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.