Norah   S and J started care with me early in the first trimester of their second pregnancy.  They desired a birth much different than their first.  Their first birth was full of hospital interventions, and this time they wanted to birth on their own terms, in the comfort of their home. Pregnancy was pretty uneventful.  At 39.3 weeks, S text me at 330 in the morning and said her water had broken.  Water breaking first in labor is not an overly common thing, happening in approximately 10% of births.  It is also an unfortunate thing to happen as it does start that awful “clock.”  Being that S was GBS negative, we had a longer clock, and felt certain things would progress. S said she was tired, so I encouraged her to sleep since baby was moving well and no contractions had started yet.  I sent a text my awesome mother-in-law and asked her to come to my house at 7 to watch my boys since my husband was out of town, and then tried to get a couple more hours of sleep myself. S text that she was awake, and I arrived around 845 that morning to do the first assessment and give some suggestions.  Vitals were perfect.  Cervical check found S to be 3-4cm dilated, 60% effaced and baby at a -1 station.  Baby was definitely acycnclitic as I could feel the top of her ear very clearly.  We talked about taking vitamin C frequently, hibiclens washes and curb walking to move baby’s head.  S and J wanted to run to get breakfast and run a few errands.  I discussed the possibility of doing acupuncture later that day if contractions had not started. S text me that the acupuncturist was going to come at 2.  I told her I would arrive then as well.  Looking back and talking with S, her instincts didn’t feel good about it, but she did it since I encouraged it.  The acupuncturist arrived late, at 3 pm and started the three hours of labor induction.  It did virtually nothing.  S had a handful of contractions and some cramping, but nothing much more than she had prior.  Her vitals still looked good.  S wanted to go have dinner with her parents and wanted to rest.  We discussed that I would come over bright and early the next day to do a variety of things to try and encourage contractions if she did not call me sooner. I arrived at S’s house around 740 the next morning.  She stated that at 330 again (notice this time is a running theme!) she had another large gush of fluid.  After that gush, she felt crampy and contractions that pulled her out of bed around 6am.  They were coming about every 5 minutes, short and mild, but labor had started.  We were all very happy! I did a cervical check and found S to be 4-5cm/70%/0 station.  We began some herbal tinctures to help contractions come more frequently, and diffused clary sage and thyme essential oil to help contractions come stronger. We took S for a walk, with some curb walking.  She sat on her ball, walked around her home.  She did excellent alternating positions.  Vitals were perfect, and S was doing great at listening to her body. Close to noon, S asked if the birth team would leave for a bit so she could rest and regroup.  We left to eat lunch and let S get some rest. We arrived back around 130.  We decided to try one dose of blue cohosh and see what it would do to the contractions.  It was just the trick we needed.  Contractions shifted and S moved into active labor.  S alternated doing hip circles, sitting on the ball, lunging, hands and knees encouraging baby to rotate and move on down. A little after 3pm, S moved to the bedroom to rest and do hands and knees.  Contractions were coming every 3 minutes, lasting over a minute.  S stated that these definitely felt harder. At 3:40 I performed another cervical check on S.  She was 5-6cm/80%/0 station.  Vitals were perfect.  S decided to hang out in her bedroom for awhile. We could hear S lightly moaning with contractions.  It seemed it was time to start preparing her birth pool.  We added some air to the pool and began filling it with warm water so that it was ready for when S was ready for the pool.  Contractions were coming every 3-4 minutes, lasting 90 seconds and appeared to be strong. A little after 5pm, S was ready to get into the pool.  She labored in hands and knees position, with J beside her.  She snacked and drank between every few contractions.  The birth team hung out in the living room letting S and J labor together. S labored beautifully for the next few hours.  Close to 8pm, S asked to be checked as she was feeling pressure.  She was 6cm/90%/+1.  She was feeling tired and discouraged, hoping she was closer to pushing her baby out.  She decided to get out of the birth pool to get some rest in her bed with her spouse. A little after 10pm, S decided to get back into the pool.  The lights off, S gently moaned and rocked with each contraction with J by her side. As midnight appeared, I talked to S about doing another check.  We talked about how it had been 4 hours and since she was having hard, close contractions for many hours, we want to be sure that progress was being made.  S and J agreed and I did a cervical check.  S was 6cm/70%/0 station, with cervix swelling.  I had to share the news with S and J and have the hard conversation with them about what to do next in their labor journey.  Mom and baby looked perfect and S was doing beautifully, but with no change and a swelling cervix it seemed time to call it and go to the hospital.  They asked for a moment and decided that they would like to transport.  We talked about what the hospital would look like so that S and J were prepared.  S took the time she needed to mourn the birth she so wanted. We left the home around 1am for the hospital.  The on call OB was not supportive of S continuing to labor and ordered for a cesarean.  S felt at peace with that decision. Sweet Norah was born at 3:21 am on July 1 weighing 6.7#, 20.5″ long.  She latched right on and took to breastfeeding right away, to S’s relief. Transports are always sad for me, as I want this beautiful, peaceful home birth for them too.  S was amazing.  Labored so beautifully and calmly.  Her strength impresses me.  <3