Just want to put out there a recommendation for our wonderful homebirth midwife Susanna Napierala. Susanna was amazing for us on many levels. She has over 3 decades of experience helping moms deliver babies at home. She has been instrumental in helping to bring water births to the U.S., having studied directly under Igor Tjarkovsky, and writing the book – Waterbirth, A Midwife’s Perspective. She has extensive knowledge of many possible birthing circumstances that can onlycome from participation in so many births over the years. She prepared us very well with knowledge, tools, techniques and emotional support…she was totally there for us as our homebirth morphed into a hospital birth due to our baby coming 4 weeks early. She was a constant calming influence, offered us scenarios to consider at each stage and supported our choices. Her hands-on techniques and intuition were a great comfort to us before, during and after labor and delivery. She took the time to get to know us on a personal level, creating a bond that was critical during the trying times of labor. She is most concerned with positive outcomes (healthy baby, healthy mama) and while giving us the best opportunity to carry out our homebirth plan, she was not afraid to recommend the safest course of action when circumstances did not seem quite right. I recommend her most highly and without reservation to any potential homebirth parents on the North SF Bay Area.

 From the moment I decided to have a child I knew I wanted to have a water birth.  I thought this could only be done at the hospital or a birthing center.  After further research I found out I could also have it in the comfort of my own home.  This is what I wanted.  My husband, on the other hand, was skeptical about my safety.  After watching the documentary, The Business of Being Born, which I think every expectant mother should watch, he was on board.  We did decide to have prenatal care at the Health Center as well in case of having to be transfered to the hospital.  I then began the search for a midwife.  Susanna's website was one of the first I came across.  She seemed to have the most experience of all the midwives,  having pioneered water births in the States, written a book and with many deliveries under her belt .  When I first met her, I knew almost instantly she was the midwife for me.  She was warm and bright.  And I could tell she had passion for what she did.  It was a match made in heaven.  We started my prenatal care that same day.  I had already been going to the Health Center for a couple months.  And the prenatal visits were as different as night and day.  Susanna would spend 1 to 2 hours with me, as oppose to 10 to 15 minutes at the Health Center.  She was very thorough, covering nutrition, chiropractic care, my husband and my emotion state.  She was armed with a wealth of knowledge.  I learned so much during those visits.  I could see she knew what she was doing and  decided to give her 100% of my trust.  I gave her full rein and let her be my guide to what was going to be one of the most beautiful experiences of my life. 

My water broke at 7:30 in the evening, at which time I called Susanna.  She told me to take a hot bath, relax, eat well and rest as much as I could for the night to come.  At midnight the pain set in.  Tom got up and began to set up the tub.  There is so much anticipation when your pregnant to begin labor, but as soon as I felt the pain I immediately welcomed another week of pregnancy.  I had expected to have a long labor, as many first time moms experience.  Nothing is what you expect it to be.  My Aunt arrived, shortly followed by Susanna.  I remember feeling so relieved to see her come through the door.  One of the things I appreciated the most about my experience with Susanna is her asking me how I wanted my birth to go.  What I needed from her.  How I needed her to be with me during labor.  This she executed to a T.  I didn't need to be cuddled or have a gentle hand.  I needed someone to be firm and straight forward.  Susanna is a very gentle woman, so I feel she stepped out  of her comfort zone to give me what I needed. 

Right out the gate my contractions were a minute apart.  Susanna sent me and the hubby out for a walk for about 30 minutes, having me squat during the contractions to help get the baby to drop.  At 5 cmm. dilated I got in the tub and quickly moved to being fully dilated.  It all happened so quick that the assistant midwife had not yet made it to the birth.  This was going to be my most challenging minutes to come, to not push when every part of my body was telling me to push.  I could wait no longer, my little man was coming.  I remember letting out one scream on my first push.  Susanna looked at me firmly and told me to get a GRIP.  She told me I was not going to scream.  I was going to use that energy and push it down and get that baby out.  It was exactly what I needed to hear.  Tom got in the tub.  I laid back in his arms and with three more pushes my beautiful baby boy came out and was immediately put in my arms.  Leo arrived and 5:30 am.  It was a moment of pure bliss.  Followed by a cold feeling and severe shaking.  Little had I known that I had started bleeding a little to much for comfort.  Susanna jumped into action get the cord cut and directing my Aunt to put the camera down and get the baby and tend to him while Susanna got me out of the tub and into bed where she gave me a shot of pitoson to stop the bleeding.  We were all impressed with how well she handled the situation.  Leo was quickly brought back to my arms and to my breast.  By this time the assistant had arrived and was by my side showing me how to get Leo to latch.  After I birthed the placenta and I cleaned up a bit, they gave Tom, Leo and I time to lay in bed together and bond.  The next time I left the room my home had been cleaned, tub drained and put away and breakfast made for us.  I had not expected all that to be done for us. 

Susanna came everyday for the next week for my postpartum  care.  And continued to visit for the weeks to come.  She went over and beyond for us with her postpartum care.  She was there for me answering any questions and concerns that I had.  When I felt alone or fearful, she was there for me.  I felt, and still feel, that I can go to her for anything,  getting her full attention when I need it most.  I truly feel that my birth went as smoothly as it did due to her care.  She is so dedicated in her field.  In my eyes she is like the salt of the earth.  I feel that I not only have a wonderful midwife, but now beautiful friend in my life.   I could not Thank her enough.

The evening before my due date I started feeling a little strange, like there might be something going on with me hormonally. I felt like I had chills as if I was getting sick, but I didn't feel like I was getting sick.  Francisco said my face looked flushed.  We went to bed that evening hoping we would get to meet our little one soon.


I woke up around 2:30 a.m. feeling crampy. I immediately thought this might be early labor and lay in bed trying to sleep but I couldn't sleep because the contractions, while mild, were coming every five minutes.  I talked to my midwife, Susanna, on the phone a few times to update her on my progress.  She asked questions about the contractions, encouraged me to try to sleep and told me if this is labor it’s very early.  

I called Susanna again about an hour later to let her know how things were progressing.  She again told me it’s still early on, but asked if I was comfortable with her not being there.  At that point, I was.  At a little after 6:00 a.m. I asked Francisco to call Susanna to ask her to come over.  I was starting to worry if we waited much longer she would get stuck in rush hour traffic and I didn’t want to risk having the baby while Susanna was stuck in traffic!

At about 7:30 a.m. Susanna arrived.  I was in the bedroom.  She immediately asked Francisco to start boiling a big pot of water to sterilize her tools.  She came into the bedroom and said she wanted to check me to see how far along I was.  I was dilated 1 centimeter, 85% effaced and baby was at -1 station.  During this check Susanna stretched my cervix open to 3 centimeters.  It was painful but really got labor going quickly.


Soon after Susanna arrived I labored for a little while in the living room/kitchen area to be near Francisco and Susanna.  Susanna wanted me to eat.  Earlier that morning I had a smoothie because I knew I was supposed to eat and that was really the only thing I could stomach.  Susanna suggested I eat eggs, which sounded disgusting, so I went to the kitchen to try to find something somewhat appetizing.  While I was standing in the kitchen I felt a very strong contraction come on.  I dropped to hands and knees, then told Susanna I felt sick.  She immediately got me a bowl and I vomited up all of the smoothie. Yuck! I left the kitchen and didn’t consider eating anything else.


After leaving the kitchen I went back to bed.  Around 9:00 a.m. Susanna told me we were going to go for a walk in the neighborhood.  That sounded awful; I could not imagine a worse way to have a contraction than to be outside walking. I procrastinated and tried to get out of going on the labor walk.


Susanna checked me before the walk; I was 4.5 centimeters dilated, 90% effaced and the baby was still at -1 station.  It was nice to know I had made progress and was about halfway there, but I was not dilated enough to get out of going for the walk. 


We left for the walk at about 9:20 a.m.  Susanna told me when contractions came during the walk Francisco and I were supposed to both drop into a squat with me leaning on him.  As we were getting ready for the walk I had a contraction at the front door.  Susanna dropped into a squat with me and demonstrated how we should do it.  


We left for the walk, an dit was the most beautiful spring day I have ever seen.  The sun was shining, birds were chirping, the sky was clear and blue, the trees were in bloom, and the temperature was perfect.  Everything was extremely vivid.  It felt like a day made for a birth!


Contractions were coming one on top of the next; it felt like I couldn't walk five feet without stopping and squatting through another contraction.  I would walk a few feet then turn to Francisco and say, "Okay, let's do another."  We would both squat down, and he was the perfect support; I leaned completely into him and found myself moaning through very intense contractions.  Neighbors were stopping as they drove by to make sure we were okay.  Susanna intercepted everyone and said, "everything's fine, we're just having a baby."  I remember hearing one man say something along the lines of, "it sounds like she's ready." (I didn't care in the least at the time, but it's a pretty funny scene to look back on!)  Susanna must have agreed because she cut the walk short and we turned around and went home.


We got home at about 10:00 a.m. and I went straight to the toilet, where Susanna told me to continue laboring. In retrospect, I know now I was in transition while I was on the toilet. At the time I felt like the contractions were really intense and I didn't feel I was managing them well.  I felt my hips were tight and I told Susanna, "I can't relax on the toilet."  I wanted to go back to bed, but she suggested I get in the tub.  I immediately said yes, thinking the water might give me some relief.


I did get about a minute or two of relief as soon as I got in the water.  Susanna checked me right away and told me, "you're 9 centimeters if not complete."  She immediately yelled to Francisco, who was now back in the kitchen.  I remember Susanna yelling, "Francisco!"  He didn't respond, and I yelled, "We're going to have a baby!"   It was about 10:20 a.m. at this time.


I started pushing around 10:40 a.m.  I was getting light-headed and started breathing oxygen after each push.  Susanna was checking the baby’s heartbeat regularly and determined the baby wasn’t happy when I lay on my back.  She suggested I lay on my left side.  I couldn’t get comfortable in that position in the bathtub I started out lying down and wasn't making much progress so I switched to a squat position in the tub.  Francisco was in charge of turning on the oxygen and giving me the mask after every single push.  We had a good rhythm going - I would push, take a couple of breaths of oxygen, push again, breath oxygen, etc., until the contraction ended.  I have always heard people say it feels good to push, and I definitely experienced that.  It was hard work to push but I did not feel pain when I was pushing.


At some point Susanna told me to feel the head.  I reached down and felt a soft hairy head, but really had no emotion or interest and just wanted to get back to work.  In what seemed like no time, Luna (Susanna's assistant midwife) arrived just as I was delivering Sulema's head.  Then I heard Susanna say very calmly, "the cord is around the baby's neck twice."  As soon as I heard that I pushed hard and the rest of Sulema's body came out. It was 11:32 a.m.


I didn't see Susanna unwrap the cord, but I think she got it unwrapped even before the body came out. I was standing in the tub and Susanna handed me the baby who was already making noises and turning pink.  I was in complete shock.  Every time I watch a birth video I get teary when the baby is born, but I had none of those emotions when Sulema was born.  I was simply in shock.  I remember saying something like, "I can't believe it," over and over again and just staring at the tiny person in my arms.


Almost immediately after I stood up with Sulema in my arms I felt something warm.  I looked down and saw a stream of pee going from the baby into the tub.  Before I had time to look at where the pee was coming from I heard Francisco say, "It's a girl!"


Susanna and Luna helped me out of the tub and into the bed while I held Sulema, who was still connected to me.  We lay in bed together while Susanna and Luna checked out my tear and waited for me to deliver the placenta. Susanna said the tear was most likely caused by Sulema’s shoulders – I’m sure it happened when I did that last big push because I really pushed hard and fast.  Eventually they gave me a shot of Pitocin in the leg to get the placenta out so they could start stitching me up.  The placenta came out easily and I felt the same weird empty feeling in my abdomen that I felt when Sulema was born.  They kept the placenta in a bowl and proceeded to repair my tear.  The stitches took awhile, but weren’t painful and healed well.  Later that day Susanna showed us the placenta and explained how it works – that was very cool to see.  She stayed and helped clean up and made sure we were all doing well.  


Susanna left that evening then returned the next day, a few days later, then a week later and a month later.  It was wonderful to have that in-home support while I was healing and adjusting to having a newborn.

When I began my journey of becoming a mother for the second time, it was 8 years after I had given birth to my first child. I felt similar emotions that I had when I found out I was pregnant for the first time: excitement, anticipation, empowerment, as well as fear of the unknown. As I began to search for a midwife I spoke to a few, but was still waiting to feel a sense of relief in choosing a midwife. As I spoke with Susanna on the phone I immediately felt at ease and knew in my heart that she would be with me through every stage of my pregnancy.

During my prenatal care I was able to speak openly with Susanna about everything that was happening in my life. She helped me by answering any questions I had about pregnancy, birth, and post-natal care. Every time we met, not only did I feel confident that the baby was healthy and growing properly, but I also felt comfort in my special relationship that was forming with my midwife. She was there in every moment I felt I needed her. And always called me back promptly. Her advice and encouragement came from a place of genuine love and care for being a part of this amazing birth process that I called my own.

About a week after my due date I went into what’s considered to be false labor. Susanna came over immediately. She checked my labor progress frequently and finally, at a very odd hour we both accepted that this baby was not ready to come out. I was able to rely on her to stick around till morning, just in case anything changed. Knowing she was there helped me rest with ease, even though I was waiting with great anticipation. Low and behold, a few days later I went into labor… my daughter was TWO weeks late!!!! I went into a deep primal place within myself through my labor, for the most part, I wanted to be left alone. Susanna respected my wish, however insisted on giving me medical attention to ensure that both me and the baby were safely progressing towards birth. As I got closer to birthing, I remember Susanna gently reminding me to deepen my sounds, rather than come from a place of fear vocally (these are my words, she didn’t say that) and find the strength within to help get the baby out. She breathed with me and supported me in the exact way that I needed her too.

As the miracle of my child came into the physical world and out of my womb, I was able to hold her in disbelief that I had jut given birth to a perfect child. Susanna checked to make sure she was 100% in good health, fulfilling her duty as midwife.

After the birth, my hormones took over, giving me ease in the pain I had felt throughout the process of labor and child birth.  Excitement kicked in full force. Susanna stayed with me for hours, offering food and to answer any questions that came up for me or my partner, and even my son. Once she was able to tell I was in great physical health and had my husband to help properly monitor and care for me, she left with graciousness. Over the next few days I received frequent calls from her to simply check in, along with weekly visits to check on all of us, baby, me and the rest of the family. Throughout this whole process Susanna made sure I was completely nourished and communicated clearly that her main priority was to help me have the best experience possible in ever way.

I can't express in words how thankful I am that I was able to have such a wonderful midwife take care of me through my pregnancy, birth and post care. Susanna is exceptional at making one feel well taken care of. She is attentive, accessible and hard working. She has the experience and knowledge that great midwifes have along with a beautiful personality of care, love and commitment to her work. She has gone above and beyond what I could have ever asked for from anyone in the medical field, and I will always be grateful to her for giving us such a perfect birth experience. 

Our fourth daughter, Eleanor Sue, was born July 15, 2011, at Kaiser Permanente in San Francisco.  I had been going to my regular prenatal visits at Kaiser, but in the second trimester hired Susanna to attend the birth as a doula to help prevent an unnecessary c-section.  My first daughter had been born by c-section at 32 weeks gestation; and I had had two VBACs since, but still wanted to have a strong advocate by my side during labor because I knew that, even though I’m normally pretty forceful with a hospital staff about what I want, labor is not the time I want to have to fight for what I think is reasonable.  I remembered having had to argue with the doctor over continual fetal heart monitoring, over my decision to avoid antibiotics even though I had not taken the GBS strep test, etc., during my third daughter’s birth.  And, I remembered how much I disliked having to argue and defend my decisions instead of just focusing on and “enjoying” the labor and birth.  This time I wanted to have someone else whom I trusted watching over me while I labored in peace.  And, I wanted to have someone very experienced, whose word I could trust in case she concurred with the hospital staff that I should have a c-section.  If Susanna had said at any point that I needed to have a c-section, then I would have believed it.  I had always felt that my previous c-section was the result of my ignorance and giving in to the medical staff’s routine response to any labor slightly different from normal.  On the operating table I was told that about 30% of women at Kaiser in San Francisco give birth by c-section.  So, I was always suspicious that I had been duped.  

At our first meeting with Susanna, I knew I had called the right woman for the job.  She was so warm and so supportive – not assertive and dogmatic like some birth attendants can be.  She just wanted to help me make the labor and birth what I wanted it to be.  She was also extremely helpful in moderating between my husband and me.  I am very “natural” (as in “granola”), and my husband is more, well, mainstream.  So, Susanna helped us both understand each other’s point of view and helped us rationally and reasonably (with all the facts) come to some decisions about tests, procedures, etc., that we could both live with.  

Susanna went above and beyond my expectations, treating me as a midwife treats her patients, even though I had just hired her to be my doula (since I was to give birth at Kaiser).  I felt that it was good to have a second opinion – another care provider checking the baby and me at each visit.  I also was thrilled to have someone who could answer all my questions.  I had picked Susanna out for several reasons, but one important reason was that she is so much more experienced than most doulas and even midwifes.  I needed someone I could rest assured would know what to do in any situation during the labor and birth process; and I was never disappointed.

A week before Eleanor was born, I called Susanna and told her that I thought I needed to go to the hospital.  I thought I was in real labor, and thought I should know since I had been through it a couple of times before.  Susanna wasn’t so sure, but she drove to Kaiser to meet me.  It was a false alarm, and we all went home after a few hours at the hospital.  I was grateful that Susanna never made me feel bad about making her drive to the hospital for a false alarm.  

Susanna was also very good about answering questions I had about my contractions and physical sensations (pain, etc.) and concerns as I approached the due date.   She was always accessible and easy to reach by phone.  This was reassuring to me.  It was so good to have an expert to consult at any time!

The next Friday, it really happened.  My husband, my mom, and I drove from our home in El Cerrito across the bridge to Kaiser in San Francisco.  We had called Susanna, and she was on her way to meet us there.  I hid out in the bathroom in the triage room, waiting for Susanna to get there to help me avoid any unnecessary vaginal exams.  I labored on the toilet there for 20 minutes or so until Susanna arrived.  I felt like she was a guardian angel, and I was able to relax as soon as she got there.  

My labor progressed quickly, but the hospital was out of birthing rooms, and I was going to have to deliver in the operating room.  My husband, my mom, and Susanna had to get into scrubs – and only one of them could come into the room with me.  The other two would watch from the hall.  At first my husband went in with me.  I was ready to push as soon as I got into the room, but the OB/GYN checked and noticed a “lip.”  She told me to wait until it went down.  This was torture.  (As planned, I had refused pain medication.)  My husband tried to help me through the contractions, during which I had an extremely strong urge to push.  I was having such a hard time, and the minutes were ticking by so slowly – I was watching the clock the whole time.  After a few minutes, my husband went out into the hall and let Susanna take his place.  Susanna got me through the rest of the half hour or so I had to wait through the contractions.  She had me focus on looking in her eyes, as she told me that I could indeed make it through.  Finally, the lip was gone and I could push.  Eleanor was born a few minutes later, 9 pounds, 6 ounces.  At this point I was moved to a room, and Susanna prepped it and made sure that everything was comfortable for me.  She brought me juice right away, answered the nurses’ questions, got me anything I asked for, tucked me under the blanket, and even fed me my food!  I felt very well taken-care-of.  But, most of all, I was grateful for another safe VBAC and a birth experience as good as it can be in a hospital setting.