#339 | Pitocin Without An Epidural Plus An Unintentional Free Birth

I'm Cynthia Overgard, birth educator, advocate for informed consent, and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Show. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

My name is Emily and I live here in New Hampshire, and I have two beautiful children, a daughter who is three and a half and a son who just turned one last month. So I have two actually very different birth stories. The punch line of those birth stories is my daughter's birth was an absolutely magnificent and fantastic unintended hospital birth. And my son was an absolutely magnificent and fantastic unintended free birth.

So very, very different birth stories. But the one that I absolutely love to share the most is my daughter's. I became pregnant with my daughter in 2022. I was actually ten weeks pregnant at our first wedding anniversary, so it was very exciting, very new, very eager to jump into this birth experience.

My mother had always talked very positively about her birth experiences. She had me and my two sisters naturally, very quick, very easy, very positive experiences. So I didn't come into pregnancy or birth with any fear. In fact, the only thing I knew I wanted to do was have a natural birth.

So I did what every woman does, and I called my gynecologist and set up my first appointment and just had my regular first meeting where they confirmed I was pregnant. They kind of talked about the do's and the don'ts. And it didn't really hit that itch for me. I was so excited to be pregnant. I was so excited to be able to experience pregnancy and birth and all these things that I decided to really dig into research.

Something about my personality is I am very, very research oriented. It's my educational background. It's something I love to do. I don't go into anything without just diving completely in, whether it's just a hobby or an experience or absolutely anything at all. So I think I might have googled like how to have a natural birth or podcasts about natural birth. And the Down to Birth podcast popped right up. So this was very, very early on in my first pregnancy that I found you both and started listening.

And as I was listening, I became more aware of the different things I needed to educate myself on to ensure I had this natural birth. My one goal was I wanted to have my birth naturally. And as I started learning all of the different facets to this medicalized world that we were living in around birth, I realized that I wanted to make sure I could be my own advocate in these settings.

My mother had given birth in a hospital all three times, so there wasn't a fear of a hospital birth. But as I started going down that path of understanding hospital policy and all these other things that can really impact your birth experience, I realized I didn't think that was the path I wanted to go down. So I started looking into birth centers. And to my husband's credit, he was incredibly open. He pretty much told me, “I know you're not going to do anything that's unsafe for you or the baby, so I'm here to support you in whatever that looks like.”

So around the end of my first trimester, I had another appointment with my OBs, and they rotate you through OBs in the gynecologist's office so you can kind of meet everyone because you never know who you're going to get. And I feel very lucky that I ended up with this particular OB because I began talking to her about my birth wishes and my birth plan. Very simple things. I wanted to delay cord clamping because I was anemic when I was born, so I wanted to make sure all those nice, good red blood cells went to my baby. I wanted uninterrupted skin-to-skin when they were first born. I wanted to be able to not have continuous monitoring. I didn't want to be on an IV. Very simple asks.

And she became more and more aggressive as those sessions and those questions came up, to the point where I think to one of them it was like, “Well, as long as you don't have a dead baby.” And I was like, nope, we're done. Walked out, did not schedule that next appointment, and immediately went to the birth center I'd been looking at. It was the straw that broke the camel's back for sure, even though I'd already been on that path.

I found these amazing midwives at a standalone birth center that I was very, very excited about. Beautiful facility. Absolutely loved it. Had great appointments. Everything was going absolutely swimmingly—until my 34-week appointment and my high blood pressure.

So in New Hampshire, if you have two high blood pressure readings, you are now considered high risk and you have to birth in a hospital. So at my 36-week appointment, I was doing everything to stay calm. I'd been really resting the last couple of weeks. I'd worked out my entire pregnancy. I'd eaten a healthy diet. I was doing everything. And I still got this second high blood pressure reading. I was doing a HypnoBirthing track on my way to the appointment just to try to make sure I was in a nice, calm space. And I got a second high blood pressure reading.

So the midwives were kind of held back by that. Can we just pause for a second and talk about this? The state of New Hampshire declares that if a woman has two high blood pressure readings in late pregnancy, she has to birth in a hospital. This is not the birth center policy. This is the state law, correct? What happened to “live free or die”? That’s their slogan. That’s the whole state slogan, right? That is the slogan. Live free or die.

Not when you have high blood pressure. Not when you’re pregnant. For women or whatever. There is so much evidence that suggests that blood pressures in clinics are taken incorrectly all the time, and that white coat hypertension is a real thing. And this is just so upsetting that a state would have a law like this, when of course, when you have that kind of pressure on you, you’re going to have high blood pressure every single time you go to the office. It’s absurd.

Was there no option to do a home blood pressure monitor? So I had been doing home blood pressure monitoring all those two weeks between the appointments, actually. And when I was calm, when I was sitting down, I was getting decent enough blood pressure readings. And to my midwife’s credit, at the birth center they took it several times. They let me calm down. They let me change positions. It just wasn’t happening. It was not going down.

And I fully believe in a lot of the coat syndrome associated with it. But at the same time as my birth went on, I did definitely have some high blood pressure. It’s just hard to say if that was related to being switched to a hospital and all the other stress, or was legitimately gestational hypertension. Gestational hypertension is a real thing, and you may very well legitimately have had it. But I’m sure many, many women who just have white coat hypertension are unfortunately having their birth plans altered because of this state law. Yes, absolutely.

Especially as we went into my second birth and I had absolutely no issues at all, it was harder to determine what was the cause of it at that first birth. So my midwives’ hands were tied and they had to transfer me out of their care.

So I called my doula, my absolutely amazing and fantastic doula. We mourned the loss of my birth center birth because that was definitely something I had to deal with, and we began looking for a hospital that I would want to go to. Obviously, I didn’t want to go back to my original OBs. I already had a bad experience. So we used her experience of different hospitals. We talked about what that would look like.

I knew coming in with potentially gestational hypertension, I was going to need to be induced or I was going to be encouraged to be induced. So I wanted to find a place where if we did go down that track, I would have good control over what that induction looked like. I wanted to make sure it was something that we could start manually, not really get into the aggressive use of Pitocin and different things like that. So I again jumped into my research background and started scouring the internet for positive birth stories at different hospitals, C-section rates, how they were happening over the past couple of years, if they were going up or down at different hospitals, different things of that nature.

I ended up settling on a hospital in Portsmouth, actually, that my doula had had a lot of experience with. They had doulas on the staff there. And you have a lot more control over the induction methodology. I had a very positive trend in their C-section rate. So it ended up being the one that we chose. I sent them my information, and I knew that probably the next day they would call me in for an evaluation, which most likely would result in them wanting to perform an induction on me.

That night, I decided to again dig into my research, and if I had to be induced, how could I make sure I still got the birth that I wanted? My husband and I talked a lot about our priorities, and again, to my husband’s credit, he did not say, “Oh, I just want you to be happy and healthy. I want the baby to be happy and healthy. That’s all we need to go for.” Because through our conversations, through listening to your podcast, that’s the bare minimum. Of course we want a happy, healthy baby, but I want more from my experience.

So making sure we avoided a C-section and making sure I was able to have a lot of autonomy in my birth, those were our primary goals. We created our list of priorities and we started talking about that. And I started looking into positive birth stories of women who got induced but still gave birth naturally. I found one, and it wasn’t even a full birth story. It was a comment section in a longer birth story where this woman had been induced, had Pitocin, but didn’t end up with an epidural.

There are plenty of women who end up with epidurals and still have positive birth stories, but I did not want an epidural. And knowing what induction methodology can do for your experience when you’re birthing, I know that that is a fast pace into an epidural. So that’s what made me a big advocate for sharing my birth story with my daughter. I wanted to get more stories out there of women who are induced, but can still get everything they want out of their birth story.

So I found that one kind of threw me for a loop that I couldn’t find more. I did get a little afraid that the induction potentially could result in a different experience for me. But again, my husband was just kind of there talking me through our priorities, our plans. I had been deep into HypnoBirthing at this point, so I just took a lot of time that night to just practice my HypnoBirthing tracks and all my affirmations, getting into that right place before the next day.

And of course, I got a call from my new OBs. They wanted to see me and I should have a hospital bag. So I packed my hospital bag, knowing that I was going to be in a hospital and not a birth center. And I told them I would come at the end of my workday. So we waited until I was done with work, and then we headed to the hospital.

And yep, as soon as they saw me and evaluated me, they wanted me to be induced. So again, to the credit of my OBs, actually, we had a full conversation. It lasted at least an hour and a half. Should we do it now? Should we wait?

I know it’s better for the baby to wait until at least thirty-nine weeks if you do have gestational hypertension. Better for me if you wait until thirty-eight weeks. I was just shy of thirty-seven weeks at this point, so I didn’t necessarily want to get induced that early. But I also knew that the readings I was starting to get were very high. I think it was—yeah, the bottom number was one hundred, and the top number I think was like one ninety. Oh yeah, one sixty, something like that. It was very, very high.

That sounds concerning. There’s a difference between ninety and one, there’s a big difference between one ninety and one sixty though. I think it was legitimately one ninety over one hundred. It was like a very high reading. They weren’t going to let me leave the hospital. So if anything, I was going to have to stay on bed rest and be monitored for an extended period of time. And given that I was having such high blood pressure readings, the OBs left.

My husband and I were talking, and I didn’t want to end up in a situation where they wouldn’t let me give birth naturally at all. Where essentially they would say, you’re too high risk, your blood pressure is too high, we’re going straight to a C-section. Or if I did end up getting induced later, that they would be thinking C-section way too early on in the process. So as long as I could do it manually, I agreed to start getting induced.

So we did the Cervidil that night, and I just slept with it in. And then we took it out, and then we did the Foley balloon in the morning. So no Pitocin yet, we were just doing the Foley balloon. And when they did the Foley balloon, they checked me. I was already two centimeters, so my body was starting to go down the path.

I started having symptoms, I guess you could say—signs that I was going to go into labor. I had a lot of Braxton Hicks. I could tell my body was getting into it, so I kind of trusted that and thought we could just start to see if we could push it manually into labor. As soon as the balloon was put in, as soon as I had that pressure on my cervix, contractions started. My body very much kicked in, which made me feel good that I was listening to my body, that we were close enough to labor.

In fact, my son was actually born at thirty-eight weeks and one day. No one in my family, no women, go past thirty-eight weeks. So at the thirty-seven-week mark, I felt comfortable enough that I was probably going to go into labor soon anyway. And this way I could have more control over avoiding that C-section rate with understanding.

My blood pressure was, in fact, quite high. I did make a point with my OB to confirm that they were not concerned about preeclampsia—that I just had high blood pressure, there were no signs of preeclampsia, and I wanted everyone to understand that. So that was another big piece of advocating for myself in this story: we were just talking about high blood pressure, nothing else. Because I know that’s just such a slippery slope.

So Foley balloon in, contractions start to kick up, which is great. My husband’s job this entire day with this entire process was to give a copy of my birth plan to every single person that walked into my room. Every single new person. Knowing that I was in this setting I’d never been in before, with people I’d never had any contact with before besides my doula, everyone needed to understand what my birth plan was.

Anything on my birth plan that was a “do not” was bolded and underlined and highlighted. Do not break my waters. Do not do a cervical check without my permission. Do not do an episiotomy. All of these big “do nots” were on there. I want to be able to eat. I want to be able to walk around. I don’t want to be attached to a monitor. All these things that I wanted were very clearly listed out.

And my husband gave a copy to every single person who walked in that room. He actually handed a paper copy to every single person who walked in the room. How many copies did you take with you to the hospital? I had two dozen. I was going to be prepared. Just the fact that any woman should need two dozen copies says so much—like how many strangers can potentially walk into this birth scene.

What was the response when he handed it to them? Were they respectful? Did they stop walking in their tracks and read it for a moment? Did they acknowledge it? Did they say, “Okay, got it”? Or did they basically say “thanks,” grab it, and put it aside the way people do with flyers they don’t want?

Most stopped and read it, which I was very pleased to see. The OB who started the next morning—not the OB that admitted me, but the new one because obviously it changed over—that’s why I wanted so many copies—she had as close to midwife energy as I think an OB could possibly have. She read through that whole thing with me. We talked through all of it. Every nurse that came through sat and read it with me, at least while I was aware.

Once I got my HypnoBirthing going, then my husband was just on his own with those birth plan handouts. But I was impressed that I felt very respected in my wishes and that everyone was acknowledging them.

I do think that it happens that when we conduct ourselves with self-respect, people are sort of—they’re going to respond in kind. And when women are too apologetic, saying, “Oh, sorry, could you please take this, sorry I wrote this down,” they’re more likely to receive a response that isn’t very respectful. But if it’s gently assertive—“Here’s my birth plan, please give it a read”—they’re more likely to actually do so.

We can’t always control how people will respond. I brought it up with my own obstetrician. I was assertive, I’d say, but she was still disrespectful. It’s not foolproof. But when women do this, they need not be apologetic. Women start a lot of sentences with “sorry.” They don’t even know why they’re saying it. But I think women need to be just plainly matter-of-fact about it: “Here’s my birth plan. Please take my birth plan.”

Of note, I had really done my research in picking a hospital that had a lot of green flags. They were very doula supportive. I investigated their C-section rate. These are things that many women never think to check before entering a hospital birth. I set myself up for a good response, and I was very well prepared.

Absolutely. And I think that’s part—a big part of the story. Not only setting myself up, but then advocating for myself, being confident in the knowledge that I had, the understanding I had, my relationship with my own body, and being prepared for what was coming. Those things made a difference.

So the birth plan was given to absolutely everyone, and they were respectful of it. They very much were respectful of it. And I think that was a key piece to this—understanding that they knew what I wanted.

When the contractions started, they were very random, very intermittent, not consistent at all. So I agreed to a very small, small dose of Pitocin to help try to even it out and keep things moving. Very small. I forget how it’s measured, but it was like two units of however it’s measured. Yeah, it was two. And that did it. That definitely kicked everything up. The Foley balloon was removed a short time later, but it definitely kicked everything up.

Immediately my contractions were full-blown labor. Having gone through the birth with my second, where you get this nice easing into contractions becoming more consistent, stronger, and longer, I can absolutely see how getting induced leads to other interventions.

If natural birth and spontaneous labor is like starting to ease into a run—starting to walk, then jog, then run, getting into a flow and rhythm—induction is like stepping onto a treadmill that’s already at level eight. Suddenly you’re expected to run.

That was tough mentally, and I felt myself slip a little bit in that moment of, how am I going to do this? This is incredibly overwhelming—all of a sudden, at once.

My husband looked at me and said, “Put on your HypnoBirthing. This is what that is for. Get into your space.” To his credit, that was exactly what I needed.

My doula also saw that I was starting to tense up. It was a lot of that fear feedback loop coming in. She had another doula on site who she knew was a masseuse come and give me a hand and neck massage to relax me.

So getting into my HypnoBirthing tracks, having that massage, just relaxing completely—I ended up falling asleep for the next six hours. My doula moved me every thirty minutes, but I was asleep for most of my early labor on Pitocin with no epidural.

When I woke, they checked me and I was six centimeters. Impressive. I had dilated that much while essentially asleep. I was so happy in that time. It just flew by. I say I was asleep, but maybe I was just in that HypnoBirthing hypnotic state.

My husband ended up watching TV the whole time because I was just lying there, and my doula moved me every thirty minutes. I was in my zone. HypnoBirthing was a really big part of this story. I advocate to every woman I know who is pregnant to try HypnoBirthing, to at least look into it. I started it in my first trimester, and I was diligent. It was one of the best things I ever did.

It’s a practice, like yoga or meditation. We all have the same kind of brain; the question is whether we’re willing to go through the effort. It takes tremendous effort to learn to control the mind. Many people think yoga is just moving your body on command, but true yoga is aligning your breath with each movement and maintaining deep focus. HypnoBirthing is the same.

With practice, you become conditioned. Over time, you get more deeply relaxed more quickly. By the time I was pregnant with my son, it was even easier. Those pathways were already there, so it became natural to sink into that state.

During this hospital birth, even with IVs in both arms, a blood pressure cuff going off every fifteen minutes, Pitocin, and the stress of being transferred from a birth center, HypnoBirthing kept me focused. My contractions actually lowered my blood pressure and heart rate. My baby was never at risk.

I didn’t make any noise until I was pushing. At one point I vomited, but because I had done my research, I knew that meant I was in transition. I was excited, knowing I was close.

After my water broke, contractions got much more intense. Without the cushion, I started to feel like I couldn’t do it anymore. I thought, “I need an epidural. I’m done.” But I also knew, thanks to my preparation, that this was the adrenaline surge of transition. It meant I was close.

So I reframed it: this was good. It meant I was going to meet my baby soon. Even if I asked for an epidural, they probably couldn’t get it to me in time. I clung to my HypnoBirthing affirmations: every surge is bringing you closer to your baby. This is you and your baby together. Keep your hands relaxed. Keep breathing.

I stayed in that zone, and soon the fetal ejection reflex took over. My body began pushing on its own. I was on all fours on the bed. The OB came in, sat down next to me, placed her hand on my leg, and said, “You’re doing great.” That was the only engagement we had during pushing.

I remember five pushes. They told me it was about twenty minutes. My daughter was out. I leaned back, brought her through my legs, and onto my chest.

Then I looked up, and the room was full. Every nurse on the floor, plus three other doctors, had come in. The nurses had never seen a natural birth with Pitocin, and the OBs had never seen HypnoBirthing so successful. Word had spread, and they all wanted to watch.

I had been so deep in my zone that I had no idea they were there. Thankfully, everyone was smiling, and no one tried to take my baby. My husband later told me the TV was still on. Ironically, it was the episode of The Office where Pam gives birth.

I think word spread that a woman on Pitocin had birthed without an epidural. That was unusual enough to draw a crowd. But I was so inwardly focused, I wasn’t even aware of it.

They tried toward the end to turn the Pitocin up to four, and my contractions just started going right on top of each other, so they turned it back down. Then toward the end, I believe they turned it off.

So I experienced, for a brief moment, what most women endure—too much Pitocin. That’s when it becomes brutal and totally intolerable for most women. It’s not that they can’t handle birth; it’s that what’s happening isn’t normal. That’s a chemical intervention.

I was shocked to learn afterward that they had increased it without telling me. My doula was the one who noticed and explained why the contractions had suddenly stacked on top of each other. I remember thinking things were getting more intense, but I just went deeper into my HypnoBirthing zone. Thankfully, they brought the dose back down quickly.

That’s really how Pitocin should be used—just a whiff, barely there, enough to get you started, and then let your body take over. Too often hospitals keep it going, or even increase it by protocol, without regard to how the mother is coping.

The provider I had that day aligned with my expectations. She was patient, willing to let my body do its work, and careful not to rush interventions. I feel blessed to have had her in that role.

From the time the Foley balloon went in, my labor was about twelve hours. Roughly nine in the morning to nine at night. For a first baby, that’s pretty quick. I had asked for the smallest possible dose of Pitocin, and that likely changed the entire outcome. I believe that decision—and sticking to it—was one of the reasons my birth plan held together.

I always tell women in my classes and conversations: if you do need to be induced for medical reasons, first ask them, “Based on my body weight, how much Pitocin do you plan on giving me?” Then negotiate to start with less. Tell them you believe your body can work with it. If you just say, “Can you go easy on me?” they’ll nod, but that doesn’t guarantee anything. If you get them to state a number first, then you can say, “I want to start with less,” and they can’t increase it without your consent. That one step can completely change your outcome.

Hospitals often have Pitocin protocols that steadily increase the dose, and some won’t turn it off at all. So when you’re investigating where to birth, especially if induction is possible, it’s important to ask about their Pitocin policies.

At Portsmouth, they offered what they called “gentle inductions.” They started at the lowest dose—two units—and I wanted that immediately. Because I knew some women end up at twenty units, even thirty, which seems absurd.

That explains why, with my second birth, things moved so quickly and ended in an unintended free birth. My body is very responsive to labor, and everything I had practiced mentally helped it progress fast.

So this explains why I had an unintended free birth with my second child. I had a pretty fast first labor, and my body is very responsive to birth. Everything I taught myself mentally about birth helped my labors progress quickly.

For my second baby, I did plan to have him at home. Even though I had this great hospital birth with my daughter, that experience pushed me to want a home birth. I didn’t want to have to advocate for myself as much. I wanted to be in my own space, having even more of that internal experience.

I planned for a home birth and labored all day on the tenth. Contractions were moving up. They had gotten to ten minutes apart for a full hour. Then labor just stopped. My doula was on her way, my midwife was getting ready, but everything halted completely. I hadn’t even started my HypnoBirthing tracks yet. I had just been running around with my daughter all day.

My midwife said, “Oh, it’ll kick up after she goes to sleep.” But it didn’t. I ended up just eating half a watermelon and going to bed because my husband said, “Let’s just go to sleep. If it starts again, it starts again.”

So I went to bed. Contractions woke me at ten thirty, eleven, and then twelve. They were half an hour apart but much more intense. By midnight, I texted my midwife and doula: “I think you should come. They’re still pretty far apart, but you should probably get here.”

Around twelve thirty, I finally woke my husband. He was awake for all of twenty minutes before I told him he needed to text my midwife that the baby was coming. He never got the text off. Three pushes later, my son was out.

I had the wherewithal earlier in the night to get a towel underneath me while I was laboring. About twenty minutes before, I thought to myself that we should be prepared. Then, with the next push, my water broke. I told my husband, “Babe, you’ve got to get my shorts off.” We got them as far as my ankles before the baby was out on that third push.

My son was born at 1:02 a.m.

Twenty minutes later, my midwife arrived. By then, my placenta had already come out on its own. I was sitting at the end of the bed, leaning against the headboard, holding my baby. I saw the placenta, so I moved it to make sure there wasn’t blood pooling behind it.

I had been listening to the same HypnoBirthing track that I had used with my daughter. This time, different words stood out. With my daughter, it had been “every surge is bringing you closer to your baby.” With my son, the words were, “Your body was made for this. Surrender into it. Trust your body.” Those were the words I needed, because I knew the baby was coming before anyone else arrived.

People ask me if I was scared. And I always tell them: if I was scared, it wouldn’t have happened that way.

Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.