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Natural Birth
MrsW101011
member
IV vs. Saline Lock
MrsW101011
member
When I first talked to my doctor about how I didn't want an IV she didn't feel comfortable with it and explained to me that it's hospital policy that everyone have an IV and it's just how it is. I didn't argue with her right then, but as time went on, I realized I felt pretty strongly about not having an IV, so I brought it up again. She told me that I WILL NOT be allowed to eat or drink so I will have to have fluids to stay hydrated so she brought up an idea that I agreed on. Her idea is that I have a saline lock in place and receive fluids intermittently. I'm really excited about her willingness to compromise and feel comfortable with this plan but I'm just hoping I'm not missing something. What do you all think? Is this a good idea and a decent compromise? What would you do?
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Re: IV vs. Saline Lock
Well, I would give her the ACOG recommendations for food and drink in labour:
https://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Oral_Intake_During_Labor
And then I would ask why she goes against that when there is no evidence that depriving you of water is beneficial. To me, that's a big deal and a sign that if you can switch caregivers, you should.
If you really want to stick with her, a saline lock isn't a huge deal. I was going to get one, but I arrived late in labour and no one brought it up. So my other advice is that if you're going to stay with her, arriving at the hospital as late in labour as possible is going to be very beneficial to you.
Excessive fluids can make breastfeeding more difficult because you get really swollen and it takes a few days to go away. So it's not "just" fluids - they have impacts in other areas. If you get them for many hours before birth, it also swells the baby. Then the baby loses a bunch of water weight and everyone freaks out about it being over 10% and pushes formula.
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All of this... even intermittent fluids is going to swell you and baby more than eating and drinking as you feel the need. It's not a very good compromise. A compromise is a hep lock and drinking water. Or even a "you don't need fluids until you've been at the hospital X number of hours" so you at least have the potential to avoid them completely.
Call the hospital and ask if it's their policy and not just your OBs. If it is, you might need to find a new provider that delivers at a different hospital as well.
A hep lock is a pretty commonly suggested alternative to an IV. If agreeing to that is a big deal to her, I suggest considering if another provider may be a better fit. Also, saying you can't even have water is another red flag to me that she may not be an optimal provoider for an unmedicated birth. The no food rule is bogus to me, but at least I understand the history behind it in the hospital setting. Saying no water or ice chips simply seems outdated and flat out incorrect.
That said, you can always refuse something--hospital policy or not. And you can certainly eat or drink as you'd like if you are fine with breaking the rules. Of course, doing those things may cause tension. The impact that has on you will depend on your personality. We did a hospital birth with DS and I knew that I would be "playing nice" to get the hep lock and make things smoother with the staff. I am a rule-follower and get tense breaking the rules.
Personally, if I could do that birth again I would skip the heplock. It interfered with my ability to fully use the water and shower for relaxation because I had to worry about it staying dry and in. My doula devised a cover for it out of latex gloves and medical tape, but that would tug on it. It also meant that they could suggest/administer interventions just that much more quickly. I do think a heplock is a fine compromise, and it can be beneficial in an emergency, it just wasn't the fit for me.
More Green For Less Green
That's not really a compromise, that's just her getting her way. What does "intermittent mean to her"? A liter every few hours? 15 minutes on out of every hour? A 15 minute break every few hours? See how this could go so many ways? It really just sounds like she's trying to appease you while still insisting on fluids.
With the next baby I will probably agree to a saline lock, and while hospital policy seems to be continuous lactated ringers for a VBAC momma, I'll plan to refuse those.
I would find a new provider, if possible. If not, I would accept a SL, refuse the fluids, and eat and drink as you want.
Some people are okay with the saline lock. I, personally refuse it because I don't want anything interfering with my ability to progress in labor. I feel like it will make me uncomfortable and also, it just provides easy access to medical interventions that I don't want.
The opposite side of that is, of course, that if there were an unlikely emergency, they would have to put an IV in quickly. But my thought on that is, don't they have to do that all the time in the ER?!!
Better not eat from week 38 on, too, in case you need an emergency c-section. Could happen any moment!
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In our birth plan we stated that we didn't want the IV or the hep lock. The nurse kept trying to convince us that we needed the hep lock, but the hospital midwife who was assisting us didn't have a problem with it, we just needed to sign a waiver releasing the hospital from liability.
It ended up being a moot point, because almost as soon as we were set up in the delivery room, LOs heart rate fell drastically and everyone rushed in to hook me up to all kinds of machines. At which point the midwife said to me..."I'm sorry, but your baby is our patient too". It only took a few seconds to insert the IV - so I don't think having the hep lock even saves that much time. Of course, since it was medically necessary at that point, we would have agreed to the IV...we had clearly stated that in our birth plan.
I don't think under normal circumstances an IV is necessary, since you can stay hydrated through ice chips (I think these are generally permitted). I feel like if there's a hep lock already in place your provider will be more likely to use it....even if it's not really necessary. I don't plan on having an IV or hep lock next time either - I feel like if its absolutely necessary then you can decide in that moment, but having them up front is just a routine that encourages unnecessary interventions.
If a mom is allowed to drink as she pleases, she probably will not be dehydrated. It's rather ridiculous not to allow women to drink during labor (as PP mentioned ACOG guidelines), then require an IV so they stay hydrated.
I actually found my saline lock, then IV INCREDIBLY uncomfortable. As in more intensely painful than contractions. I would not be able to adequately relax with one in and will be declining one this time--in a true emergency I trust the staff to get an IV in ASAP.
This.
My issue with the "compromise" isn't the presence of the saline lock, but the fact that you're not being allowed to drink during labor. You DO need to stay hydrated during labor, but the practice of denying you liquids then insisting on an IV to make up for them is asinine (and outdated). As token said, check out the ACOG guidelines. I'd find out if this is hospital policy or practitioner policy and consider switching if possible, if an unmedicated birth is important to you. If the practitioner or hospital standard is immediately hooking you up to an IV and not permitting even water during labor it doesn't, IMO, bode well for their experience or comfort with attending unmedicated natural births.
For me, I will refuse an IV during labor, and will drink on my own to stay hydrated, but I am willing to compromise with having a saline lock placed for "preventative emergency purposes" as this particular issue doesn't bug me too much and it makes the nurses more comfortable. But the saline lock is not there for the purpose of hydrating me--my cup of water will handle that, thanks.