Stacy had a planned cesarean birth with big brother Ethan (Breech presentation) and was determined to have a VBAC this time around. She described herself as stubborn, I saw incredible determination to the “10th” degree. She did her homework, planned, prepared, found a supportive OB group, and hired a doula. That’s me, and this is her birth story from my perspective.

Stacy called me first on Wednesday, May 22, around 9:30 pm to let me know things were happening- she had been having consistent contractions since about 4:30pm, but they were still mild and she could talk through them. By 11:30pm they were getting stronger and she anticipated wanting help. I jumped in the shower and waited, hearing from her again at 12:30am, saying “please come”.

I arrived at their house at 1am, finding Stacy propped up on a dining room chair in hands and knees. Contractions were coming frequently at 2-4 minute intervals. Daniel was working on getting Ethan to bed– it had been a rough night. I helped Stacy work through the contractions, she was relaxed and vocalizing through them. The double hip squeeze helped greatly!

Daniel “appeared” at 1:30am– Ethan was finally settled. It was Dad’s birthday today, and he had been kidding that this baby would appear on his day! By 2am, Stacy felt like things were pretty intense, so placed a call to OBGYN North and talked to midwife Siobhan, who said head on in.

We arrived at North Austin Medical Center around 2:45am and were taken directly to Room 1. Siobhan did an exam and said Stacy’s cervix was still “closed” but it was about 80% thinned, and the baby was -2 station. There was a lot of show, so Siobhan was fairly sure it was labor. We went ahead and got admitted while Stacy continued to manage the contractions with position, relaxation, and lots of vocalizing.

By 3:45 we were “fully” admitted, and it was time to get the first round of antibiotics going. Daniel looked exhausted, so I encouraged him to get a few winks– I could support Stacy for a while so he could rest, and be ready for the “big stuff”.

Siobhan confirmed the baby’s head was down via ultrasound, just to be safe, then let us labor. From 5-7am, everyone dozed in between contractions, which remained 3-5 minutes apart. Our new nurse came in at 7:30am for another dose of antibiotics (3rd one!)

Siobhan came in at 8am and wanted to do an exam to make sure all this work was getting us somewhere. She reported that Stacy was now a good 2cm, very soft, and the baby’s head was in better alignment. She was very pleased! (Stacy was not!) A whole night of work and only 2cm?

I sent Daniel out for breakfast and Siobhan allowed for a light snack for Stacy, so I made her some peanut butter crackers and juice. Within the hour the contractions spaced to 7-8 minutes apart– they were still strong but there was enough time in between them for napping. I reminded Stacy we still had a long way to go (if I had only known) and encouraged her to rest. I went to my car to nap myself.

When I returned at 11:30am, the room was quiet and everyone was dozing. Stacy was listening to her hypnobabies CD, which helped her relax.  Siobhan returned at noon, soon followed by Dr. Schmitz. At that point the contractions had spaced to 10-15 minutes apart, and Stacy was no longer in “active labor”. They recommended she go home and come back when things got busy again. At first, Stacy thought we were crazy! She couldn’t imagine going home still pregnant. But the more we talked about it, and discussed the alternatives, she agreed, home was the best place for her for now.

She ordered lunch and I packed up. She was given an Ambien prescription to help her rest, with strict orders to get some sleep. I headed out and went to sleep myself!

The contractions never went away– they remained spaced for the remainder of the day until around 9pm they started getting consistent again. Over the course of the evening they got close, then spaced again… she was in the tub a good part of the night as that helped with the pain of the contractions, however she really never got any “real” sleep. They texted me off and on, trying to decide when to head in again, not wanting to go unless it was “real” labor.

By 5am, Stacy was exhausted, frustrated, and was considering interventions- she couldn’t go on like this anymore, so they headed in. At 5:30am she was 4cm, 80% effaced, and the baby was lower at -1 station! It was good progress, and they asked me to come.

I arrived around 7am, to find Stacy on the ball, with contractions 5-6 minutes apart but long and strong. The double hip squeeze still felt the best. She was offered narcotics or an epidural and still wanted to avoid those if possible. We felt encouraged that she was finally making some headway! We talked about letting things proceed on their own vs augmenting labor and she decided she was “tired of waiting and resting”… it was time to get busy having a baby! The midwife Lisa took over for Dr. Schmitz at 8am and was super encouraging. The only sad part of the morning was they decided no more pudding, now that Stacy was in active labor (bummer).

We continued to labor, with Lisa our nurse, and her trainee Kristin. They were very encouraging and supportive of natural birth. I suggested some gentle nipple stimulation to trigger contractions. Stacy was “noticing” the baby felt lower now- all good signs.

Daniel took advantage of my presence to catch another nap– he was exhausted too. Stacy was so tired she was falling asleep between the contractions. Those endorphins finally kicked in! After a while she needed to move, so we tried “childs pose” on the bed to try to help her rest, but that didn’t feel good. We stood a while, leaning over the ball on the bed, and the contractions picked up! Stacy was using even more vocalizing and movement to cope.

Midwife Lisa could see lots of good signs of progress, so was not pushy for an exam. She wanted to let Stacy do her thing. We got into the shower- Stacy loved that! Daniel stayed with her, we tried to give them some space. The contractions were 5-7 minutes apart, but 1.5-2 minutes long- an unusual pattern to say the least, but we hoped effective at getting that cervix open!

Another round of antibiotics brought her out of the shower at 11:30am. Her back was hurting more so we put some heat on it. She was feeling a little chatty, refreshed from the shower, telling stories about Ethan. After a bit, those endorphins (and exhaustion) kicked in and she laid her head down to rest. I sent Daniel off for yet another meal and took over with the hip squeeze and heating pad.

Stacy tried another shower– that felt great! She stayed in there a while, and if she hadn’t started to fall asleep on the ball, would have stayed in there forever. She realized she needed to rest. We got her in bed, upright, sleeping in between contractions. Lisa suggested some music to help the mood– Stacy found it did help her relax.

Nurse Lisa left at 3pm and Amber took over. I did a foot massage, in hopes to trigger closer and stronger contractions. Stacy was doing fine but it seemed like she was in a “holding pattern”– I knew things needed to get harder to get her to complete.

By 3:30pm, she finally agreed to lay all the way down into a side lying position to fully rest. She was worried the contractions would feel horrible, but she did fine! She was able to effectively nap in between them for a while.

By 5pm, the contractions did slow again to 8-10 minutes apart and Stacy’s frustration appeared again. We wondered if her cervix had changed, and how much. Exhaustion was becoming a problem in the long run– how much farther did she have to go? I encouraged her to think about several “What if” scenarios to process where to go from here. What if she was still 4-5 cm dilated? (Dirty look) What if she was 9cm? What about 7cm? She realized getting that information was important at this point – although she had not wanted an exam earlier she realized it was critical now, in helping us decide where to go from here. Midwife Lisa agreed. Her 5:30pm exam was still 4cm, 100% effaced, and the baby was very low at 0 station. While it was progress, it was not a lot for 12 hours of work.

Stacy needed to shed a few tears of disappointment and frustration. We talked about options- she needed real rest (more than a narcotic drug could offer) and we needed progress. She decided an epidural for rest, and to have her water broken to hopefully augment the labor and help with progress. Lisa thought it was a perfect plan.

We got things ready– it took a while to get fluids in, and call anesthesia in, but we finally had an epidural in place by 7:40pm. It was time to rest! By 8pm, she felt like she could close her eyes and get some real sleep. I headed home for re-inforcements, a shower, and dinner… and told her I’d be back but would let them sleep. I’d be “in house” but wanted them to have privacy and quiet.

I returned at 10pm and let them know I was there, but to let me know if they needed me. Daniel texted me at 1:30am saying the last exam was the same, and contractions were 5-7 minutes apart. The baby was a little unhappy, so they were not going to proceed with pitocin. By 2:15am I received another text that Stacy was feeling pressure and wanted me there. By the time I got into their room, Lisa had already checked her and she was 8cm!! The head was coming down nicely! That’s what all that pressure was about! It was great news!

We turned Stacy over and helped her get comfortable again. The baby had one big scary deceleration at 2:45am, but oxygen and a position change resolved it just fine. After that we watched him carefully, not sure what had caused that. From 3-5:30am, it was fairly quiet and both Daniel and Stacy got some rest, while I dozed and kept the room quiet.

Amber came in at 5:45am and did an exam– Stacy was complete, but the baby was still too high to start pushing, so she said we’d just continue to “labor down” a while longer. It would most likely be the day shift who would help us with pushing. That was fine with Stacy- more rest sounded good!

We dozed more– by 7:30am our new nurse Jackie (a traveling nurse midwife from Minnesota) came in, checked Stacy and said it was pushing time! She was full of energy and Stacy needed a moment to “catch up” to her. Jackie was a VBAC mom herself, so knew how important this was to Stacy, so suggested gentle pushing so as not to stress the baby. She recognized his reserves were low and we wanted to proceed cautiously.

By 8am, we started with side pushing, gently– lots of encouragement from Jackie. Dr. Schiemenz came in (our 4th care provider!) soon after and praised her efforts– the baby was almost +3 already! We continued gentle pushing, rotating Stacy from right side to left side periodically. That baby needed time to mold and rotate– we made progress, but it was slow and gentle. Any time he acted up, we just paused and took a break. After a while, Stacy started to feel the urge to push, despite the epidural, and was having a harder time not pushing hard– she was following her body’s signals now!

Over time, the baby’s head slowly came down, we saw the first sign at 10:15am, and by 10:45 he was almost crowning! Dr. Schiemenz was super patient, offering gentle encouragement and very slight massage to encourage Stacy’s tissues to stretch. At exactly 11am on Saturday, May 25th, 60 hours after regular contractions had first started, Xavier James was born. He was placed directly onto Stacy’s belly, where she and Daniel were thrilled (and almost shocked) to finally meet him! Stacy cried with relief and joy, she had done it! Despite odds, exhaustion, and everything, she had her VBAC!

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How does a doula really make a difference?
Results from different studies have all suggested that having a doula reduces the overall cesarean rate by 50%, Pitocin use by 40% and requests for epidurals by 60%. The use of a doula also showed a major reduction in the length of labor due to fewer stress hormones being produced in the laboring woman’s body.

The Doula Book © 2002; Klaus, Marshall, Klaus and Kennell.