IV during labor?

[Anonymous]

Anonymous wrote:Former RN here. I've seen cases where it took incredibly experienced nurses more than 20 tries to place an IV in a dehydrated patient. In one case I recall, our resident IV expert (former prison nurse who excelled at finding veins even in junkies) could NOT find a vein on a 20 something young woman. Next step was to call in the flight nurses (trauma team) to try. Oops, flight nurses were on a flight. Next up: anesthesiologist. Oops, all were otherwise engaged with patients. The poor girl was about two minutes from having a central line placed (MUCH more invasive than IV and placed in the patient's neck or chest) when FINALLY, after dozens of tries, we finally found a vein in her lower leg. This all took probably around two hours and by then she was in far more serious condition.

Now clearly that's not typical - but I share it as an example of an otherwise healthy young woman who happened to be fairly dehydrated and was suddenly a terrible candidate for a "quick and easy" IV. There is no good reason to refuse having a saline lock placed. It could make a HUGE difference in case you eventually do need fluids or IV medication.

Keep in mind that agreeing to a saline lock doesn't mean you agree to anything else. It's just a good safety measure to have one in place.

Just out of curiosity, for any L and D nurses out there: provided a normal, laboring woman has been able to drink fluids as desired, how often does this happen? My OB said she required at least the heplock because she'd seen too many ugly cases like this, but I know that midwives "allow" food and drink as desired. Answers, people with more education than I?

[Anonymous]

Not an L&D nurse but have given birth sans
epidural: I was not the least bit interested in drinking anything. Focus was on contractions and delivery and NOT on water pitcher. I often forget to drink even when
I know I should.

[Anonymous]

Anonymous wrote:when you say a heplock goes in the arm, where in the arm? Inside the elbow? I've had IVs placed there before and it was horribly uncomfortable for me.

Mine was on my forearm, roughly in line with my thumb or index, and about halfway from wrist to elbow. I think the idea is to get it somewhere where the skin doesn't move much as you bend/flex your arm and hand. I couldn't feel the heplock.

[Anonymous]

Anonymous wrote:Not an L&D nurse but have given birth sans
epidural: I was not the least bit interested in drinking anything. Focus was on contractions and delivery and NOT on water pitcher. I often forget to drink even when
I know I should.

Roughly the same story here. Toward the end of transition, I also vomited, losing much of what I ate & drank over the previous hour.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Not an L&D nurse but have given birth sans
epidural: I was not the least bit interested in drinking anything. Focus was on contractions and delivery and NOT on water pitcher. I often forget to drink even when
I know I should.

Roughly the same story here. Toward the end of transition, I also vomited, losing much of what I ate & drank over the previous hour.

Same here. The pain from the contractions made me very nauseous. I didn't want anything for the last 6 or 7 hours of labor.

[Anonymous]

Anonymous wrote:Just out of curiosity, for any L and D nurses out there: provided a normal, laboring woman has been able to drink fluids as desired, how often does this happen? My OB said she required at least the heplock because she'd seen too many ugly cases like this, but I know that midwives "allow" food and drink as desired. Answers, people with more education than I?

Nurse here. I think this is where an active partner, doula, or even care provider is really helpful with focusing on fluid consumption between contractions. The mom will be in "labor land" but the partner/doula needs to have a water bottle handy and between every single contraction, a little sip of water will really go a long way as far as staying hydrated. Now, this situation is advised for a normal length labor. For labors than continue past 24 hours with risks of dehydration, infection, exhaustion increasing, IV fluids might be suggested by a care provider even if the mom continues to labor without pain meds.

[Anonymous]

ITA with PP. My labor was 22 hours and I was never dehydrated. Get straws, makes drinking easier. Stock up on Gatorade and coconut water. Long labor does not equal dehydration, but you do need help.

[Anonymous]

I was throwing up for the last 18 hours of labor. Everything I tried came back up, other than ice chips. Puking up jello in between pushes was particularly fun. I ended up with an epidural and IV after 36 hours, so wasn't dehydrated after that, but it was tough. It really seems to depend on the person, as the posts here tell you.

[Anonymous]

I don't think anyone denies that labor can result in the need for IV medication or hydration. It's just that -- what's the EVIDENCE for requiring the helplock or the IV the minute you walk in the door?

Also, it's not like the heplock is without risks. It's a hole in your arm holding a vein open; it could get infected. If you have difficult veins (I know I do) they could mess up trying to insert the heplock the first time, which will then mean that your vein isn't accessible if you actually NEED the IV. And last but not least, heparin can cause serious, catastrophic complications on its own.

Really, this is one of those classic hospital interventions that's done for the convenience of the hospital rather than the patient and can lead to the "cascade of interventions."

[Anonymous]

"And last but not least, heparin can cause serious, catastrophic complications on its own. "

CNM who attends births in a hospital here. Just to reiterate a PP's point, we use saline locks in L&D, not Heparin locks (even though we are in the bad habit of calling them "Heplocks"). We would not use Heparin in any L&D that I have ever worked in except under extraordinary circumstances because it can cause/worsen bleeding.

There are plenty of reasons to object to IV access in labor, but this, fortunately, is not one of them.

[Anonymous]

Anonymous wrote:"And last but not least, heparin can cause serious, catastrophic complications on its own. "

CNM who attends births in a hospital here. Just to reiterate a PP's point, we use saline locks in L&D, not Heparin locks (even though we are in the bad habit of calling them "Heplocks"). We would not use Heparin in any L&D that I have ever worked in except under extraordinary circumstances because it can cause/worsen bleeding.

There are plenty of reasons to object to IV access in labor, but this, fortunately, is not one of them.

I wonder how long you have been a CNM? While not in use today, heparin most certainly was used for quite some time. Point being: many things are done which are not evidence-based, and then later found to actually be harmful.

For this particular issue, I really don't have a strong opinion. Though, if a woman wants to refuse it she should absolutely just say no - say no to the fluids, or say no to the heplock altogether. Yes, the hospital staff will rant and rave at you, but ultimately they cannot change how they are caring for you and certainly cannot kick you out.

The example the nurse gave above is so extraordinarily rare, that I honestly see that story as more of a scare tactic than anything helpful. And, quite frankly, if anyone (who previously refused the heplock) were even marginally trending towards actually needing one, I would guess that most women would then comply. I think the issue these women have is the administration of an IV (or even heplcok) to ALL woman as soon as they are admitted. A simple conversation and examination can determine whether or not a woman has been able to adequately hydrate during the labor, whether her labor seems to be progressing, and whether or not she is at risk for needing/wanting other medications or procedures.

Remember, women in out-of-hospital birth situations do not routinely receive an IV or even a heplock. If those midwives are able to appropriate and safely judge when that intervention becomes necessary, then it surely cannot be too difficult for a well-equipped hospital to do the same.

[Anonymous]

"Heplock" is an outdated term medical professionals still use. I've been a nurse for 20 years and haven't put heparin in a peripheral IV for 17 of those 20 years.

I imagine the reason for putting an IV in upon admission does make it easier because if the delivery isn't progressing as it should, the IV is one less step to worry about. Just because you normally have 'good veins' doesn't mean you will during a difficult labor. The body can clamp down, veins collapse and perhaps there isn't a person who can put an IV in very well.

If it was me, I'd want the iv in as an insurance policy. One less thing to worry about because in an emergency, you'll need that IV and not having it in means there's a delay in intervention. That delay could be 15 minutes. Precious precious time.

[Anonymous]

Anonymous wrote:"Heplock" is an outdated term medical professionals still use. I've been a nurse for 20 years and haven't put heparin in a peripheral IV for 17 of those 20 years.

I imagine the reason for putting an IV in upon admission does make it easier because if the delivery isn't progressing as it should, the IV is one less step to worry about. Just because you normally have 'good veins' doesn't mean you will during a difficult labor. The body can clamp down, veins collapse and perhaps there isn't a person who can put an IV in very well.

If it was me, I'd want the iv in as an insurance policy. One less thing to worry about because in an emergency, you'll need that IV and not having it in means there's a delay in intervention. That delay could be 15 minutes. Precious precious time.

Honest question -- did you work L&D? If so, how often did you see such a situation? And I mean, a situation where there were absolutely no other indications that there were any problems, where the mother was 100% unmedicated, where everything was progressing completely normally, and then within a matter of minutes, the mother was in such a state that her veins were collapsed and unable to be accessed? Yes, I understand there are emergency situations - especially when risk factors are already present - but in all my years attending homebirths, we have never, not once, encountered this specific situation. There are always some indications which then call for IV access -- so we always have IV access before it becomes an emergency. Even in the absolute worst hemorrhage I've ever seen, there was time to start an IV because we were paying attention and caught the warning signs just as it started.

Regardless, women should and do have the right to take any risk they want to with their own body. As long as her baby is still inside, she holds that power. No protocol should trump what she wants, period. This includes women who want elective c/s - yes, it is riskier for both her own and her baby's body (and of course any future babies she carries) yet still, if she can afford it, it is her right. We should not be scaring women into submission.

[Anonymous]

They are probably talking about what others here are calling a hep lock, but it has saline in it rather than heparin. They just place the needle and tape it down so that if you do need an IV, it's already there. You aren't actually attached to anything. This is what I had. It was in my arm and it didn't bother me at all during labor.

I delivered with the midwives at GW and Whitney recommends getting it because if you lose a lot of blood, it can be difficult to place an IV, which you'd need to administer pitocin to help stop the bleeding. This is exactly what happened to me and I was really glad to have the needle already in place so they could quickly hook me up to pitocin and slow down the bleeding after I'd delivered.

[Anonymous]

Anonymous wrote:I don't think anyone denies that labor can result in the need for IV medication or hydration. It's just that -- what's the EVIDENCE for requiring the helplock or the IV the minute you walk in the door?

Also, it's not like the heplock is without risks. It's a hole in your arm holding a vein open; it could get infected. If you have difficult veins (I know I do) they could mess up trying to insert the heplock the first time, which will then mean that your vein isn't accessible if you actually NEED the IV. And last but not least, heparin can cause serious, catastrophic complications on its own.

Really, this is one of those classic hospital interventions that's done for the convenience of the hospital rather than the patient and can lead to the "cascade of interventions."

ITA.