Labor and Birth at The UVM Medical Center
During labor, Certified Nurse-Midwives (CNM) provide comfort measures and emotional support, as well as evaluate the progress of labor. We encourage your partner/support person to assume as active a role as possible in the labor and birth process.
We make every effort to facilitate the natural forces of labor in a non-interfering manner and to ensure that you have the birth experience that you want.
However, certified nurse-midwives are prepared to intervene and consult with a physician should the course of labor deviate from what is considered safe for mother or baby. Nurse-midwives can provide pain-relieving medication as appropriate for the needs of women in labor.
During the birth process, nurse-midwives perform normal vaginal birth and may, when necessary, cut and repair an episiotomy. The CNMs examine and evaluate the newborn after the birth.
If an operative delivery is indicated, the UVM Medical Center obstetrician performs the procedure while the nurse-midwife maintains a supportive role.
Labor Induction at the UVM Medical Center
For a variety of reasons, your labor may need to be induced before your body naturally goes into labor. Your doctor or midwife will discuss the need for your induction with you. Information about the induction process, what to anticipate, when your induction is scheduled and the contact number is at the bottom of this page.
- Discuss with your provider whether you should eat prior to your arrival.
- If you are taking medications for medical conditions, discuss with your provider whether or not to take them before your arrival on Labor and Delivery.
Cervical Ripening Verses Induction of Labor
Before induction your provider may want you to receive medication to prepare your cervix for labor. Cervical ripening involves the administration of a medication to help your cervix soften and prepare for labor. You may or may not experience contractions during this time. Cervical ripening is usually scheduled the evening before your labor induction. Cervical ripening involves a 2-3 hour stay in the Birthing Center after which you may go home to return the next morning. Not everyone needs this preparation. Do not be concerned if your provider did not mention this step. If it is too busy for you to come in for cervical ripening, you may still come the next morning for induction. Your provider will decide whether to start cervical ripening then or to start your labor induction. Labor induction involves administration of medication to start contractions and labor. This is a longer process than cervical ripening and different medications are used.
Prostaglandin gel (Dinoprostone)
Dinoprostone is a synthetic prostaglandin similar to that made by your body to prepare for labor. It is administered into your cervix. When you are admitted to the Birthing Center, you will be placed on a baby heart rate and contraction monitor. You will need to remain on the monitor during your stay. A doctor or midwife will insert the prostaglandin gel into your cervix. You will be monitored for at least two hours. You will have to remain in bed for the first hour. You will be allowed up only to go to the bathroom during the second hour. Occasionally you will need to remain in the hospital overnight for further monitoring. If all is well after two hours, you will be sent home.
Induction of Labor
When you arrive at the hospital for your induction you will be placed on the monitor to assess your contractions and your baby's well being. An intravenous line (IV) will be placed, blood work drawn, and an induction medication will be administered to start contractions. You should expect to be on medication to maintain your contractions throughout your labor. Monitoring is continued throughout labor to make sure that you are receiving the appropriate dose of medication and that your baby is tolerating the contractions as well. Although you will need continuous monitoring, the new monitors in the Birthing Center allow walking in labor in many cases. You may ask your nurse about this ability as your induction gets started.
All medications take some time to work before labor begins. It is important to remember that true labor is both contractions and cervical thinning and dilation. You may have contractions without much change in your cervix for many hours. This is common and may still be considered a normal labor.
You are allowed to drink clear liquids or have ice chips during your induction but solid food is not permitted. Women undergoing induction may labor in the tub but may not have a water birth at this time.
Occasionally, despite medication, you may not go into labor. Your provider may decide to stop the medication and reschedule your induction for a later date. In this case, you should follow the instructions below regarding your readmission to the Birthing Center.
Misoprostol is a synthetic prostaglandin similar to what your body makes to start labor. This medication is not approved for use in labor induction by the United States Food and Drug Administration (FDA) but many studies have shown it is safe and effective when used carefully. Your provider or resident will place a small tablet of misoprostol next to your cervix. More misoprostol may be placed every 3-6 hours depending on the dilation, length, and firmness of your cervix. Often the misoprostol starts your labor and oxytocin is used later in the induction process. Occasionally you are contracting too frequently to receive misoprostol. In that event, your provider or resident will discuss an alternate plan.
Oxytocin is a manufactured medication that is identical to a hormone which is naturally made by your body. It causes contractions to start labor. It is FDA approved for the induction of labor. It is administered through your IV, starting at low doses and increased over time.
Amniotomy, or "breaking your water", is frequently performed to help you get into labor. It is usually performed after receiving medication to start your induction. Occasionally it may be used alone to start labor.
Scheduling a Labor Induction
If an induction is necessary, your doctor or midwife will schedule it with you through the office. Keep in mind that if the Birthing Center is full, or another patient has a greater medical need, you may be delayed or rescheduled.
- Please call before you come in and the nursing staff will indicate if admission is possible, due to room availability and staffing.
- Call 847-3830 at 3:15 p.m. for cervical ripening later that day. The charge nurse will discuss with you when to arrive at the Birthing Center.
- Call 802-847-3830 at 6:00 am for induction in the morning. You should be prepared to leave home immediately after making this call. The charge nurse will discuss with you when to arrive at the Birthing Center. Please be prompt in arriving at the hospital to ensure a quick start to your induction. Occasionally, your admission may be delayed due to the number of patients on the unit at the time. We will make every effort to get you in later that day.
- When you arrive at the hospital, be sure to check in at the admitting/patient registration desk before coming up to the Birthing Center.
- Remember to bring all of the things that you packed for delivery, as well as things to help make you and your partner more comfortable for several days (e.g., music, CD or tape player, pillows from home, snacks for partner, etc.). Also pack a bathing suit for your partner if he/she intends to get into the tub with you.
- Please be sure to leave your valuables at home.
- Sometimes you will be sent home undelivered. Your provider will plan your readmission with you.