Monday, October 17, 2011

It's Just an IV -- What's the Big Deal?

I posed a question on my Facebook page this weekend asking if an IV was required at your place of birth.  As expected, the majority of those birthing in the hospital said yes.  I recently had an IV when I went for a colonoscopy, and I must admit, I did not like it.  My number one complaint is that feeling of cold fluid running through my veins.  Not a fan. 

What about for labor though?  Should an IV be a part of a normal labor?  The hospitals think so.


Let's face it -- nearly everyone who finds themselves on the Labor & Delivery floor will have an epidural.  Or an induction.  Likely both.  Before an epidural is placed, a mom will receive a couple of bags of IV fluid.  Epidurals are notorious for causing the blood pressure to drop, so these fluids are necessary.  Here's why they want you to have an IV when you walk through the door:  The minute you say you want an epidural, they can give it to you.  Otherwise, they have to wait for these IV fluids to be administered.  They believe that you will eventually beg for the epidural, no matter how many times you say that you want an unmedicated birth.  I hate to sound paranoid - or make others paranoid - but the truth is quite ugly when we talk about IVs.  You will very likely have other things running through an IV besides saline water, with pitocin at the top of that list.  Even if you don't have pitocin during the labor, you will assuredly have it after your baby is born to "aid" in the delivery of the placenta.  If you have an IV, you won't even know pitocin was added.  They simply do not ask your permission. 

Antibiotics are often added to an IV.  This is given, typically, under three scenarios: 

1) Mom develops a fever.  This could be due to infection, but epidurals cause fevers in many women.  Since we aren't sure either way, antibiotics are administered.
 
2) Water is broken so antibiotics are given routinely, you know, just in case she might develop a fever.  (Can you hear my eye roll?)   

3) Mom tested positive at 36 weeks for Group B Strep and antibiotics are standard procedure.  This post is not a post about GBS, but suffice to say, antibiotics are very necessary if the baby actually acquires GBS on the way out of the birth canal, but only 2 out of 1000 babies that are born to GBS-positive mothers will be affected.   One-third of women will test positive, so that is a lot of women receiving antibiotics -- just in case.   I have strong feelings about antibiotics from my own personal experiences, but you may not care one way or another.  Maybe you feel that it is better to be safe than sorry.  It's a decision each parent needs to make for themselves.

Is an IV ever necessary in labor?  In short, yes.  A woman in labor should be eating and drinking plenty of water.  Water is crucial in helping the uterus work effectively.  Without it, the uterus can become "irritable," often making an IV necessary.  Under these conditions, she'll often experience contractions close together and intense, but only lasting about 30 seconds.  An IV might help her stay hydrated and therefore causing more effective contractions.  If a mom can't keep fluids down, she might also require an IV.  As with all interventions, there is a time and place for everything.  IVs should not, however, be a routine part of a normal labor. 

 It seems that many moms end up consenting to a hep-lock, which is an open vein.  If they need to give you an IV quickly, they won't have to "fumble" to find a vein.  To quote one of my Facebook readers, "They said it was in case there was an emergency and I started to bleed out.   I said "If you're telling me if there isn't anyone here that can save me in an emergency if I dont have an IV line in already then I need to leave because I don't feel safe." They laughed, said good point and left me alone."  The hospital group I refer to in the Fort Worth area, the UNT Health Nurse-Midwives, have not required even a hep-lock for my students unless there was a medical reason to do so.  

One more thing I found extremely interesting about IV use in labor.  This can have a negative effect on breastfeeding.  Mellanie Sheppard, IBCLC, explained this at a Tarrant County Birth Network meeting one evening:  When a woman has IV fluids, she becomes swollen and puffy until the extra fluid has time to leave her body.  This can include extra fluid in the breast.  A woman who didn't think she had flat nipples before now may have a problem with the baby latching properly.  She might be started on a nipple shield and thus started down a road that could have been prevented by simply avoiding the IV in the first place.  

Last week I wrote about various policies that contribute to the high c-section rates and neglectfully left routine IVs off that list.  It should have been there.  Drink your water.  Talk to your care providers.  If you are choosing to birth in the hospital, search out the care providers who practice evidence-based maternity care.  You will likely have to concede on some issues, but choose your "battles" carefully and thoughtfully.   

11 comments:

Shannon B said...

It seems like I have also read the IV fluid adds water weight to baby meaning they will lose more of true birth weight which can also impact breastfeeding if mom is told baby has lost too much and we need to supplement.

It is definately an intervention and should only be used as needed. :-/ great post D!

Janie said...

I think not having that stupid thing, or getting poked in the hand repeatedly during a contraction was one of the best parts of my homebirth!

Unknown said...

excellent point, Shannon B...

Samantha said...

I refused to have ANY IV for my second birth, and it was well worth it! I'm a nurse, so I know that in an emergency, they can get one in...it's not a big deal. So, don't try and tell me I need a hep-lock "just in case". I'm not buying it...ever.

melissa said...

The doctors at my birth were fine with my refusal of the IV, which was really important to me because of the whole issue of administering pitocin without permission that you mention. They respectfully requested that I allow a heparin lock and I agreed. It was annoying, but it wasn't an IV.

e and w said...

I had to be induced at 39 weeks and 6 days because of high blood pressure. I was already 4 cm, so my dr said she would only have to break my water - after a few hours and only 1 cm progression, I was talked into a "small" pit drip. I was already hooked up to an IV for gbs antibiotics. I had no idea the nurse was cranking up the pitocin every hour. I also had no idea they started me on fluids when there was no good reason. I was downing gatorades and peeing nonstop. Hospitals are tricky bitches and I'm looking forward to a homebirth next for this very reason.

This was a great post. Thank you!

JoyfulJ said...

I birthed at a maternity Center...It was awesome...no IV's the only thing I had to concede was 1 vaginal exam when I first arrived in labor. The OB who was 'over' the center demanded it, period. The midwife would get in trouble with out it, so I agreed. It turned out she was unable to give it because by the time I got to the bed, minutes after arriving, baby was crowning lol! Totally awesome experience catching my second born!

Laura: The Sushi Snob said...

There are those of us who have veins that are hard to find on a GOOD day without any kind of emergency. It's normal for me to get jabbed a few times when I give blood. I'm considering allowing a heplock when I give birth because I don't want to know what would happen in an emergency. I may change my mind, but I don't know. Thankfully I have a few more months :)

Manda said...

I had a very necessary IV after my daughter was born (very low blood pressure, was passing out every time I tried to move). It was inserted by midwives at my home before I was transferred to the hospital post-birth.

I am glad that the services were available and that I received the care I needed but the positioning of the IV was so thoughtless. It was on the inside of my arm and was tender and sore which made breastfeeding and holding my tiny bebe pretty uncomfortable. I had to request that it was removed and a new one inserted on the outside of my wrist which took the resident consultant 3 tries to get right. I had pretty purple bruises the next day that took ages to heal.

Heather said...

Wow...I had that exact problem with breastfeeding after an IV. I had never had a problem with flat nipples in my life...sure enough when I went to breastfeed, my baby couldn't latch on one side. I ended up pumping on the side that was effected to try and relieve the resulting engorgement and eventually she was able to latch. But, it was pretty uncomfortable, not even to mention how annoying it was to nurse with an IV hooked up into the inner elbow area of my arm. I feel that if not for hospital policy, I would have had my baby without intervention. Consequently both children were born via c-section...even though I desperately tried for a VBAC with the second.

Unknown said...

My water broke I was not given preventative Iv antibiotics and 3 days later ended up horribly sick readmitted for 36 hours of antibiotics. They would not allow my baby to stay over night as "I was the patient not the baby" I was to sick to care for her alone so she had to leave. needless to say my breast feeding experience with her was a continuous struggle for a few months before I gave up. I was unable to get my milk production high enough. My subsequent babies were all successfully breast feed. Iv antibiotics were never offered to me but might have saved me a lot of hassle and missed opportunities.