IV during labor?

[Anonymous]

"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."

Exactly.

[Anonymous]

I'm sitting here and find all this talk of how difficult it can be to place an IV in someone in an emergency, and I just don't get it. Maybe I was lucky. Maybe I had the world's best IV placer. I was in a pretty nasty car crash, all sorts of broken and dislocated bones, bleeding, concussion, shock. One of the few things I remember is this amazingly deft insertion of the IV (ever try and start an IV on a needle-phobe who is thrashing and not really aware of what's going on?), like it was no problem. My friend, who walked away from the accident, saw it and marveled at the ease in which they were able to do it.

Anyways, I figured if they can get an IV into me when I'm thrashing about and trying to scream "NO!" despite the fractured and dislocated jaw and trying to swat the nurse away with an arm that's at a funny angle, you can get an IV into pretty much anyone.

And now I hear abut how bloody hard it is to insert IVs and that's why I need that damnable not-hep heplock in my arm....well, you see why I'm wondering just what the heck is going on here.

[Anonymous]

Anonymous wrote:I'm sitting here and find all this talk of how difficult it can be to place an IV in someone in an emergency, and I just don't get it. Maybe I was lucky. Maybe I had the world's best IV placer. I was in a pretty nasty car crash, all sorts of broken and dislocated bones, bleeding, concussion, shock. One of the few things I remember is this amazingly deft insertion of the IV (ever try and start an IV on a needle-phobe who is thrashing and not really aware of what's going on?), like it was no problem. My friend, who walked away from the accident, saw it and marveled at the ease in which they were able to do it.

Anyways, I figured if they can get an IV into me when I'm thrashing about and trying to scream "NO!" despite the fractured and dislocated jaw and trying to swat the nurse away with an arm that's at a funny angle, you can get an IV into pretty much anyone.

And now I hear abut how bloody hard it is to insert IVs and that's why I need that damnable not-hep heplock in my arm....well, you see why I'm wondering just what the heck is going on here.

This kind of thing is why I felt like the OB was using scare tactics. I'm aware things can go wrong in labor; I'm curious how often it happens "out of the blue". I once had a phlebotomist who'd been a nurse in Iraq. As I was trying to get my needle phobia under control, I was imagining all the terrible circumstances under which he said he'd inserted lines and drawn blood.

Maybe if hospitals didn't actively discourage eating and drinking as desired (I know some women have zero desire for either) they wouldn't have to have IVs as a matter of course.

[Anonymous]

Can we once and for all agree that there is NO HEPARIN instilled in the IV? HEP LOCK is an outdated term. NOONE following current practice guidelines puts heparin into peripheral IVs.

Anyway, I just don't see what the BFD it is to put a f-in iv in your arm. Are people going to start requesting the type of stitch that goes in their hoo-ha when they get a 2nd degree tear?

[Anonymous]

Anonymous wrote:

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.

Well then I think hospitals should start having women sign a form that they waive the IV placement and understand that they may *may* be putting themselves at risk due to the delay in treatment caused by lack of IV access when it's really needed. Yes - it may be for the nurse's or doctor's convenience but also a liability to them if its not in place and causes a delay in getting some intervention because they have to put the dams thing in.

[Anonymous]

Anonymous wrote:Can we once and for all agree that there is NO HEPARIN instilled in the IV? HEP LOCK is an outdated term. NOONE following current practice guidelines puts heparin into peripheral IVs.

Anyway, I just don't see what the BFD it is to put a f-in iv in your arm. Are people going to start requesting the type of stitch that goes in their hoo-ha when they get a 2nd degree tear?

So it's not a BFD for you to have plastic tubing in your arm. For some women it is. I was absolutely conscious and annoyed with my saline lock (happy? Hope you don't need any Band-Aids or Kleenex. Excuse me, adhesive bandages or tissues.). It hurt. It distracted me. I don't want another one.

[Anonymous]

Anonymous wrote:

Anyway, I just don't see what the BFD it is to put a f-in iv in your arm. Are people going to start requesting the type of stitch that goes in their hoo-ha when they get a 2nd degree tear?

i don't understand this comment - it seems nonsensical - i don't see how the scenario you mentioned about choosing stitching for a vaginal tear is comparable to the issue of a woman in labor opting not to have an IV or saline lock inserted in the absence of a medical need for one.

[Anonymous]

For all of those who don't want to get a saline lock in the hospital, you'd better also not want an epidural. None of you want one, right? Besides the fact that they have to bolus fluids in you before the epidural (via IV), they will also be sticking a needle in your SPINAL CORD, which is a helluva lot more invasive that a peripheral vein.

So, none of you want an epidural, right?

[Anonymous]

Anonymous wrote:I'm sitting here and find all this talk of how difficult it can be to place an IV in someone in an emergency, and I just don't get it. Maybe I was lucky. Maybe I had the world's best IV placer. I was in a pretty nasty car crash, all sorts of broken and dislocated bones, bleeding, concussion, shock. One of the few things I remember is this amazingly deft insertion of the IV (ever try and start an IV on a needle-phobe who is thrashing and not really aware of what's going on?), like it was no problem. My friend, who walked away from the accident, saw it and marveled at the ease in which they were able to do it.

Anyways, I figured if they can get an IV into me when I'm thrashing about and trying to scream "NO!" despite the fractured and dislocated jaw and trying to swat the nurse away with an arm that's at a funny angle, you can get an IV into pretty much anyone.

And now I hear abut how bloody hard it is to insert IVs and that's why I need that damnable not-hep heplock in my arm....well, you see why I'm wondering just what the heck is going on here.

Have you EVER tried to place an IV yourself? Until you do, don't presume to understand how easy or hard it is.

[Anonymous]

Anonymous wrote:For all of those who don't want to get a saline lock in the hospital, you'd better also not want an epidural. None of you want one, right? Besides the fact that they have to bolus fluids in you before the epidural (via IV), they will also be sticking a needle in your SPINAL CORD, which is a helluva lot more invasive that a peripheral vein.

So, none of you want an epidural, right?

Yep, for me that's correct - didn't want (and didn't get) an epidural.

[Anonymous]

Anonymous wrote:So, none of you want an epidural, right?

Correct. I do not need ror want an epidural.

[Anonymous]

Anonymous wrote:For all of those who don't want to get a saline lock in the hospital, you'd better also not want an epidural. None of you want one, right? Besides the fact that they have to bolus fluids in you before the epidural (via IV), they will also be sticking a needle in your SPINAL CORD, which is a helluva lot more invasive that a peripheral vein.

So, none of you want an epidural, right?

Yes, that's right. And I've had a saline lock before and I hated it, so I don't want another one.

[Anonymous]

The other night, we had 6 people try to start an IV in a dehydrated patient. All good sticks....we could hit the vein, but the pt was so dry they wouldn't thread.

Not everyone has good veins. And I hope you aren't even a tiny bit overweight, or possibly edematous d/t the end of your pregnancy: Both situations obscure veins.

[Anonymous]

Anonymous wrote:The other night, we had 6 people try to start an IV in a dehydrated patient. All good sticks....we could hit the vein, but the pt was so dry they wouldn't thread.

Not everyone has good veins. And I hope you aren't even a tiny bit overweight, or possibly edematous d/t the end of your pregnancy: Both situations obscure veins.

Yeah and I hope you're not my nurse.

[Anonymous]

My reason for refusing an IV or saline lock was not because I am afraid of needles, but because there was no reason to automatically put one in. An epidural is different (although I did not get one of those, either) because it's not something that gets administered automaticallu, upon arrival, to every laboring woman, regardless of her situation or her needs.