From Cholestasis to Birth: My Journey to a Positive Induction Experience with Vienna
“Despite the unexpected twists and turns, Vienna's birth was beautiful in its own way. It wasn't what I had planned, but it was more empowering than I could've imagined. It created a whole new part of me, stronger and more whole than I was before
Planning for an Unmedicated Birth at a Birthing Center
My second pregnancy was a rough one. I had a five-year-old, was working full-time and let’s be real…I was no longer in my 20s.
Even though I was much more exhausted during this pregnancy than I had been with my first, I still felt healthy overall. I had set my sights on giving birth at Our Birthing Center in Morristown, NJ. I was ecstatic about using the birth center because it wasn't open when I had my first son, although it was in the works. This time, I was determined to have the waterbirth I had envisioned and go home the same day!
But life and pregnancy can be unpredictable.
Around 35 weeks, I started to notice something unusual—an intense, almost uncontrollable itching in my hands and feet. It was the same symptom my sister had experienced with her pregnancies, and I immediately suspected cholestasis or Intrahepatic Cholestasis of Pregnancy (ICP). Although I wasn't a doula then, I had done my research and knew enough to bring it up with my midwife. She ordered lab work to confirm my suspicions. After a frustrating delay due to a COVID surge slowing the labs, she sent another test to a different lab to expedite the results.
NYC Half Marathon
Facing Cholestasis and Preparing for Induction
I received the call while heading home from cheering on my husband at his half-marathon in Central Park: the results weren't good. My bile acid levels were high, and I would need to be induced the very next day. I was 36 weeks and 2 days pregnant, and though I had hoped to wait until at least 37 weeks, my midwife felt it was too risky. I knew from my research how serious cholestasis could be.
Grieving the Birth I Had Planned
I was heartbroken. My unmedicated, water birth at the birthing center was no longer an option. Instead, I had to face a medical induction—a scenario I had feared because of the stories I had heard about the "cascade of interventions." It was incredibly emotional. I wasn't just scared for my health and Vienna's; I was grieving the loss of the birth I had envisioned.
I sat with these feelings, and after talking with my midwife, I decided to take control of what I could. I started reading positive induction birth stories, researching the different methods, and asking my midwife all the questions I could think of. If this was the birth path I needed to walk, I was determined to walk it with strength.
The Induction Plan
I spent the entire night before my induction rewriting my birth plan, absorbing as much information as possible about the process. Those who know me know I am a planner if nothing else. Learning all the things helps me feel better. I would not recommend that approach—I didn't sleep a wink and learned the hard way that you can't prepare for everything. That's something I always remind my clients of now: Let's have a plan for all different outcomes, but know we cannot predict what will happen!
Thankfully, my midwife suggested we try something a little different to avoid immediate medical intervention: she recommended taking castor oil at home and pushing the induction by one day to see if labor would start naturally. Though I was hesitant, I agreed to try one round. It was rough. I won't go into detail, but let's just say I spent a good amount of time in the bathroom! After that, I decided not to try castor oil again. We planned to meet at the hospital the next night to start the induction.
When we arrived that night, the induction began with a low dose of Cytotec (misoprostol). I tried to get some sleep and mentally prepare for the long journey ahead, but sleep never came. My nerves were still running high. In the dark, I talked to Vienna, telling her how much I loved her, how scared I was, and how I knew we could do this together. I told her I couldn't wait to meet her and how I already knew she would have her daddy's beautiful blue eyes. That connection, that conversation with her, helped me find some peace.
Just before I finally lay down to try to rest again, my midwife came in to check if I was ready for a second dose of Cytotec. I agreed, still hopeful but exhausted.
I took some time to look up a few more positive birth stories. I used some time to do forward-leaning inversions and other maneuvers to ensure Vienna was engaged in the pelvis (see more in my blog post here). If I wanted to minimize interventions, she would have to be in position and ready to go!
Managing Labor: Deep Breathing, Swaying, and Showers
Partner Support
My husband supporting me through my contractions.
A few hours later, at 6am, I woke up to a loud pop—my water had broken. I called my midwife, but she was attending another birth and would come as soon as she could. Contractions quickly ramped up, and I leaned into what I knew at the time, using deep breathing, rhythmic swaying, and rituals to manage the intensity. I also utilized the shower for relief, but the contractions were relentless, pushing into one another with hardly any space in between.
At one point, as the pressure and intensity grew overwhelming, I had the classic thought: I need to give up. It's something I've seen many women experience—a telltale sign that you're deep in transition, even if you don't realize it yet. I was in the thick of it, and I didn't know just how far along I was.
My midwife checked on me intermittently. I was coping well with contractions, so a few hours later, she was surprised to find I was fully in the thick of transition! It wasn't until the midwives were doing a shift change and my husband mentioned that I was saying I needed to push that they checked me—and discovered that Vienna was already well on her way.
Vienna’s Fast Arrival: A Suprisingly Quick Delivery After Transition
Meeting Vienna
“We did it girl. We did it”
At 9:12am, just about 3 hours after my water broke, Vienna was born. No one, including me, realized how quickly everything had progressed. Inductions are known to take hours, even days, but before I knew it, baby girl was in my arms. Her arrival was swift, and looking into her beautiful blue eyes was everything I had imagined.
Despite the unexpected twists and turns, Vienna's birth was beautiful in its own way. It wasn't what I had planned, but it was more empowering than I could've imagined. It created a whole new part of me, stronger and more whole than I was before.
Reflections on Choice and Flexibility
Looking back, what I've learned is that flexibility and self-trust are key when it comes to birth. Things don't always go the way you expect, and that's okay. Cholestasis threw my original plan out the window, and I had to grieve that. But I also embraced what I could control—staying informed, asking questions, and finding ways to make the experience as positive as possible.
The Importance of Doula Support During Labor
One thing I will say: this experience really highlighted why doulas are so necessary. My midwife was attending another birth when I needed her most, and that gap made all the difference. Doulas offer continuous support and focus that can make these unexpected moments feel less overwhelming.
Reflections on Adaptation and Choice
Looking back, I would tell any person facing a shift in their birth plan to lean into the process, even when it's part of their original plan. It is taking back your power and being a part of the process that really influences birth satisfaction.
The power of flexibility and being informed about your options is so important. Now, as a doula, I know the importance of helping families adapt and navigate unexpected changes, especially with diagnoses like cholestasis. My experience with Vienna taught me that birth can be beautiful, even when it looks different from what you envisioned. It's all about finding strength in the journey.
