Drama much? How is it not a doula's "scope of practice" to say to a nurse "she wants the IV In her forearm, not her wrist"?

Anonymous wrote: My doula told me she'll help me to make sure the heplock is place correctly (in my arm, not wrist) so that it doesn't make changing position uncomfortable during labor.

Is your doula a trained nurse? Be very careful of people with minimal education who do not adhere to their scope of practice. (for a doula, the scope of practice is support, not medical advice, and definitely not supervision of trained medical staff.

I felt the exact same way OP. I hate IVs, but due to medical issues have had them a lot.

As I see it, you have 2 options to help you feel comfortable.

1. A hep lock, but not in your hand or elbow. Get an older experienced nurse to put one in your forearm. Its a tad tricky to get them in there. Ask them if they are confident doing it and if they aren't have them find someone who is. I'm super sensitive to IVs, but find this option very manageable. You can also ask if they will use a smaller gauge needle, which for just fluids is adequate. But most likely they won't because if you had an emergency c, they'd have to change it (or worse, it might get forgotten and the meds wouldn't work as well).

2. At the time of admission, tell them you decline the iv except in the case of emergency and will sign whatever they need you to. As long as you keep drinking yourself, you will stay plenty hydrated. It's actually better to drink water orally as it is more direct. Iv fluids tend to go into various tissue spaces in the body, so not as effective. They work, but not as well. The only complication you may have is if you throw up during labor (which I did). If that's the case, definitely ask for iv- you will need your strength to go natural.

Good luck! You can do it!

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 HEP LOCK is an outdated term.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?

The BFD is that UNLESS it's a TRUE emergency, it's unneeded and carries risks. Why don't you google secondary hospital infection? Or watch the news? Point IS that the PATIENT, NOT the "god"-like doctor has the finally say.

No doctors are not regularly seeing patients go into this type of emergency. What is more common though is for a woman to become dehyrdated from not drinking fluids (most hospitals don't allow drinking fluids), decides that she does want an epidural for pain relief and the nurses have a hard time inserting the IV. Getting the epidural is not an emergency, but everyone thinks I am glad this wasn't an emergency because we had a hard time finding a vein.

Anonymous wrote:

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?

Its VERY doubtful that your OB "had seen too many cases like these" since hospitals pressure almost everyone to have a heplock. I know several ob/gyns and they freely admit that they overstate things to get the patient to make the right choice without freaking them out with the real behind the scenes facts. Ironically, the fact that it doesn't happen very often is why they prefer the heplock to be in place. Nursing skills vary by department. An ER or trauma nurse who is not an expert at placing an IV in all types of situations would be eaten alive by her fellow nurses and then fired or advised to switch to another department. ER nurses also get lots of practice inserting IV's in bad situations with bad veins. IV skills are not paramount for ob/gyn nurses and quite frankly many of them aren't very good at it even in a fully hydrated, compliant patient with normal veins. The ob/gyn nurses get very little if any exposure to placing IV's in an emergency situation so you would lose time.

I remembered this when I had my child and my nurse took 15 minutes and several tries to get the IV/heplock in place. I certainly would not have wanted to rely on her to place an IV in an emergency.

Honestly, at the time I didn't think she'd seen "too many" if she were being honest and imagined that the was an "ulterior" motive, in addition to that just being the hospital policy. It still doesn't seem like the majority of women would ever need an IV and I still come down on the side that getting an IV or saline lock as a general matter of course is not good medicine. Thanks for the answer. If you have an other "secrets" your OB friends have shared, would you mind spinning off another thread? I'd be very curious.

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?

Its VERY doubtful that your OB "had seen too many cases like these" since hospitals pressure almost everyone to have a heplock. I know several ob/gyns and they freely admit that they overstate things to get the patient to make the right choice without freaking them out with the real behind the scenes facts. Ironically, the fact that it doesn't happen very often is why they prefer the heplock to be in place. Nursing skills vary by department. An ER or trauma nurse who is not an expert at placing an IV in all types of situations would be eaten alive by her fellow nurses and then fired or advised to switch to another department. ER nurses also get lots of practice inserting IV's in bad situations with bad veins. IV skills are not paramount for ob/gyn nurses and quite frankly many of them aren't very good at it even in a fully hydrated, compliant patient with normal veins. The ob/gyn nurses get very little if any exposure to placing IV's in an emergency situation so you would lose time.

I remembered this when I had my child and my nurse took 15 minutes and several tries to get the IV/heplock in place. I certainly would not have wanted to rely on her to place an IV in an emergency.

Anonymous wrote:Well guess what - the hospital experience is not about you. You one to normally buck the rules? Stuff doesn't apply to you when you don't agree with it?

Seriously? We're consumers of healthcare products and services just like everything else in life. Even the hospitals acknowledge this. Do you know how many billions of dollars are spent by healthcare organizations each year to measure and improve patient satisfaction and outcomes? What does this eventually result in? CHANGING HOSPITAL POLICY. If people stopped advocating for themselves, we'd go back to the way healthcare was 60 years ago when people just blindly listened to their doctor without even a thought. Sure, sign me up for one of those twilight sleep births where I'm completely knocked out because you're right, my child's birth and my birthing experience as a mother just aren't "about me". Nevermind what evidence-based practice or current research says about birthing practices. Just listen to your doctor folks and all will be fine in this world. No need to exercise that brain of your own.

Anonymous wrote:
Well guess what - the hospital experience is not about you. You one to normally buck the rules? Stuff doesn't apply to you when you don't agree with it?

Okay this post screams clueless man.

"Well guess what - the hospital experience is not about you."

This comment surprises me, as I think the "hospital experience" should most definitely be about you.

Anonymous wrote:

Anonymous wrote:My OB recommended a heplock (his word) and intermittent monitoring when I said that I'd like to be able to get in and out of the shower during labor. There was no drama. I agreed and we moved on. I didn't find the saline lock to be all that uncomfortable. It was a little annoying, but the contractions took the focus off of my hand.

It seems like some of you are making a bigger deal of out this than it needs to be.

Or, it could be that some women feel differently about things. I'm the previous poster who had a saline lock, and it hurt and really bugged the hell out of me. If one is needed, i.e., I start labor dehydrated or tired and it looks like good preventative care, well, I'll figure it out. But if it's just hospital protocol, no.

Well guess what - the hospital experience is not about you. You one to normally buck the rules? Stuff doesn't apply to you when you don't agree with it?

Anonymous wrote:

Anonymous wrote:There's no debate that monitoring improves outcomes -- the debate is intermittent vs continuous. There's no reason for a woman to be stuck in bed with continuous monitoring when intermittent has shown to be just as effective.

agree. With my second, nurse was insisting that i get into the bed and be on monitor 24/7...i said i'd happily be on monitor 15 min out of every hour, but would not lie in the bed indefinitely, as this is counterproductive for labor (and also, contraxns were much more painful lying down). She was so nasty about it that we had to call my OB in to tell the nurse that it was okay. Then the nurse was angry with me for the remainder of her shift.

You have the right to fire your nurse. (This is coming from a nurse). Legally, we can't just stop being your nurse w/o reporting off to someone else, but you absolutely have the right to fire your nurse at any time.

Anonymous wrote:There's no debate that monitoring improves outcomes -- the debate is intermittent vs continuous. There's no reason for a woman to be stuck in bed with continuous monitoring when intermittent has shown to be just as effective.

agree. With my second, nurse was insisting that i get into the bed and be on monitor 24/7...i said i'd happily be on monitor 15 min out of every hour, but would not lie in the bed indefinitely, as this is counterproductive for labor (and also, contraxns were much more painful lying down). She was so nasty about it that we had to call my OB in to tell the nurse that it was okay. Then the nurse was angry with me for the remainder of her shift.

"It's called 'The Business of Being Born' "

There's no debate that monitoring improves outcomes -- the debate is intermittent vs continuous. There's no reason for a woman to be stuck in bed with continuous monitoring when intermittent has shown to be just as effective.