Nikki, a 5 foot 1 inch woman who weighed 105 pounds, gave birth to three boys in a row by cesarean section and was done having babies. Her first boy was born by cesarean after an induced labor in which she got an epidural as it began. She was scared of birth, saying through the pregnancy that she, “wants my epidural in the parking lot!” With the help of Pitocin and an epidural, she got fully dilated and pushed for a few hours before they all decided that the baby was not going to be born vaginally and a cesarean was performed. Her baby was just over 8 pounds and the staff assured her that the cesarean was absolutely necessary because she had such a big baby and she was such a tiny woman that the baby simply couldn’t fit! She was surprised at how much sadness she felt after the birth – both dealing with a severe bout of postpartum depression as well as disappointment with her birth experience. When she found herself pregnant again, she played with the idea of having a VBAC but when the doctor told her, “If it was my wife, I’d want her to have a repeat cesarean” she agreed to a scheduled repeat cesarean. Her baby boy was born with a weight similar to his brother and she was again assured that she was too small to birth such large babies. She dealt yet again with postpartum depression and challenges breastfeeding. By the time her third baby boy was born, a VBAC wasn’t considered a realistic option as she’d already had 2 cesareans and being able to find a care provider willing to attempt a VBAC seemed impossible. Another round of postpartum depression and breastfeeding challenges that lasted months followed, and she knew that they were done having babies.

For the next two years after her last son was born, she became a doula and a childbirth educator. She read books, attended births, researched, and learned more than she ever thought she would. The more she learned, the more upset she became about her births. The sense of loss of the birth experience, the disappointment in her body, became unbearable. It affected her marriage as well as invaded her thoughts every day. She began to go to therapy to work through her many negative feelings regarding her births. She dreamed of how it would be if she got pregnant again, of the choices she would make, how it could have been different – but it was just a dream because she knew for a certainty that she and her husband were done having children. She didn’t want to face surgery again or the postpartum depression that was so overwhelming, and they already had 3 boys. She would have LOVED a girl and dreamed of things being different…but had to accept that she would never have a daughter, never have a vaginal birth, and for her postpartum depression and nursing difficulties were just ‘how it is’.

Until she got a positive pregnancy test! She was terrified, excited, anxious, in shock. It was one thing to dream about what you will do in a situation, and another thing to actually be in the position to make the decisions. But her decision had already been made…if she were to find herself pregnant ever again, she would have the baby at home and vaginally!

Nikki had spent 2 years being a professional member in the birth community where she lived and had made many friends who were doulas and midwives. She asked her friend who was a licensed midwife if she would be willing to attend her at home. Where they lived, licensed midwives were legal – but a licensed midwife could not legally attend a VBAC as the primary care provider. Nikki was determined and prepared for the possibility of having the baby at home without a medical care provider present. Her midwife friend knew a doctor that might be willing to attend the birth as a favor to her – so that she, the midwife, could provide care to her friend under the physician. Nikki was excited…what an opportunity!

Halfway through the pregnancy, Nikki and her family had an ultrasound, During the ultrasound they found that they were having a GIRL! All of her dreams seemed to be coming true! She floated through her pregnancy without any complications, enjoying her pregnancy for the first time ever. She didn’t realize with the first three that the process was something that could be enjoyed – it was always a ‘means to an end’ for her and she dreamed of her birth, of her daughter, and what was to come. She hired her doula, rented a birth pool that was put into the bedroom, and waited.

Nikki had never made it to her due date until now. Just after her due date, labor started with contractions that lasted through the night, getting stronger and stronger. She called her doula who helped her sway and relax and breathe through contractions, and called her midwife in the morning. The birth team (doctor, midwife, student midwife, doula) were all in place and contractions continued. She stayed 4 cm for much longer than she thought she would, but she knew that as long as the baby was healthy and not having trouble, and as long as she was healthy and not having trouble, she would not go to the hospital. She labored into the late afternoon and found that she was still 4cm dilated. She was frustrated, trying every position she knew of, feeling the baby kick and squirm and turn herself into a better position. When labor started, her baby was towards her belly (otherwise known as “posterior) and she had to spin almost in an entire circle until she was facing towards Nikki’s back before she could move into her pelvis. As evening wore on, the baby finally finished her spinning and nestled into the pelvis. Nikki’s water broke on its own (another first for her) and she was quickly 8cm!

The energy in the room was renewed as she had been 4-5cm since early this morning, and it was now nearing midnight. The end was finally in sight! She stayed 8cm for hours much to everyone’s disappointment. Nikki did everything she knew she should – she ate and drank and changed positions and moved and got on the birth ball and got into the tub and sat on the toilet. Still she was 8cm. Everyone left the room, leaving her and her husband alone to reconnect in privacy. In only took about 20 minutes before she asked everyone to return and requested another check, sure that she was done – and she was! Completely dilated and feeling an urge to push!

Pushing would be as challenging as the labor and progress was very slow. She used the birth stool, squatted next to the bed, tried hands and knees, and finally ended up in the position she never dreamed she would assume – on her back! It took 4 hours of pushing, but the baby’s head was beginning to crown. She took her hand and placed it on her baby’s head and felt her daughter’s hair in the palm of her hand…and it became real! “Oh my gosh!” she exclaimed, knowing that it was happening, all of her dreaming of this moment and it was really here! It was early morning and 5 hours after she had started pushing when she pushed with all of her might and her baby’s head slipped slowly – very slowly – out of her body. The midwife told her that the baby was a large baby and that she would have to push very VERY hard for the shoulders. Nikki pushed with everything she had, and the baby didn’t come out. The midwife encouraged her to push, that she could do it, push push PUSH! Nikki pushed with everything that was left inside of her as the midwife helped maneuver the baby’s shoulders. It took a few minutes more of pushing, but the shoulders began to come out very slowly, followed by the body that inched out slowly until past the baby’s belly.

Nikki reached down and helped lift her baby out and onto her chest and looked into the eyes of her baby – they did it!! She and her daughter had worked as a team, and now they were lying here in her own bed. She had never held a baby this new before as they’d always been whisked away and out of the room. She looked down and exclaimed to all in the room, “It’s a girl!” She and her husband marveled at their daughter and fell in love again. It wasn’t until they weighed the baby that they realized the full extend of their accomplishment – 9 pounds 13 ounces!! Over a pound and a half larger than her largest baby previously!

Nikki had some healing to do. She tore, but not enough to need stitching. She had spent over 24 hours in labor and was exhausted. Within 3 days she was exclaiming to the world, “SO much better than a C-section!” She braced herself for the postpartum depression, the nursing challenges, all of the things she had experienced the previous three times. The days wore on, and she waited for the challenges to begin. She was pleasantly surprised to find that she experience no signs of postpartum depression at all, breastfeeding was perfect and had no added challenges, and she felt great! What a difference!

Nikki had so many obstacles to overcome, and definitely felt a sense of triumph, Her body wasn’t broken, she could birth a baby, she could nurse a baby – she felt a sense of healing and closure. Now they know that they are done having babies, but for all the RIGHT reasons and not out of fear of what another pregnancy would do to her or her body or fear of the postpartum period. They are happy, their family completely, and she now knows that she can accomplish anything she sets her mind to. She had her baby her way, on her terms, in her home after having three cesareans and now she knew the truth – she is a powerful woman.