difficulties. We both feel very grateful that for us, it just kind of brought us closer together and made it more solid. I want to stay with this person. I want to be with this person above and beyond all of this.

Debra Pascali-Bonaro: Yes. Well, thank you for giving voice to that. I am sorry for your losses. I know having journeyed with you, each loss is really hard. And to know how you’ve worked individually and together is such an inspiration to see you today. But also for everyone listening who may also be on their own journey of fertility, or may have experienced prior loss and are pregnant and they’re listening along, so thank you for sharing all of what that’s been to bring you today. And third trimester, so your birth is coming pretty soon when you think about it. It’s hard to believe.

Nicole Heidbreder: Very soon. I know that for me, I woke up the day of my birthday and there’s messages, there’s phone calls, and there’s just our connection. We went and got a massage together, and went to a hot spring, it was so lovely. And then that was the next day after I was like, oh, but it’s right around the corner. There’s all the nesting, there’s all the things that need to happen. But I also feel, we’ll do it, we’ll get to it, trying not to be too crazy or too wound up about that. I think there’s a phrase I’ve heard about parenting that the days are long, but the years are short. And I’ve come to learn that pregnancy has also its own strange timing pattern. When you’re in that first trimester and you’re feeling so nauseous and so fatigued, just a deep fatigue that is like nothing, you can really imagine before you actually experience it. Those days seem so long, and the waiting to get out of that discomfort can seem very long. And then now that I’m out of it, it seems like there’s only a little bit of time left of this pregnancy. So the way that time passes is very interesting in pregnancy.

Debra Pascali-Bonaro: I really love how you express that. I know the title of what we thought to talk about is the magnificent cesarean, and I want to remind everybody that you’ve worked as a nurse in labor and delivery. You’ve been a doula, you train doulas for so many years. Take us up to that journey, what you’re envisioning for your birth, and how these decisions are coming and feeling for you?

Nicole Heidbreder: Thanks for that question. I will be honest and say that that has been a very difficult emotional journey for me. Feel a little emotional just speaking that out loud. After 17 years of being at these births of various kinds, it’s difficult to not in the back of your mind, a little part of you would be imagining what your own birth might be like, and thus kind of creating an attachment and a story to what that is. And I would say that before our fertility journey, it had its ups and downs. I would have said to you that I’m 100% having a home birth. I know who my midwife is, I know who my Doula would be. I felt a vision of all of that. A very, very, very clear vision of all of that. Forget about miscarriage. But at some point in time, it became clear that my uterus would benefit from having what’s referred to as a myomectomy, which is a surgery to remove different kinds of fibroids that were in and around my uterus. So there were some that were inside the uterus, there were some that were in the uterine wall, and then there were some that were also outside of the uterus, in addition to a little bit of endometriosis. And I got my first opinion from an OB doctor, a friend of mine. They explained to me that more than likely, I would probably continue the pattern of getting pregnant very easily, but continuing to have miscarriages if I didn’t have this surgery in order to remove the fibroids and remove the endometriosis. But then they also shared with me that because of the way the fibroids are within the wall and the location of the fibroids, it would also mean that I would eventually have to have a cesarean for my birth. 

The first time I heard that, I really wasn’t able to hear it. I really was like, well, that’s not an option. I don’t want that. And then I proceeded to get like three or four more opinions, have three or four more doctors look at the ultrasound and the MRI images just to see if they had a different opinion. But in the end, it was very unanimous. Every doctor that looked at the images right away said almost verbatim what the other provider had said. There wasn’t a lot of wiggle room. I had to take several weeks, maybe two and a half months or so to really be able to let go of my image of birth, of my attachment to having a home birth, my desire for that before I could fully really get in alignment with having the uterine surgery and accepting that. That would mean having a scheduled cesarean. It’s wild how it all played out. I’ll save that story. But there were some delays in surgery, there were some other things that were happening, but it was all kind of beautiful and how it unfolded. Because in the end, I really do feel fully aligned with what happened. I’m so grateful that I have the surgery to have the fibroids and the endometriosis removed. We got pregnant literally right away. Our surgeon had explained that we have to wait three months. We waited three months. And then immediately, yes, pregnant and had fun doing that. And that was beautiful. And now, I’m working with a midwife who is an incredible midwife. So she’s doing all of my prenatal care, and we’ve met a wonderful obstetric surgeon who is just a very kind person. And they are supportive of the midwife coming into the operating room. So we’ll have that continuity of care with her being with us now that we’re journeying all of our prenatal time with her. Because as a doula, I would say, as a labor and delivery nurse, I know how important having an empowered cesarean can be for people who venture into those cold, bright operating rooms. I’ve talked with our surgeon about that, and I’ve advocated for things that would make me feel more comfortable. And he was really open to anything that I desired.

Debra Pascali-Bonaro: So happy to hear your journey, both the challenges. I can really hear that changing and shifting your vision, but also putting together such an important team that’s listening and honoring to you, and that you’ll have your midwife and continuity of care. But I’d like to hear from Amir too. This has been a journey for you in shifting visions, creating a team and a birth vision. What’s that been like for you?

Amir Niromand: Obviously, I didn’t know much about this world of the birth world and the importance of home birth to the extent. Maybe a little bit on the surface, but I kind of got to learn a lot more about knowing Nicole, and then seeing how going through that journey, obviously was very difficult. I guess my job was to not try to fix things and just really be more of a listening board, and then help in decisions. Sometimes you think that if you know more, it’s better. Sometimes, it’s more difficult because you have too many doctors talking, and every decision is okay. I talked to five midwives and doctors, and then you need to integrate all of that. You have so much opinion about everything, and you have so much vision about everything. So it’s not always easy. I thought this would be easy. This is okay. It’s quite a project. But the clarity on your piece came, in my opinion, more after the second miscarriage. Because before the second miscarriage, we were feeling that a little bit, maybe it still works. The probability is higher. Do we want to give it a second chance? Once the second miscarriage happened, now I just care about having a baby. Let’s shift into what a supportive cesarean looks like, and what’s the care, and what’s the postpartum. Who’s the best surgeon, and how do we get there? A lot of other factors started rolling in. And I think the emotional piece also kind of shifted. I feel like that was a big, big turning point after the second miscarriage that we really went to this area. Really being grateful, really being able to fully appreciate the pregnancy and not really having something lingering on the back that this is what I wanted. No, this is what we wanted. And also having appreciation for the amazing surgeon who did the myomectomy. It was Nicole’s friend. Dr. Gabby is just amazing. Everything that we have for our care, so there is definitely a lot to be appreciated. A lot of support, that’s how I see it. We’re happy about it.

Nicole Heidbreder: I think both of us felt like something that I do feel we did, quote unquote, right. I would try to recommend to others is really, really giving space for the grief, not pushing that grief down. But really being able to have open and honest conversations about that grief, about that sorrow and about that longing for something will not come to pass. And I think that we just gave it so much space and did rituals around it. Acknowledged it amongst our community, amongst our friends, such as yourself that that were witnessing and supporting us. I don’t know if it was easier, but then it just felt a natural shift, the gratitude that we’re on the path. And it looks different, but we’re on it together. And there are other beautiful things to also focus and hold on to.

Amir Niromand: I want to share something. As Nicole shared, she’s both a birth doula and death doula. So she kind of works on the post transition sides. And it’s fascinating how these two are the flip sides of the coin. Through my journey with her, I know this about birth, as much about death. One practice that we had, which is kind of related to what you were saying from the beginning, we did not hide the pregnancy. A lot of people say, don’t say anything in the first three months. You might lose the baby. I don’t know, then you lose the baby. And that happened to us twice. But just being real with it, and then also knowing people and having the community to support us. Being in grief helps really moving through it rather than just, okay, no one knows. It didn’t happen. Let’s not talk about it. That was also an element that we really fully live with. That’s life.

Nicole Heidbreder: We’re being witnessed by everyone. We’re sharing it.

Amir Niromand: It might die. I just wanted to name that. I appreciate you bringing a lot of that, so definitely do. It was really helpful in that sense of being able to digest it, and move through it.

Debra Pascali-Bonaro: Beautiful point. Thank you for sharing that. I think it’s so important, how you’re talking about having your community and sharing, being witnessed and allowing that grief as a process and learning in so many ways. And it brought you to where you are today. I love to hear that you can come to the gratitude and really preparing.I love that you wrote to me and said the magnificent cesarean. Can you take me there? What are you visioning now? What are you preparing? What do you see for your birth? That’s going to really honor both of you and your baby in a gentle, loving way.

Nicole Heidbreder: There’s a desire to have it be magnificent. That’s one thing. I don’t know if this will make sense. But for me, having the courage to even say that out loud and to have that intention is not easy. But I’m there. I do have that intention. I want it to feel like a wonderful experience for me, a wonderful experience for Amir, and a wonderful experience for us as a couple becoming a family. So I feel that. I would say, that’s like the guiding light behind all the decisions that we make. One thing is just putting that intention out there. Other things that we have planned. I’ll give an example. If I were planning on a vaginal birth, I previously had thought for myself, I’d have this amazing blessing with all of my midwife and doula friends. It would be this exceptionally witchy pleasure, priests deceit type experience. And I think when I originally thought, well, I have to have a scheduled cesarean. I didn’t actually think that I would do something like that. Because I thought, well, I’m just going on a scheduled date. And it not only removed from myself the fantasy of the birth, but I removed from myself the fantasy of other things that went along with that. 

So part of this healing journey we’ve been on has been to reclaim those things and to say, no, I’m still going through a type of birth, and a type of major emotional, hormonal, psychological, physical transition. And we, as a couple as well. So we do already have a blessing. Amir and I planned with our community to circle around us and bless us, and to witness us expressing our hopes, our dreams and our fears as we enter into parenthood and go into our birthing situation. So that’s something that we have planned that I’m really excited about. And I think we’ll be beautiful. A little unusual, we live on a community farm in rural Canada just outside of Vancouver. And there are three other women that live on the farm with me that in many ways will be around this child a lot. So we’ve also envisioned ways that we as a sisterhood, as a collective of women will be honoring the transition that we’re going through. So here, just together, the four of us will do a belly and a breast casting, and some art, and some rituals around the farm, around the land together. So we have that planned as well. And we’ve also done considerable planning for our postpartum period. Because we know that we’re having a cesarean, it’s important for me to have a little bit of extra support around our home. We felt that a postpartum doula would support us really well in that. And it’s not easy finding one in this rural area where we live. So I spent a lot of time looking at different websites, talking to different people. And actually through word of mouth is eventually how I found a wonderful postpartum doula. So we’re really happy about that. 

We’ve also planned for ourselves to have a very nutritive, nourishing postpartum meal plan. It will look different than what it might look like in the city. Because again, we live in such a rural place. I’ve also thought a lot about that. I want to have a meal train. I know that such a psychologically and spiritually important thing for people that are new parents to be on the receiving end because I have been a part of coordinating those for so many friends over the years. And it’s been unanimous from all of them that they’ve said that it’s worth it, it weighs in gold. It was critical for them in those first four weeks to have something like that so we spent a lot of time masterminding, well, how could this work? What can we do? Again, putting a desire out there, and then being very intentional how we could fulfill that desire. And then one of the other things but the last thing I’ll mention in this interview is finding a supportive surgeon, supportive provider. We met with him for our first visit, which of course, as an American, I just assumed it was going to be like a 6 to 15 minute quick visit. It ended up an hour and a half of talking, relating and connecting.

Amir Niromand: It was very special.

Nicole Heidbreder: Really lovely. And talking very openly with him about my desires and my concerns. So putting it out there, what are some of the things that I would like. I would like to be able to play my own music in the operating room. They don’t have clear drapes in their hospital so at least the surgical drapes should be lowered so that I can see my baby coming out of me. I can witness the first cry, the first gasp of air. That’s something that’s really important for me to be able to visually see myself. Also Amir being able to cut the umbilical cord, I think is really crucial for partners or family members of any kind when they accompany someone in the operating room. I know as a nurse back at my old hospital, we were very encouraging of that.

Amir Niromand: Which I don’t have the guts to do.

Nicole Heidbreder: You might, you don’t know. Making sure that the NICU team, which I know of course, needs to do a brief assessment on my baby. That really will be very brief. And that the vitamin K shot will be delayed until the end of my first two hours postpartum, such then the baby can really just be wrapped and brought over to Amir and I in the operating room while I will still have the surgery, closing my uterus, closing my abdomen. So again, any of these things that I said to the surgeon, he just was like, yeah, sounds great. Okay. Yeah, why not? Let’s try it. So there was a lot of openness. Additionally, I wanted, and he even wanted for me to meet with anesthesiology team before the surgery so that I also really know who they are, and feel very comfortable with what they’re going to be doing, how they’re going to manage me and my body under their care in the operating room as well. Everything in the conversation just felt like a win-win. There was nothing that I desired that was particularly difficult for him, even our desire to, for example, bring the placenta home and plant it here on our farm underneath the tree, doing a ritual again with our community at some point this summer. He was like, yeah, great. That’s wonderful. Just remind me of the day so that I don’t forget. There was no pushback, or discouraging remark, or anything. I felt very respected and very seen as an autonomous woman, as an autonomous person. What did you like about them?

Amir Niromand: I just like everything that you’re doing. I was listening to you and him talking for one and a half hour about medical systems, worse and everything, and I really enjoyed it. I love how clear you are about what you want, and you have your voice.

Nicole Heidbreder: That’s true. But I would say, yes, if that’s something that I could recommend or encourage other pregnant people to do is to try to have that clarity about their wants, their needs and their desires. And then to verbalize from a place of clarity to their provider, I actually really think that that inner state of clarity is very important in the conversation.

Amir Niromand: Yeah, 100%. All of the medical pieces that Nicole says, and I think there’s also a big piece around the community and support. Nicole has moved here from DC to Vancouver, and here is my community. I feel that it’s more on my plate to make sure that we can mobilize people and things. That’s the piece that I can take. What is realistically given the operations that we have here at the farm, that we make sure that there is food here, and there is backup food here, and there is backup for that. If you need something, you have people who acknowledge that you can reach out to us, the support network being in place. I think one thing that I learned through the gazillion workshops that we did was to anticipate the needs, not try to ask the doctor what do you need, but just handing in the water, handing it to tea, and taking the baby. Educating myself to be able to do that. .Our community that people want to help, people love to help. But way easier to not come in here and say, what do I do? Check the kitchen and see what needs to be done. So the mental work. Not just the physical work, but also distributing the mental.

Debra Pascali-Bonaro: Well, you gave us so many good tips. I know people that are listening, probably like me, are just really in awe of your journey and the way you really have created communities, set your boundaries, expressed your needs, and that you really sat with your obstetrician to make sure that all your voice was heard and how beautifully honored. I started this out by saying, voice and choice is so important in whatever birth paths of you. I just want to wish you both a really magnificent, beautiful love filled cesarean birth. I hope that you’ll join us to share after your baby moon, after taking plenty of time to be nourished and nurtured to come back and tell us what your feelings were from birth. And hopefully, share your magnificent story.

Amir Niromand: I’m thinking that you plan things with the baby, but things never go according to plans. So I’m sure that it takes too long to land all of these, but let’s see.

Debra Pascali-Bonaro: And that’s life. So again, thank you so much.