The Truth about Labor after Premature Rupture of Membranes: My Induction without an Epidural

This is the birth story of my first child, Ruby.

Before going into labor, I was planning a peaceful, unmedicated birth at a birth center with as few interventions as possible, but that’s not how things unfolded. After nearly going overdue, experiencing a failed midwife’s induction, premature rupture of membranes (PROM), three days of labor, a hospital transfer, a Pitocin induction without an epidural, and using nitrous oxide to help me cope, I finally gave birth to my daughter.

It wasn’t the birth I had planned, but it was the birth that made me a mother.

One of my favorite ways to prepare for labor was by reading birth stories, so I hope that sharing my experience can be helpful to some of you and provide a little strength for your own journey!

Preparing for Birth

I did a fair amount of research for a first-time mom. I read Ina May’s Guide to Childbirth as well as Natural Childbirth: The Bradley Way. It was during COVID, so no in-person birth classes were available, but I took the Lamaze online birth class with my husband. My sister and mother had both had unmedicated births, and I fully expected to have the same experience.

My baby was due December 16th, and many of my family members traveled to visit us, excited to spend Christmas together and meet the new baby! But my due date came and went, and Christmas came and went, too. I tried to remain calm and patient, but the mental pressure really started to build.

Adding to the stress, we had initiated an insurance provider switch that would take effect at the start of the new year. If I gave birth after December 31st at midnight, the birth would be considered a preexisting condition under the new plan, and we’d be stuck with the entire bill.

To avoid this, we decided that if I hadn’t gone into labor by December 28th, we would schedule a hospital induction. But I really didn’t want to start the cascade of interventions, so we also planned to try a midwife’s induction at the birth center the day before.

The midwife we spoke to about scheduling the induction wasn’t optimistic about it working. So, while we planned to go to the appointment, we weren’t mentally prepared to stay if labor actually started.

December 27th, Start of The Midwife’s Induction

At 41+5, we went to the birth center for our appointment. The midwife on call (let’s call her Sarah) checked my cervix. I was 70% effaced but not dilated at all. The check was very forceful and painful, she was attempting a membrane sweep, which I was fine with at the time. However, I didn’t realize then that membrane sweeps can cause premature rupture of membranes, and looking back, I believe that’s what led to my water breaking later that day.

They asked if we wanted to go home or try the midwife’s induction, and we opted to go for it. We hoped it would jumpstart labor and help us avoid interventions like Cervidil and a Foley balloon at the hospital.

We went to Chick-fil-A, ordered a chocolate milkshake, and mixed in the castor oil. I drank it at 2 p.m., and honestly, it wasn’t bad, I could hardly taste it!

Back at the birth center, we checked into the Peach Room, and I started alternating black and blue cohosh every 15 minutes while walking laps around the parking lot. A new midwife was on call, let’s call her Rebecca. She was much more optimistic about the midwife’s induction working.

At 3:40 p.m., while walking outside, I suddenly felt a gush followed by a trickle, my water had broken!

We tested the fluid, and sure enough, it was amniotic fluid. Unfortunately, because the first midwife had discouraged us so much, we hadn’t packed our labor bag, so I had nothing to change into! Luckily, the birth center had a spare nightgown for me to borrow. Looking back, I can’t believe we made that mistake!

At first, I was encouraged, thinking that my water breaking meant labor was starting. But I didn’t realize then that premature rupture of membranes would ultimately complicate my birth experience.

Premature Rupture of Membranes: The 24-Hour Countdown Begins

Premature rupture of membranes is when the amniotic sac breaks before labor begins. It affects about 8-10% of pregnancies. The main risk of premature rupture of membranes is infection since the protective barrier around the baby is gone.

Many women go into labor naturally within 24 hours, and if they do not (like in my case), many providers require the start of an induction to prevent infection.

Premature rupture of membranes put me on a 24-hour deadline to go into active labor, or have to transfer to the hospital. It also meant hourly monitoring of the baby’s heart rate to watch for infection.

The hourly checks made me feel like a watched pot that wouldn’t boil.

The First Night: Labor Begins But Stalls

Everyone talks about how castor oil causes stomach distress and diarrhea, so I had prepared for the worst! Hilariously, my body just digested it like normal food. Maybe I have a stomach of iron from all my years living in China.

Since I had planned to have my mother and two of my sisters at the birth, they packed their bags (and ours) and came to the birth center. Looking back, it was too many people. I love my family, but as a first-time mom, I underestimated how much privacy I would need during labor.

We were optimistic that all of our efforts, the castor oil, the herbs, and my water breaking would surely start labor that night. My husband even booked my mom a hotel nearby so she could rest and be ready to come back when things picked up.

By the evening, I was having short, frequent contractions about 1 minute long, 2 minutes apart. My sister gave me back rubs through them, but every time a midwife or nurse walked in to check the baby’s heart rate, my contractions stalled.

Labor continued like this for 10 hours. The contractions were strong enough to keep me awake, but not strong enough to actually progress labor.

December 28: The Morning After, a Tough Decision

At 7 a.m., I had another cervical check. I was only 3 cm dilated.

I felt so discouraged after laboring all night with little progress.

Rebecca suggested Therapeutic Rest, a medication to help me sleep so I could wake up refreshed and hopefully in stronger labor. I didn’t know at the time that this medication could pass to the baby, but I was so exhausted that I was willing to try it.

I slept for about three hours, and when I woke up at 11 a.m., my contractions had completely disappeared.

Pushing Past the 24-Hour Mark

A new midwife was now on call, let’s call her Laurie.

I knew that if I didn’t go into active labor soon, I would hit the 24-hour mark and have to transfer to the hospital.

I walked constantly around the small parking lot, took the herbs again, and did everything I could to get labor going. But, nothing happened.

At 4 p.m., the midwives gave me two choices:

1. Go to the hospital for labor augmentation with the midwives.

2. Go home, lose midwife care, and just go to any hospital when labor finally started.

Of course, I didn’t want to go to a hospital without the support of the team I had trusted my whole pregnancy, so we chose to transfer to the hospital.

We packed up, and I talked with my mom and sisters. Since this was during COVID, only one person could come with us. We sent my mom and younger sister home, and my older sister stayed with us.

The midwife called the hospital to transfer me, but UNC was overcrowded and understaffed. They said they had no room for me and would call when a bed became available.

So… we just kept walking and waiting.

December 29th: The third day, more walking, waiting, and pumping

I was surprised when I woke up in the morning to find that the hospital still hadn’t called. My sister reached out to one of her friends, who suggested I try using a breast pump to help induce labor.

So I began a routine:

• Pump for 20 minutes

• Walk for 20 minutes

• Repeat

I learned that it was better for my mental state not to know the exact timing of my contractions. I also felt much more at ease with fewer people in the room.

As the day went on, my contractions grew stronger and closer together.

By 3:45 p.m., Sarah was the midwife on call again. My husband was helping me through a contraction with a hot rice sock when she came in and suggested that I try getting into the birth tub.

I was excited, maybe she thought I was making some real progress!

They filled the tub, but as soon as I got in, I immediately felt my labor slowing down. Disappointed, I got out, dried off, and went back to walking and pumping.

Looking back, I think it was way too early to get in the tub. I wasn’t even in active labor yet!

The Forebag Breaks: Labor Picks Up Again

At 5:40 p.m., Sarah offered me another cervical check.

After all the walking, pumping, and contractions, I was only 4 cm dilated. I was so discouraged, it felt like I had been stuck between 3 and 4 cm forever.

She then discovered that I had a bulging forebag of waters. Apparently, since my waters had been broken for so long, they had resealed. She suggested breaking it to see if it would help kick my labor into gear. I agreed.

The moment she broke my forebag, my contractions immediately intensified and became far more painful.

Realizing that we might be in for a long night, my husband ordered Jimmy John’s, but I could barely eat. Labor was picking up fast.

We were just settling in, thinking that maybe this baby would actually be born at the birth center after all, when suddenly the hospital called. Our room was available.

The Hospital Transfer

We arrived at the hospital at 9 p.m. after a very intense, but thankfully short, car ride. Of course, it was pouring rain, and the GPS took us to the back of the hospital near the dumpsters. We had to walk through the rain, following signs to a different entrance because most were closed due to COVID restrictions.

I was on my knees in the passenger seat, bracing through each contraction. Laboring in the car was brutal.

When we checked in, a nurse told me I needed to wear a mask during labor. I just looked at her and said, “No, I can’t.” Thankfully, she understood and said I could skip the mask if I agreed to a COVID test, which of course, I did. It came back negative later.

As quickly as possible, we headed straight to the shower to keep coping.

Pitocin and Hitting My Mental Low Point

At 10:30 p.m., my midwife from the birth center (let’s call her Beatrice) arrived at the hospital to continue supporting me.

She offered to check my dilation, I consented.

I was at 5 cm.

After three days of labor, I was only 5 cm.

I felt crushed. Completely and utterly demoralized. I lost faith that I could ever dilate to a 10.

Beatrice told me that because my labor had been so slow, and my waters had been broken for so long, Pitocin was necessary. I pleaded with her that I didn’t want it, but she firmly told me, “You are here in the hospital because you need more augmentation.”

Looking back, I think she was right.

They started me on Pitocin. I felt so defeated.

Josh Becomes My Anchor

At this point, something deeply powerful happened between my husband and me.

I still can’t think about it without tears.

He just stepped up in the most incredible way.

We went back into the shower, and he was intensely present through every single contraction. He never broke concentration.

I would tap him when a contraction began, we would lock eyes, take a deep breath, and back into the hot water.

We began batching the contractions by 10, every time I finished 10, we would celebrate, and I would say, “I can do 10 more.”

It was intimate, intense, and meant everything to me. I would have given up at this point if it weren’t for him.

At some point, my sister came in and read me encouraging messages from my family.

The Pitocin worked, my contractions became stronger, more regular, and more effective.

I began yelling through contractions, which felt good, I was channeling my frustration and exhaustion into getting through each one.

December 30th: Transition and Nitrous Oxide for Pain Relief

At 12:50 a.m., Beatrice checked my dilation again.

I was at 7 cm.

Looking back, I should have felt encouraged. I had dilated 2 cm in 2.5 hours, whereas before, it had taken 3 days to get to 5 cm!

But all I could think was that I still hadn’t reached transition and the worst was yet to come.

I asked Beatrice if there were any pain relief options besides an epidural.

She recommended Nitrous Oxide (laughing gas), explaining that it wouldn’t affect the baby and would leave my system quickly.

I was so relieved to have an option that was in line with my birth goals.

She told me to ignore the anesthesiologist. He would say to breathe the nitrous during contractions, but she wanted me to breathe it in between contractions instead.

That poor anesthesiologist.

He was young, probably in his 20s, and looked traumatized after watching me scream through a contraction in between giving my consent. He asked, “Do you want an epidural?”

I remember feeling so determined when I looked him in the eye and said, “No!!”

I heard later from my sister that she overheard him asking the nurses at the front desk if I was going to be ok. They giggled at him and said, “She’s just in labor!” 

I couldn’t be in the shower while using nitrous, but honestly I was so sick of the shower at this point! It felt good to do something different. 

For the next 4 hours I labored with nitrous oxide in various positions, upright on the hospital bed, on the birth ball, and standing. I would breathe the nitrous between contractions and let myself go loopy, then when the contraction hit I would stop using it and yell. 

The nitrous oxide was interesting. It wore off before the contractions peaked, so in that sense it didn’t take away the pain, but it helped me mentally to forget where I was between contractions. 

Finally Ready to Push!

At 4:45 a.m., Beatrice checked me again. I was fully dilated!

It’s funny how the mind impacts pain.

The moment I heard I was at 10 cm, my mental state shifted completely. The anguish of labor was over for me after that point.

I tried various pushing positions, on my side with my leg propped up, kneeling upright on the bed, the running start, etc. In the end I used the squat bar at the end of the hospital bed. Pushing felt so good to me, so productive. I felt like I could finally do something to contribute! 

At some point my Pitocin IV fell out, and actually never got replaced before the baby was born. 

I also stopped using nitrous oxide during the pushing, as I found I needed all the oxygen I could get to push effectively. 

I remember the nurses and midwife saying they could see her head, one of them said “She has hair!” That really got me motivated to push harder! 

The Final Push: Meeting Ruby

I was coached to stop yelling and start holding my breath to push more strongly, and that felt very effective to me. 

After a little over 1 hour of pushing, Ruby was finally born at 5:51 am! 

I’ll never forget it as long as I live.

When her head came out, I thought I would still have to push her body out, but it just slithered out as easily as could be. Beatrice lifted her up to me through my legs. 

I was stunned.

I held her out a little in front of me, just taking her in. She lifted her head slowly, and looked at me with wide, large, beautiful eyes. We just stared at each other as if we were both thinking, “what just happened?!?” 

I pulled her close, and within moments started nursing her.

I was in bliss.

Immediate Postpartum

I remember that when the midwife came to cut the cord, I said in shock that I wanted to do delayed cord clamping! She told me it had already been about 15 minutes and the cord had stopped pulsing—my sense of time was so disoriented that I thought it had only been 1 or 2 minutes since she had been born! 

Going through such a long labor without an epidural was no easy task.

After all those hours of laboring and yelling, my voice was completely hoarse. To make matters worse, I had a 2nd degree tear, and came down with a cough! 

Thankfully I had my family and husband to support me. Once I got home from the hospital I just snuggled my baby in bed and they brought me tea and kept me comfortable. I felt so loved! 

Lessons Learned 

Looking back, the support from my husband meant everything to me and made all the difference in my ability to get through labor. 

Premature rupture of membranes definitely changed the tone of the whole experience. It created a sense of anxiety and watchfulness about time. 

I learned that it was better for me not to know the exact timing of my contractions, and instead just go with the flow of labor and accept it for what it was.

Although Ruby’s delivery didn’t go as planned, I was so grateful that she always had great heart tones and never showed any signs of distress or infection! 

I definitely wanted to do things differently the next time, but I was so grateful for all that did go well, and to get to meet my beautiful daughter.