Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

“I Needed to Know My Body Could Do It!”: A VBAC Story March 26, 2009

Last week I had the honor to be a part of one of the most beautiful VBAC (Vaginal Birth After Cesarean) hospital births I have ever witnessed. I would like to share that couple’s story with you today as both a feel-good tale of personal triumph and a story of inspiration for all those moms planning a VBAC out there that might stumble upon my blog. Since this is a blog about “a nurse’s view from the inside” this story is probably much different than any other birth story you might have read from the mother or father’s point of view. But then again, maybe that isn’t so bad! Enjoy!


It was ten to 11 o’clock am as I walked through the lobby doors of the hospital I work at, rushing towards the elevator so I could punch in on time. As the elevator doors started to close, a hand shoved through the crack, forcing the doors back open. “Please make room!” said the woman, a phlebotomist who works in the hospital, in a shaky voice, “Woman in labor here!!” Following behind was a very pregnant woman, huffing and puffing as she waddled into the elevator, followed by what looked like her husband and her mother. “Don’t touch any buttons!” said the phlebotomist, “We’re going right up to labor & delivery!” Since that was where I was headed too, I smiled at the husband and said, “Don’t worry, you’re here now and she won’t have the baby in your car! I work up on L&D so I’ll show you were to register.” Something told me that if this woman was truly in labor then she would be assigned to me since I was just starting my shift. But she had to “pass” triage first, so after helping the family to the registration desk, I hurried into the locker room to change into my scrubs.

Fifteen minutes later the triage nurse came to the main desk, “I’ve got a term mom, 40 weeks 5 days, who’s five centimeters,” she said, “We’re gonna need to put her in a room…. And she’s a VBAC with a ‘birth plan’.” “I’ll take her!,” I said excitingly, knowing that I have my best days when I can assist a woman through labor, as opposed to getting stuck on the OR team or in the high risk ward running magnesium. (Not that those women don’t need a lot of TLC too, it’s just that I like labor the most!) Birth plans, natural unmedicated labor, and getting my patients out of bed…those are my specialties! I quickly set up the room across the hall as the resident finished the patient’s history and physical in the triage room. Then I quietly knocked on the triage room door and let myself in. The patient, Alyssa*, was standing by the bed, rocking her hips back and forth, as the continuous monitors strapped to her abdomen traced the baby’s heart rate and her contraction pattern. It looked like she was contracting every 3 minutes, and the baby’s heart rate was beautiful and reassuring. Her husband, Jared, was leaning nervously against the wall and her mom, Deb, was sitting quietly in the corner. I could really tell that Alyssa was lost in “Laborland” and I wanted to make the transition to her room as seamless as possible as to not break her rhythm and concentration too much. I quietly introduced myself and with the help of Jared and Deb, moved all of their belongings across the hall as Alyssa waddled behind.

I could tell that Alyssa was coping well with the contractions while standing but a quick glance at her prenatal summary revealed that she was Group B Strep positive and would need IV antibiotics (our hospital’s policy) and hence, and IV. Now I feel that I am pretty skilled at starting IVs, but I have not yet mastered starting an IV with the patient standing and swaying! So in the two minutes between the contractions, I explained to the Alyssa what I needed to do before the admission process was complete: get 5 more minutes of continuous monitoring on the baby (to equal the “20 minute strip” my hospital’s policy requires before we can switch to intermittent auscultation), take a set of vital signs, draw three tubes of blood, start an IV, and ask a few more questions. “Give me 8 minutes sitting on the bed,” I said, “and I can have everything but the interview done. The rest of the admission can be done with you standing up.” “Okay,” she said, “I can do eight minutes.” Eight minutes later the IV was in, antibiotic running, labs drawn and sent, vital signs done, monitors were removed, and the patient was helped out of bed (Phew!! That was close!! J). And it wasn’t a moment too soon because Alyssa was having a lot of back labor and sitting in bed was just making it worse!

Then there was a knock at the door. Here’s how the subsequent conversation went down…

Me: “Who is it?”

Med Student: “It’s just the medical student,” (said as he walked right into the room)

(I hadn’t yet gotten a chance to ask Alyssa if she was okay with medical students so I just kind of looked over at her and Jared and tried to judge their reaction.)

Med Student: “Hi I’m Michael. I have to ask you a few questions.”

(Have? How about “Is it okay if I ask you a few questions? Sheesh!!)

Med Student: “Are you being induced today?” (asked as he stared down at his paper)


Med Student: “Okaaaaay. Umm, any problems with this pregnancy?”

Jared: “Do you really need to ask these questions right now? The resident already asked her that stuff.”

Med Student: “Umm yeaaaah, I do. There is a lot of repetition but we have to ask again.”

Deb: “Doesn’t her prenatal summary tell you all of that?

Med Student: “Ummmmm….”

Me: “With all do respect, Michael. But I think they are trying to tell you that they do not want any medical students. Or anymore residents for that matter. Okay? So I think we are done here.”

Med Student: “Ummm, what am I supposed to tell the resident?”

Me: “Tell her I said that the next induction that comes in is all yours.”

As the med student left, Jared, Deb, and Alyssa all looked at me simultaneously and said “THANK YOU!” “I don’t think he was getting the hint,” said Jared. “Yeah,” I said, “I figured he needed it spelled out.” In hind sight, I think this was one of the moments that really helped me to bond with this family because after all, I understand how difficult it must be for families to come into the hospital and have to work with a nurse that they have even never met during one of the most intimate experiences of their lives!

I spent the next fifteen minutes finishing up the patient’s admission assessment as quickly as I could. I told Alyssa that if she was having a contraction to just ignore me, and asked Jared to help answer any questions he knew the answers to. (Unfortunately, our hospital’s pre-registration does not include performing an admission assessment and hence, it has to be done on arrival to the hospital. Usually, if a patient comes in for false/early labor a time or two, it gets done then but Alyssa had not been to the hospital her whole pregnancy, which is great, but it meant that I did have to bother her with some silly questions during labor. Kind of a bummer, but with the help of Jared, it went pretty smoothly.) It was during the admission interview that I found out some of the details of Alyssa’s pregnancy and prior cesarean section. Alyssa had an unremarkable health history and a normal, healthy, uncomplicated pregnancy. She was a G2P1, but since her first baby was born by cesarean section, she technically was considered to be a “primip” (healthcare slang a woman who is about to deliver her first baby) regarding a vaginal delivery.

Jared told me that when their son was born two years ago, Alyssa was persuaded into an induction at 39 weeks for “LGA” (a.k.a. large for gestational age, which by the way is NOT recognized as an appropriate indication for induction of labor by ACOG), was first given a few doses of misoprostol to “ripen” the cervix, followed by pitocin to stimulate contractions and continuous external fetal monitoring to monitor those contractions, then given a couple doses of Stadol and eventually an epidural for the pain, followed by artificial rupture of membranes to place a fetal scalp electrode after the epidural dropped Alyssa’s blood pressure and caused a prolonged fetal heart rate (FHR) deceleration, then an intrauterine pressure catheter to assess if the pitocin induced contractions were “adequate”, and eventually a cesarean section after 1 hour of pushing in a back-lying position for “failure to descent & cephalopelvic disproportion (CPD).” Thirty minutes later baby Kevin was born at approximately 2:00am, weighing in at 7lbs, 5 oz.

In my opinion, Alyssa was a victim of the “cascade of interventions.” Many maternity interventions, including elective induction, pain medication, artificial rupture of membranes, epidural anesthesia, back-lying positions for labor or for birth, etc. have unintended effects. Often these effects are new problems that are “solved” with further intervention causing a domino effect that ends up creating yet more problems. This chain of events has been called the “cascade of intervention” and unfortunately often leads to vacuum extraction/ forceps delivery, episiotomies or 3rd or 4th degree tears, and even cesarean section. Many of these women are often also then mislabeled with diagnoses like “CPD,” “failure to progress,” “failure to descent,” and at the end of it all, the obstetricians turn around and say, “Thank God we were in a hospital; look at all the technology we needed! So when will your repeat cesarean be??”

This time, however, things were different. After the birth of their son, Alyssa and Jared started to research more about labor and birth, VBAC, and natural birth. They interviewed and chose a doctor (Dr. Z) that was supportive of natural birth and VBACs, with the statistics to prove it! And here they were now, at my hospital, ready and rearing to go! Alyssa said that for the past few days she had been having contractions “on and off” but that they really started to get going at 8:00 am. When the resident had checked her on admission, her water spontaneously broke during the vaginal exam at 11:15am. It was now 11:45am and Dr. Z’s midwife entered the room. Although it had only been 30 minutes since her last vaginal exam, the midwife decided she would check Alyssa again since she seemed pretty active. And boy was she ever! The midwife’s exam showed that Alyssa had progressed to 7-8 centimeters! “I don’t think I can do this anymore,” Alyssa softly whimpered to the midwife. We all reassured her that she was doing so well and that things were getting more intense for a reason and to stick with it!!

The midwife then offered to help Alyssa into the shower to help alleviate her back pain. Alyssa seemed skeptical at first but we assured her that if it wasn’t helping, that we could get her right back out. So Alyssa agreed and the midwife and I, along with Jared, helped the patient into the shower. What happened for the next hour was one of the most beautiful displays of love, perseverance, hard work, and dedication I have ever witnessed. Alyssa turned her back to us and rested her hands on the grab bar on the shower and her head on the shower wall. Her cadence was this: Between contractions she would sway side to side, as if she was slow dancing. During contractions she would squat up and down, up and down, moaning in a low tone as she carried out her ritual. She just moved with the rhythm of her labor, listening so instinctively to what her baby and her body were telling her to do. Jared used the hand held shower head to spray Alyssa gently with a stream of warm water up and down her body, concentrating mostly on her lower back. I quietly entered the bathroom a few times that hour to check the baby’s heart rate with the portable doptone, trying hard not to disturb Alyssa’s concentration. Mostly, however, the midwife, her mother, and I stayed outside the bathroom door as to give Alyssa & Jared the privacy they needed to facilitate the progress of her labor.

At 12:35pm Alyssa told me that she was starting to feel a strong urge to push. The midwife entered the room and as Alyssa knelt in a hands and knees position in the tub, the midwife checked her cervix. To everyone’s surprise Alyssa only had an anterior lip of cervix left to go (this means she was about 9 ½ centimeters dilated)! After the next contraction, Jared and I helped Alyssa out of the shower to the toilet where we both used warm towels to dry her off. Then Alyssa walked over to the bed, “Can I kneel on my hands and knees?” she asked. “Sure!” we all said in unison, as we helped her up onto the bed. “I feel like I have to push!” Alyssa said convincingly and when the midwife checked her cervix, the anterior lip was gone…Alyssa was fully dilated at 12:45pm, only 1 hour and 55 minutes after arriving at the hospital! “You can start to push anytime,” said the midwife.

One of the best things about being a part of this experience was the fact that it was one of the only times that I have been present at a delivery where that a birth attendant has allowed the mother to use spontaneous or mother-directed pushing, as opposed to directed pushing. I knew that Alyssa was interested in using a variety of pushing positions for the second stage of labor from her birth plan and for the next hour and a half the midwife, Jared, Deb, and I helped Alyssa get into a variety of positions including right/left side lying, squatting, hands and knees, and kneeling.

(Side Note: I would like to digress for a moment to point out how important it is to be physically fit during your pregnancy whether you are planning for a natural birth or not. Many a woman I take care of blindly fills out a “birth plan” they find online where they can click on the boxes for options that sound “good” to them, without actually researching or thinking over what they are writing down. For example, they say that they want to try squatting during labor and birth, but couldn’t even do a squat at the gym pre-pregnancy. Although it is definitely true that a woman can sum up and realize an incredible amount of strength during labor and birth related to not only hormones but also sheer will power, it should also be known that labor is HARD WORK and pushing out a baby is HARD WORK which both require a great deal of physical strength and stamina. This is yet another reason why it is so important to follow a modified exercise plan and eat a healthy well balanced diet rich in protein and omega-3 fatty acids before, during, and even after your pregnancy.) Let’s continue with Alyssa’s story…

What was so amazing was that although there were plenty of times during the labor and pushing phase that Alyssa would doubt her ability to go on (“I can’t do this anymore!” “The baby isn’t moving?” “Is the baby moving?” “I am so tired!”), she never gave up on herself. Each time she made a comment like that, we all took it as a request for more support. And every time we gave her more encouragement, cheers, and reminders of her progress and goals, (“Keep going!”, “You are doing so well!”, “We can see so much more of the baby’s head!”, “She has lots of hair!”, “Just a few pushes more”, “You are so strong, you are going to do this!”, “You can do this!”), she found the ability to keep going! Towards the end of the pushing stage Alyssa was (understandably) exhausted and was pushing in a modified lithotomy position while Jared and I supported both of her legs. Then all of a sudden Alyssa popped up and said (and I quote) “I need GRAVITY! I need to be UP!” as she sat upright into a full squat and pushed her baby’s head out with one gigantic roar! “Whoa, whoa!” the midwife and I said almost simultaneously, “Easy, easy, baby pushes.” “Blow like you are blowing out birthday candles,” I said. The midwife checked for a cord around the neck (which there was none) and cleared the baby’s mouth and nose. And with only a few more “baby pushes” Addison Joy was born at 2:27pm!

The room erupted into cheers of excitement and tears of happiness J! I put the baby skin to skin on mom as I dried her off with warm blankets and cleared her mouth and nose with the bulb suction. A quick palpation of the baby’s cord revealed that her heart rate was nice and strong and she was pinking right up! Jared and Alyssa kept hugging and kissing each other and talking to their new baby girl, “Hi Addison! Hi baby girl! I am so glad to finally meet you!” The midwife waited until the cord stopped pulsating before she cut it (per mom and dad’s birth plan) and checked Alyssa for any tears. Except for some swelling, she only had a small tear on her right labia that didn’t even require any stitches!! We kept mom and baby skin to skin for a full hour after birth and baby Addison nursed almost the whole time. When she was an hour old, I weighed her to satisfy mom’s curiosity and to everyone’s surprise the baby weighed 9 lbs 3 ozs!!! So much for “cephalopelvic disproportion” huh!!

And it was as I handed baby Addison back to Alyssa that she looked up at me and said softly, “I needed to know my body could do it. I knew my body could do it! I really needed this. Thank you.” So as you can imagine, I started to well up. I have never felt so honored to be a part of something so special. What a privilege to have a job where I witness the miracle of birth and the miracle of motherhood every week!


So let’s recap shall we. Alyssa, after having a cesarean section for her 7 lb 5oz son two years earlier for “CPD” and “failure to descent”, pushed out a 9lb 3oz baby after a 6 hour and 27 minute labor, including 1 hour and 42 minute of mother-directed pushing, without any pain medications or an epidural, monitored by intermittent auscultation, needing not a single stitch to her perineum! Her tools included good and relevant labor & birth preparation, appropriate and helpful family support, sheer strength, determination, and will power. The midwife’s arsenal included extensive knowledge of and experience with natural birth and labor support, a doptone, a trust in birth, and a belief in Alyssa’s ability to do it! No medications, no vacuums, no scalpels, no scissors, and no doubt!

Boy how I love my job sometimes J


*As always, names and any identifying information have been changed to protect privacy.

For more information on VBAC please visit: International Cesarean Awareness Network and Childbirth Connection


24 Responses to ““I Needed to Know My Body Could Do It!”: A VBAC Story”

  1. briome Says:

    Great, just great!
    I posted it on my group for a mother who is planning a hosptial VBAC in a few weeks!

  2. Molly Says:

    Oh Melissa! I am crying too! That is so beautiful!!! I wish you were my L&D nurse! I am so thankful that you exist in the setting you do… for now! Immagine what this birth story would look like if you were one of the “old school” nurses who really pushed interventions! Thank you for doing your job how it should be done!!!!! 🙂

    PS: what is the deal with those med students questions??? I had that too.. and it was so silly! WHY do they do that… there is nothing they could possibly learn from that… except how irriatated people get when you ask them stupid things when they are in labor!

  3. nursingbirth Says:

    thanks briome! It makes me so happy that you would post a link to this story on your ICAN website so that VBAC moms can be inspired and empowered! I really appreciate it!!

  4. nursingbirth Says:

    Thanks Molly, you are so sweet! I wish I was your L&D nurse too 🙂 As for you comment about “Imagine what this birth story would look like if you were one of the nurses who really pushed interventions!” I totally agree! And also, imagine if this patient had signed on with an OBGYN that she did not research and was not supportive of VBACs. It is so important to ask your OBGYNs specific questions and ask for STATs! Even midwifes need to be interviewed! It happens all the time where I work! It’s like they tell you one thing in the office but another when you are closer to your due date! It is SO frustrating!!

    As for the med student thing, I KNOW! Sometimes it is so frustrating and I just think to myself, “If this mom jumps up and strangles that med student, I am not going to stop her!” Haha! I mean, I understand that I work at a teaching hospital and that I was once a nursing student, and of course I try to be as nice as I can to the med students as to not “breed” an army of doctors that hate nurses one day! But honestly, sometimes they really need to learn some tact and sensitivity. You can “practice” your health history on the scheduled induction who is comfortable, NOT my 8cm active labor patient!! Sheesh!

  5. mamaseoul Says:

    Great to read another positive hospital VBAC. It is interesting to see a nurses’s perspective. My nurses were very supportive. I didn’t even have time to give them a birth plan, but they figured it out and just let me do what I needed to do.

  6. Phoebe Says:

    Beautiful birth story! What a lucky mom to have her natural birth and such a supportive nurse!

  7. Kristen O Says:

    What a beautiful VBAC story! Thanks so much for sharing it “from a nurse’s perspective.” I wish for all VBAC moms–and all moms who want a natural childbirth–to have a nurse as supportive and encouraging and knowledgeable and *trusting* of women’s bodies as you are!

    (And yes, I was also welling up with tears while reading this story–especially your description of her “roaring” her baby out. I always think of VBAC mamas as warriors, and it just seems fitting for this warrior to have roared out her baby.)

  8. nursingbirth Says:

    Thanks Phoebe!

    Thanks Kristen O! The best part is that I am not exagerating.

    “Then all of a sudden Alyssa popped up and said (and I quote) “I need GRAVITY! I need to be UP!” as she sat upright into a full squat and pushed her baby’s head out with one gigantic roar! ”

    The following scenario and quote actually DID happen! Haha! You can’t make that stuff up! 🙂

  9. luckeelady Says:

    Thanks so much for commenting on my VBAC post… your post is so inspiring. I wish I could be a warrior like that. Although I’m not sure if my doctors within the office support VBAC since I have not have a chance to really talk about it with them, I don’t think I would change doctors if they didn’t. I do have total trust in them, although I wish they would be supportive of what I want. I will check out those other websites you mentioned… I totally wish you were my nurse too! Too bad you’re probably not in the OK/AR area

  10. Joy Says:

    This made me want to cry… and has inspired me to be more empowered during my next birth as well! Thank you!

  11. paige Says:

    What an incredible story. Thank you so much for sharing it. I wish I’d found it a few months ago before my VBAC, but it is still inspiring to read.

    I recently had a successful VBAC and I can’t possibly express how important my L&D nurse was to me. I had and was thankful for my incredible midwife, a good doula, and the support of several family members, but in the heat of labor, the most intense part, the only part when I started to doubt my ability to do it…the only voice I heard was my nurse quietly making suggestions in my ear. I will never forget her.

    • nursingbirth Says:

      Paige, your story makes me well up!!! Thanks for sharing! Sometimes when work gets so crazy and the doctors are really getting to me I wonder if I am making a difference. Your story reminds me not to fall into the “trap” of working just for a paycheck. I do what I do for women like you!!! CONGRATS on your successful VBAC. You are an inspiration! I hope you keep reading 🙂

  12. terrajones Says:

    That was beautiful!

    I’m bawling.

    I had a VBAC this past August…and I remember thinking (may have said, too, lol) those exact words, ‘I just needed to know I could do it….’

    It’s such an amazing thing…

    Thank you for sharing their story!

  13. Misty Says:

    That was such an amazing story! I think you so much for sharing! After having 2 sets of twins.. 1st set vaginally, 2nd set emergency crash c-section; and never ever wanting another c-section I thank you a million times over! Reading stories like this help that little voice in the back of my head into remember that I can and have done it before you bet your arse I’ll do it again!

    I just wish that next time I have a nurse as awesome as you!

  14. sarah Says:

    Sorry to comment on an older entry… you should have asked the couple if the med student could stay in the room if he just shut up!
    It would have been great for him to see an awesome VBAC like that, maybe make him to be an OB supportive of VBAC and natural labor.

    • nursingbirth Says:

      sarah, i hear what you are saying and I agree it would be great if more med students could “see” natural births like this VBAC instead of only the high intervention ones. However in this particular situation my gut was telling me that this couple would not benefit from the med student being there just to “watch” and it’s not quite fair for the med student to benefit and not the family. I encourage all students (med students, nursing student, EMT students etc) to find ways in which they can become part of the team of support for a laboring mother as well as the family. If they can find ways to be truly helpful, then they switch from being just voyeuristic (NOT helpful to the mom and labor process) to being part of her support system (VERY helpful to the mom and labor process.) Sadley, many medical students just want to get their “stats” filled, that is, get 5 doctors to sign 5 slips saying they watched the delivery and have no desire to be a part of the support team which is where they REALLY learn a lot.

  15. […] “I Needed to Know My Body Could Do It!” – A VBAC Story from Nursing Birth – Check out this wonderful VBAC story, told from a nurse’s perspective.  My favorite part is when the mom literally gets up and roars out her baby. […]

  16. Jill Says:

    YAYYY!!! I love happy VBAC stories! WTG Alyssa! I wish ALL hospital births could be like this!

    And I know how great it feels to know that your body is NOT broken, after all. I never believed mine was, but after my VBAC, I knew for SURE.

  17. tammie Says:

    this brought back a flood of memories. in dec. 1983 i gave birth to my son by c-section. it was considered an emergency and my husband was not even allowed in room during the delivery. i had arrived at the hospital quite early on dec. 5th and felt like I was having contractions, but the nurse said tell me the next time you feel a conraction. i did and she said “i’m not impressed”. this was quite disheartening, but my hubby and i started to walk the halls and i had been feeling some trickling and i thought maybe my water had broken. i told the nurse and she checked and sure enough it had and she said i would stay for sure now. after a day of leg and back labor and a pitocin drip, i was exhausted and hooked up to a fetal monitor. there were a couple of signs of fetal distress, but too quickly i was wheeled to the delivery room for the c-section. i didn’t even see my baby until i was being wheeled to my room. i cried when i saw him and touched his sweet face, but almost immediately i felt a loss because i had not had a vaginal delivery. it’s strange i felt this way, but i understand it’s quite common. i even felt my husband might think less of me because of the c-section. when we began to thnk about our 2nd child, i wanted to find a dr. that believed in VBACs and i did. my pregnancy went beautifully just as the lst one had after i got past the lst trimester of extreme morning sickness. one thing unusual about this pregnancy though was i spend apprx. the last 3 wks with a cast on my left ankle due to a chipped bone in my ankle. i got the cast off on april 29th and before midnight i thought i could possibly be in labor. we arrived at the hospital shortly after midnight and my baby girl was born at 3:43 apprx. three hours after arriving at the hospital. when the nurse called my dr., she asked, “does she still have her cast???” to which the nurse said, “cast, she had a cast?” i was so scared that i wouldn’t be able to deliver vaginally but 3 little pushes and she was born. it was a wonderful experience. thank you for letting my share my story. this baby girl just graduated from nursing school in may, takes her NCLEX on Thurs. and has her 1st twelve hour shift tonight at a children’s hospital. my, how time flies.

    thank you for being a patient advocate and standing up for what you believe in. You are truly an inspiration. Have a great day!!

    • nursingbirth Says:

      tammie, i just got a little choked up when you ended your story with how your daughter graduated from nursing school and just started her first job!!! Thank YOU so much for sharing your story here! This is one of my favorite things about having a blog…reading other women’s stories!! Tell your daughter I said “Good Luck” and to NOT study the day before her NCLEX…but to REST and do something FUN!!!

  18. doula_amy Says:

    What a beautiful story! I am sitting here with tears in my eyes. I am so happy for this strong and wonderful mama!

  19. See Says:

    Thank you for sharing such a beautiful and touching story. I had my vba2c in july of 2009 and am ready for another vbac in the next couple of weeks. This story gives me renewed inspiration and hope for my 4th child’s upcoming birth. Thank you. I hope my L&D nurse is as sweet and understanding as you!

  20. Michelle Says:

    Wow, I’m a complete basket case of tears right now. You are an amazing nurse. And lucky for me, remind me a lot of my L&D nurse and doula during my second vbac (which was natural)! Thank you for sharing this birth story from your point of view. It was beautiful!

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