C.M.. a 26-year-old gravida 2 para 1001, had an intrauterine pregnancy dated by last menstrual period and confirmed with a 10-week ultrasound. Her obstetric history was significant for diet-controlled gestational diabetes and a history of primary low transverse cesarean delivery. Her cesarean delivery (five years prior) was performed for non-reassuring fetal status remote from delivery. She had no other risk factors. When she entered care with the midwifery practice, C.M. expressed her strong desire for a vaginal birth after cesarean (VBAC). The midwife thoroughly counseled her on the risks and benefits of a trial of labor (TOL) with her history of a cesarean delivery. After thorough discussion with her partner, C.M. reaffirmed her desire to attempt a VBAC. The midwife then discussed C.M.'s history and current status with the consulting physician, and C.M. was deemed an acceptable candidate for trial of labor. By 41.3 weeks' gestation, C.M. still had not spontaneously begun labor, and because the plan was to have a repeat cesarean delivery if she had not entered into spontaneous labor before 42 weeks' gestation, C.M. approached her midwife regarding alternatives. She was 2 cm/50% effaced/-2 station/vertex (Bishop's score of 5). The estimated fetal weight was 3900 g. The midwife and consulting obstetrician jointly developed a plan for labor induction. The plan included admission to labor and delivery, signed consent to cesarean delivery and anesthesia if necessary to manage an emergent situation, insertion of a saline lock, and intracervical placement of a 50-mL Foley bulb. C.M.'s agreement with this plan included the understanding that if cervical ripening did not occur as a result of the Foley bulb placement and/or she did not enter labor, a cesarean delivery would be performed. C.M. was admitted at 7:30 PM with mild, irregular uterine contractions, and fetal heart tones were reassuring. During manual examination using sterile technique, the midwife threaded a 26 French Foley catheter through the cervical os up into the lower uterine segment, and the bulb was then inflated with 50 mL of sterile water. Tension was then applied to the catheter from the proximal end and secured to the patient's thigh in such a manner as to provide constant tension on the bulb. At 9:30 PM, spontaneous rupture of membranes occurred, and the Foley bulb was spontaneously expelled. By 2:12 AM the following day, the cervical exam was 6 cm/80% effaced/-1 station. At 5:15 AM, the exam was 7 to 8 cm/80% effaced/-1 station. By 6:10 AM, C.M. reported feeling pressure, and an exam revealed 10 cm/100% effaced/+2 station. C.M. began nondirected pushing with excellent effort, and at 6:28 AM she had a spontaneous vaginal delivery of a 4540-g male, with Apgar scores of 8 and 9 at I and 5 minutes, respectively. C.M. did not require pain medication or an epidural during labor. She used frequent position changes and ambulation, with her midwife at bedside to monitor and provide support. She took in clear liquids as desired. She was monitored continuously in labor, as per institutional protocol, and the fetal heart rate tracing was reassuring throughout.