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Intravenous (IV) Therapy During Labor and Birth

Friday, 24 May 2013 21:43
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If you opt to do a hospital birth, you will most likely be faced with the choice to either consent or deny the placement of an intravenous catheter (IV). The IV is sometimes not attached to any tubing or fluid. This is called a saline lock, or hep lock. It is usually placed in either the hand or the arm and provides easy access for the administration of fluid or medication. 

Medications administered via IV are instantly absorbed into the body, making it ideal for quick results. However, this instant action means that once the medication is administered, there is no time to correct any possible errors. Errors could include wrong medication, wrong amount of medication, or medication administered at the wrong time.
 
Women are often told they cannot eat or drink during labor. This is due to the fact that if an emergency cesarean becomes necessary, having an empty stomach reduces the risk of vomiting and possible inhalation of vomit while under general anesthesia. However, the laboring woman needs to stay hydrated. In order to do this, the IV is placed and fluids, usually a saline solution, are administered. So instead of allowing women to eat and hydrate themselves, they are forced to have an IV placed on the chance that there might be an emergency. 
 
Let us compare this emergency example with another situation from every day life. For example, we do not have IVs placed every time we get in our vehicles and drive somewhere “just in case” we get in a car accident. We wait until there is actually an emergency before allowing such invasive procedures. Since labor and birth are not medical emergencies in and of themselves, it might be in the best interest of the woman and baby to wait until the need for an IV actually arises. 
 
Another reason for IV placement is for medication. However, if a woman is wishing to have a non-medicated birth, having the IV access is just one step closer to having medication. It makes it that much easier for the provider to order synthetic oxytocin or some other drug that may or may not be truly medically necessary. If there is no need for medication yet the IV is placed anyways, the woman is then unnecessarily exposed to the risk of infection, fluid overload, and pain associated with IVs. Additionally, the IV poles, making it difficult to walk and otherwise move around, limit a woman’s mobility. This can lead to women becoming bed ridden during labor, which can cause malpositioning of the baby, stall of labor, and other negative effects on labor.  
 
Other possible complications of an IV or Saline lock include: fluid leaking out the vein into surrounding tissues (infiltration), infection of the vein (phlebitis), bruising from blood leaking into surrounding tissues during IV insertion (hematoma), piece of IV breaking off into vein (catheter embolus), air bubbles entering blood stream (air embolus), infection of surrounding tissues (cellulitis), infection in the blood stream (septicemia), and too much fluid in blood stream (fluid overload) which can lead to heart, lung, and kidney problems.
 
Finally, if a woman is being pumped full of fluid, it is important to remember that the baby is getting excess fluid as well. This can lead to a false birth weight. Once the extra water weight has been lost, the baby may then be classified as having lost too much weight. This can lead to a vicious cycle of formula supplementation, inadequate breast milk supply, and continued “inadequate” weight gain. 
 
As a general rule, a woman should have a thorough discussion with her care provider and ensure that the risks and benefits of either option have been fully discussed. Additionally, it may be a good idea to discuss the issues of IV placement with her care provider prior to labor and birth to determine her provider’s protocols and standards. When necessary, IVs are a great asset to both care provider and patient. However, unnecessary placement means unnecessary risk. Ensuring the actual, medical necessity of IV placement is the best way to ensure your risks are limited. 
 
Source: Fundamentals for Nursing, Version 6.1. Assessment Technologies Institute, LLC 2000-2008. 
 
 
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Breanna is a wife and mother living in sunny Southern California. Before becoming a mommy, she graduated with her Bachelors of Science in Nursing from California Baptist University and obtained her California Registered Nursing License. Her passion has always been for pregnant and postpartum women and babies, and her long-term goal is to become a midwife. She is currently a social media admin for The Birthing Site.

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