Routine IV fluids during labor, necessary or nuisance?

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The following is a student blog post by Brianna Goul

Today, the vast majority of US hospitals routinely place IVs in laboring women. But why? Are there any benefits to receiving IV fluids during labor? Or perhaps maybe even some undesirable side effects? I have decided to seek evidence based information in order to determine if this common practice is necessary or nuisance.

The rationale for routinely giving IV fluids is that labor is a physically demanding exercise. Generally when people partake in physically demanding activities, they stay hydrated by drinking a lot of water. Okay, so why are hospitals giving women IV fluids instead of ensuring that they are drinking a substantial amount of water? Well, this brings us to another commonly practiced hospital policy, the restriction of food & drink to laboring women (NPO.) The practice of restricting food and drink is based on the care providers fear that a women may need general anesthesia & that she could inhale stomach contents during surgery. In case you were wondering, the odds of that happening are seven in ten million (which, fun fact, is less than your odds of being struck by lightening.)

Routine IV fluids during labor, necessary - Birth Arts International
Routine IV fluids during labor, necessary

So then what are the supposed benefits of receiving IV fluids during labor? In 2012 a study by Kavitha et al. randomized293 moms into one of three groups: oral fluids (plain water and coconut water), IV fluids at 125 mL/hr, or IV fluids at 250 mL/hr. The women in the IV fluid groups were also allowed to have oral fluids. There were no differences between groups with length of labor (first stage, second stage, or total length), oxytocin augmentation, or any other complications. There were no differences in complication rates, and no cases of pulmonary edema (However, other signs and symptoms fluid volume overload were not measured). There was a decreased incidence of vomiting in the 250 mL group (6% vomiting in the 250 mL group versus 11% in the 125 mL group and 24% in the oral fluid group).So after reading this study I concluded that IV fluids offer only one benefit (decreased vomiting) to women who are allowed to drink during labor.

Chantry et al. (2010) followed 448 pregnant women through pregnancy and after birth to determine risk factors for excess weight loss in newborns (excess weight loss was defined as >10% of birth weight at 3 days old). Of the breastfed newborns, 16-19% experienced excess weight loss. The authors ran a regression (a type of statistical technique) to determine the causes of excess weight loss in these babies. The only two things that predicted excess weight loss in newborns were increased IV fluids given during labor and delayed milk production. If moms received more than 200 mL/hour of fluids, their babies were 3.2 times more likely to experience excess weight loss at 3 days compared to moms who had less than 100mL/hr of fluids. The infants whose mothers had a higher IV fluid rate peed more during the first 4 hours of life. When you put 2 and 2 together, this means that the babies had too much fluid in their bodies. They peed more after birth. Hence the excess weight loss at 3 days. Thirty percent of infants in this study (whose moms intended to exclusively breastfeed) were supplemented with formula.And in this study, supplementation with formula at 3 days was associated with decreased intent to breastfeed. Reason for supplementation? Excess weight loss, along with concerns about a delay in milk coming in.

IV fluids do not provide the ideal balance of energy and nutrition as do foods and fluids. They will keep you from dehydrating, but they may not keep you from reaching total exhaustion. Many women may find IV placing painful and stressful, and these are things that can actually inhibit the labor process. Having intravenous fluids can also make changing positions and moving around more difficult for the laboring woman. According to the Cochrane pregnancy and childbirth group “Routine use of IVs is not likely to be beneficial (Enkin et al.) No studies demonstrate that routinely placing an IV in low-risk laboring women prevents poor outcomes (Enkin et al., 2000; Goer et al., 2007).It should be noted that if your labor is induced or you are given pitocin at any point, you have an epidural, you need intravenous medicine such as antibiotics, or you are unable for other reasons to eat or drink, you will need an IV.

 

Sources Cited:

Lothian, Judith A., Debby Amis, and Jeannette Crenshaw. “Care Practice #4: No Routine Interventions.” The Journal of Perinatal Education. Lamaze International, n.d. Web. 02 Sept. 2015.

 

 

Dekker, Rebecca. “Are IV Fluids Necessary during Labor? – Evidence Based Birth -.” Evidence Based Birth. N.p., 24 May 2012. Web. 02 Sept. 2015.

 

Author Bio: Brianna Goul

As a mother and someone that has had both positive and negative birth experiences, I feel compelled to ensure that women are offered the information necessary to make informed decisions. I believe in the safety and naturalness of birth.

Website of the author: http://briking0.wix.com/bloominglifedoula

Facebook: https://www.facebook.com/BloomingLifeDoula

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