This is a joyous occasion; it’s almost time to meet the little angel, but there are so many things women don’t know and so many things they need to consider. It’s time to take on adulthood! Mostly, we trust medical professionals to do their jobs and take care of us during such a significant time in our lives. Heaven knows we don’t have time to do our job and their job, too—but what if their job is our job?
In just nine short months, we’ve had to learn medical terminology and become savvy in a field that might be foreign to us, but we must remember—we are our own advocates. Using research as our guide, we must be prepared to make some tough calls. During hospital labors, intravenous therapy—IV for short, is pretty standard. An IV delivers liquid substances to the veins, per Medicine Net.
Does common mean necessary, or is using an IV such an accepted part of our medical tradition that we’ve become blind to the risks? We no longer ask questions about IVs because they plague our perception of what happens in hospitals. Like the doctor with a stethoscope around his white coat, it’s what’s supposed to happen. Let us remove the blindfold and determine if an IV is a necessary precaution or an unnatural risk factor. Either way, it’s time to be an adult.
20 Saline Or Heparin In The IV
A saline or Heparin lock is common practice for low-risk mothers in labor. Hooking us up to an IV allows easy access if we need any medications during labor.
According to WebMD, Heparin is a medication that helps keep the blood flowing smoothly through the catheter—i.e., clot free. The substance is known as an anticoagulant and comes in many strengths. WebMD states that Heparin should not be injected into the body—only in an IV. According to the National Center for Biotechnology Information standard saline solutions are “heparinized”— meaning Heparin is added to the saline.
Is Heparin a necessity during labor?
19 Too Much Heparin For Baby
Medical professionals do what they’re trained to do. We don’t want to resist their professional opinions, but we do want to actively participate in our medical care. The National Center for Biotechnology Information concluded that there was no difference between using heparinized and normal saline solutions in preventing blood clots in the IV catheter.
Another outcome to consider is CNN’s report from 2008; it showed that 17 babies received too many does of Heparin. Actor Dennis Quaid’s twins had a life-threatening reaction to getting too much Heparin in Los Angeles in 2007. A Heparin or saline lock can easily be converted to a full-scale IV. In emergencies, the proper medications can be administered, as per Very Well Family.
18 What Starts Labor?
Labor induction means that the doctor or midwife will help start labor—often with a medicine called Pitocin via IV. According to the Mayo Clinic, a few reasons why labor might be induced include it being several weeks beyond baby’s due date; when mom's water has been broken for days but labor hasn't begun; there is an active infection in the uterus, or mom has maternal risk factors like Pre-Eclampsia.
According to Healthline, Pitocin is a synthetic form of oxytocin. Oxytocin—the “love” hormone—naturally occurs in the body during labor to induce contractions. Healthline says Pitocin should not be given unless the cervix is already showing signs of preparing for labor via a quality Bishop's Score. If Pitocin is given, nurses usually raise the level gradually until contractions are two to three minutes apart.
17 Pitocin: Beneficial Or Risky?
We don’t want to put ourselves or our babies at risk, so we have to consider the benefits and the risks. Sometimes, Pitocin is associated with long, slow, painful delivery because it is given gradually, so contractions build progressively. Slow and painful is not what we want, but what about the other option—cesarean section? As per WebMD, Pitocin is not the enemy in medically-warranted cases. It could be the reason a vaginal birth is possible. If the uterus refuses to contract, Pitocin saves the day—no C-Section.
On the other hand, Pitocin could overstimulate the uterus causing it to rupture; it could cause fetal distress according to Healthline. This can lead to a multitude of other interventions, and studies have confirmed this medication significant increases the risk of needing a C-section. Decisions, decisions… should we refuse Pitocin or embrace it? Perhaps there is a time and place for both.
16 To Treat Certain Infections
Group B Streptococcus (GBS) is a bacterial infection found in pregnant women's V, as per APA. The bacteria are found in many healthy women and have no symptoms.
Women can pass GBS to their babies during delivery; about one out of 200 babies whose mothers are positive for GBS colonization and are not treated with antibiotics will become ill. However, only one in 4,000 babies will become ill if their mothers are treated with antibiotics, according to the APA.
GBS can put infants at risk for sepsis, for example. GBS can affect babies, but antibiotics affect them as well, right?
15 Keep The Baby's Gut Healthy
The Centers for Disease Control and Prevention recommends that women in labor receive antibiotics through an IV during labor if test results of positive for GBS, previous babies developed GBS or GBS is present in the urine during pregnancy. Women who receive C-Sections are also given antibiotics to prevent surgical infections.
Daily Science reports that antibiotics given to a mother during labor can affect gut bacteria—microbiota—development in babies. According to Jennifer Stearns—the study’s first author—gut health is extremely important because it can change the metabolic and immune systems throughout life. The study showed that the gut bacteria seemed to recover after 12 weeks, but researchers aren’t sure what this means for the future.
14 Common Meds Given During Labor
Pain is a major concern during labor; sometimes we opt to use pain-relieving medications because let’s face it—labor can be excruciating.
There are several common pain-relieving medications—narcotics—administered through an IV during labor. According to the APA, Demerol is the most popular choice. It alters how the mother recognizes pain by limiting pain receptors. Stadol is also common; it is used in the first stages of labor and is considered more powerful than Demerol.
Both Demerol and Stadol start working in less than five minutes—an undeniably positive thing when pain is unbearable. Pain-relieving medications may feel necessary for some mothers, but we won’t know until we’re in labor.
13 A PCA Pump Might Be A Better Option
A Patient Controlled Analgesia (PCA) pump is a way that mothers can control the dosage of medication they receive per the APA. The pump is programmed to deliver small doses that relieve pain while releasing minimum medication. Demerol can be given via PCA pump.
Mother’s who opt for a PCA pump will still have to use an IV to receive the medication. According to WebMD, some PCA pumps can deliver constant flows of the medication, while others opt to self-administered as needed. Self-administration allows mothers independence and control. If we have to take narcotics, the option to minimize dosages may be an even better option.
12 Meds For Labor
First of all, what’s the difference between narcotics and opioids? According to The Recovery Village, the term opioid and opiate are used interchangeably; however, opiates are derived naturally and opioids are human-made. According to The Patient Advocate Pharmacy, opioids are a type of narcotic. Opioids work by blocking pain at one of the three opioid receptors per Science Daily.
The APA states that Fentanyl is an opiate that gives mild to moderate sedation. Nubain is another opiate that is similar to morphine. Both opiates begin relieving pain quickly and can be administered via IV during labor. The question is, how will narcotics and opiates affect labor and the baby?
11 How Do They Affect Childbirth?
Keep in mind medications always have side effects. Demerol can cause nausea and vomiting in mothers and breathing difficulties in babies, as per the APA. The same organization also states that Stadol causes respiratory depression, dizziness, and feelings of unhappiness in mothers and can bring about respiratory depression in babies.
Fentanyl has minimal fetal effects and rarely leads to respiratory issues in infants, but sedation is also minimal. Nubain causes minor nausea and has few effects on the baby, but like Stadol, it can cause feelings of unhappiness. Remember—many women have opted for narcotics or opiates with few effects to their babies; they have gone on to raise happy, healthy children.
10 Sudden Pressure Spikes During Labor And Delivery
Pain increases blood pressure, according to the National Center for Biotechnology Information. In labor and delivery, there will undoubtedly be pain, therefore, a chance for our blood pressure to spike. However, slight peaks don’t usually require medications.
As per the Mayo Clinic, Pre-Eclampsia is another reason for high blood pressure during labor. Pre-Eclampsia is a potentially dangerous complication usually diagnosed during pregnancy, but can emerge afterward—postpartum pre-eclampsia; it includes three main symptoms: high blood pressure, swelling, and protein in the urine.
Elm Tree Medical states that severely high blood pressure during labor— >160 systolic or >105 diastolic—is associated with complications and is usually treated with medication through an IV.
9 The Risks After Labor
Gestational hypertension— >140 systolic or >90 diastolic—is another cause of blood pressure spikes during labor and can lead to pre-eclampsia. According to Healthline, severe high blood pressure is associated with complications for mother and baby. Since blood pressure is closely monitored in developed countries, medications like Labetalol and Hydralazine are administered, and risks are low.
Healthline also discusses the idea that women should monitor high blood pressure after delivery. Sometimes high blood pressure during pregnancy and labor can remain, presenting a variety of risks to mothers. Preventative measures can be taken to help avoid high blood pressure during pregnancy, but during labor high blood pressure spikes often require medication.
8 No Fluids During Labor
One of the dreaded practices during labor is that dear, dear food and water is forbidden. Some doctors will encourage mothers to eat ice chips, and few have given in to popsicles and Jell-O. Why? Why is it standard practice not to let a pregnant woman eat or drink? It seems cruel.
According to UT Southwestern Medical Center, doctors start requiring women to fast during labor in the mid-20th century. Some pregnant women put under anesthesia were at risk for aspiration—when food and liquid are inhaled into the lungs. According to Evidence-Based Birth, since it is mandatory that women stay hydrated during labor, doctors began rendering “fluids” via IV.
7 IV Fluids Plus Oral Liquids May Shorten Labor
According to Evidence-Based Birth, the three common fluids administered through an IV are saline, Ringer’s lactate, and dextrose. There is little research comparing the fluids—even though they are common.
Evidence-Based Birth, in their analysis of a study conducted on mothers, concluded that dehydration might be a cause of extended labor. The study found that women who had IV fluids and were also allowed to drink freely had shorter labors than those who only drank orally.
If nauseated during labor, drinking may not even be appetizing. Sometimes risks won't allow us to drink fluids orally. It’s a smart idea to discuss the choices available to you with a physician or midwife before labor. But it's also a good idea to consider the pitfalls of not fueling the body with food-based nutrients and energy when we're about to embark on the toughest marathon of our lives.
6 An IV For Infections
Postpartum hemorrhaging is excessive bleeding after giving birth. According to Stanford Children’s Health, there are several reasons that women hemorrhage during delivery: C-section, cervix or vaginal tear, blood clotting disorder to name a few. IV fluids or blood may be given to prevent shock.
Infections during labor determine whether mothers will be given an IV as well. According to Healthline, one such infection is Chorioamnionitis—bacteria that is normally present in the vagina moves up to the uterus. Chorioamnionitis patients receive antibiotics via IV until the baby is delivered. Without antibiotics, babies are at risk for developing serious infections like meningitis.
5 Treatments And Their Risks
In some cases, bleeding excessively during labor demands a blood transfusion, according to the APA. Blood transfusions are given through an IV and are sometimes necessary to save a baby’s life. With infection, comes the “need” for antibiotics. Not only do antibiotics affect babies’ gut bacteria, but they can cause yeast infections and thrush in newborns, as per Belly Belly.
If babies have thrush in their mouths, they can pass it to their mother’s areolas causing them to crack and bleed, resulting in pain during nursing and poor nourishment for the baby. Researching and applying preventative measures for hemorrhaging and infections may save a mother and baby from having to endure such treatments.
4 An IV For Cesarean Sections
A Cesarean Section—C-section—is a surgical procedure that allows doctors to deliver a baby through an incision in the abdomen and uterus versus vaginally, as per the Mayo Clinic. A C-section is major surgery and requires anesthesia. Because a C-section poses risks such as infection, blood clots and hemorrhaging, an IV is necessary. The IV will deliver medications, fluid or a blood transfusion if the need arises.
According to Harvard Health Publishing, Mothers are given antibiotics just after the baby is delivered to reduce the risk of infection. Some C-sections require general anesthesia. If so, the anesthetic is administered via IV.
3 Other Reason For General Anesthesia During Labor
According to Healthline, general anesthesia causes a total loss of consciousness; although mothers are motionless, general anesthesia doesn’t stop contractions.
Local anesthesia is normally used for C-sections, but general anesthesia is sometimes required for emergencies. Doctors rarely use general anesthesia for vaginal childbirth because it requires active participation. Reasons for general anesthesia during vaginal birth are: local anesthetic is not working, an unanticipated breech baby (generally with a provider that isn't skilled in delivering such), the doctor needs to extract a second twin or an emergency in which the benefits outweigh the dangers or baby’s shoulder is caught in the birth canal, as per Healthline.
There is no way to predict and prevent all of the possible complications during labor, but if anything comes up, at least we can make informed decisions.
2 What Will Treat Labor Pain?
Remifentanil is a morphine-like narcotic that is regularly used as an anesthetic/pain reliever. If given to mothers, it is administered via PCA pump (attached to an IV), the University Hospital Southampton notes. Another thing to consider, most women need to be hooked up to gas and air to feel comfortable taking remifentanil. According to the U.S. National Library of Medicine, it can cause respiratory distress. Furthermore, gas and air—AKA nitrous oxide—can cause reactions and deplete B vitamins in moms who have the MTHFR gene mutation.
A study in The Netherlands compared pain management during labor using remifentanil to epidural analgesia. The study found that women who received epidurals were much more satisfied with pain relief than those given remifentanil, as per The BMJ.
1 Remifentanil: The Poor Man’s Epidural?
Remifentanil has been used in comparison with epidurals for pain relief during labor, as discussed in the previous section—The Netherland study, The BMJ. Some researchers have rebuked medical professionals for referring to remifentanil as “the poor man’s epidural" per BMC Pregnancy and Childbirth. These researchers reject using remifentanil because it is cheaper. They recognize the dangers and the need for epidurals and remifentanil both. They call for ethical practices and research when uses such risky pain relief methods.
An IV can administer life-threatening medications, but those same medications can save our lives. Labor is the means to a beautiful end. Mothers today can know the risks and make informed decisions to protect their babies.
References: Medicine Net, The National Center for Biotechnology Information, WebMD, CNN, Healthline, WebMD, American Pregnancy Association, Centers for Disease Control and Prevention, Science Daily, Science Daily/ Jessica Stearn, American Pregnancy Association, WebMD, American Pregnancy Association, The Patient Advocate Pharmacy, The Recovery Village , National Center for Biotechnology Information, Elm Tree Medical, Mayo Clinic , Healthline , Healthline, UT Southwest Medical Center, Evidence-Based Birth, Healthline, Stanford Children's Health, American Pregnancy Association, Belly Belly, Mayo Clinic, Healthline, Harvard Health Publishing, U.S. National Library of Medicine, University Hospital Southampton, The BMJ, BMC Pregnancy and Childbirth