Heplock... deciding whether to get it

[lucy_v]

I'm a 37w first timer, going to give birth in a hospital with a midwife. I'm not thrilled about the idea of birthing in a hospital, but it's my only option, financially. The midwives seem to be mostly amenable to my wanting a natural childbirth, but of course, I keep being reminded at every appointment that I will "of course" be "open to drugs, if you need them." Well, yeah, I suppose, but I'm sure if I came in saying I wanted drugs, the wouldn't respond with, "Well, of course, you're open to natural childbirth first."

So, with the understanding that yes, there may be some chance that I'll want/need medical intervention, they are suggesting that I get a heplock, the reasoning being that since they'll have to take my blood when I get there, then they'll only have to stick me once, in the event they need to give me---or I ask for---drugs. This seems to make sense to me, and DH thinks it's a sound argument. But I just don't know enough about it---and I'm inclined to not fully trust their motives---to feel confident in agreeing to it just yet.

Can anyone offer any advice on this? Will I, by having a heplock, be setting myself up for more pressure from the staff to take drugs? Will it, as they suggest, just make it easier on me if I need or want drugs? Is there anything else I should be considering with regards to a heplock?

TIA for any advice.

[MiaMama]

It seems to me that if you are at point of needing painkillers... then having an IV placed will not be a huge problem. Of course, I personally do not have a major aversion to blood draws or sticks, so I don't really see what the big deal is about getting a second one. Plus, a skilled nurse should be able to put one in in a matter of seconds, right?

If you are the kind of person who does have a huge problem with needles/blood draws, then maybe it makes sense to only have one once?

I personally think that having to wait a few minutes to get drugs is a GOOD thing. It gives you a chance to re-think your decision. I asked for something to help, (also midwives in a hospital) and they checked my dilation first... asked again. I had changed my mind by then. I was in transition.... my baby was born less than 45 min later... I am so glad that I didn't get anything right away. The desire for drugs lated less than 10 minutes of a 24 hour labor.

If it is the case where you really DO want something, and don't change your mind, the 2-3 minutes it might take to get an IV in seems totally inconsequential.

[pammysue]

I would strongly advise you to not get it. It sounds like the midwives are already not respecting your wishes for a natural birth. With a heplock it is too easy for them to "give you a little something to take the edge off" in the middle of a bad contraction or start fluids to "keep you hydrated" seriously restricting your movement and giving themselves more control.

Also, I would seriously consider hiring a doula who could help you stand up for your desires while you are in labor. If you are worried about finances, you should still call around, I know some work on a sliding scale.

[limette]

Originally Posted by pammysue

I would strongly advise you to not get it. It sounds like the midwives are already not respecting your wishes for a natural birth. With a heplock it is too easy for them to "give you a little something to take the edge off" in the middle of a bad contraction or start fluids to "keep you hydrated" seriously restricting your movement and giving themselves more control.

Also, I would seriously consider hiring a doula who could help you stand up for your desires while you are in labor. If you are worried about finances, you should still call around, I know some work on a sliding scale.

I agree with this. My first was a homebirth transfer (no emergency) and at some point I got an iv and someone slipped in some pitocin without any consent from me.

At my midwife appt yesterday (new midwives) I told them that I couldn't consent to an iv or heploc if I ended up birthing in the hospital and they were fine with it. They think it's a pointless rule anyway.

[jecombs]

I had it in my birth plan to *not* get the heplock unless absolutely necessary. I was afraid it would hinder my movement in labor. My MWs really wanted me to have it -- not sure why. Anyhow, I arrived at the hospital in transition and vomited 3x, so I allowed the MW to give me the heplock. Nothing was ever hooked-up to it because I stopped vomiting, but I still wish I had never gotten it. It did hinder my comfort while in labor. Then the nurses said it was "hospital policy" to leave it in 24 hrs after birth. I was pretty mad about that, because it was also hindering my ability to get comfortable while BFing. I basically ended-up telling them to take it out or I would do it myself.

This time around, I plan to refuse the heplock unless it is absolutely necessary. It was too much of a PITA last time.

[broodymama]

Originally Posted by MiaMama

I personally think that having to wait a few minutes to get drugs is a GOOD thing. It gives you a chance to re-think your decision. I asked for something to help, (also midwives in a hospital) and they checked my dilation first... asked again. I had changed my mind by then. I was in transition.... my baby was born less than 45 min later... I am so glad that I didn't get anything right away. The desire for drugs lated less than 10 minutes

ITA with this! My oldest was born in a hospital with a CNM. When I hit transition (didn't recognize it at the time, of course) I told the nurses "I don't want a kid, I just want my cats! And I want drugs." They started to try to get the IV going right away, but I wouldn't hold still. If I had already had a heplock then I would have been given a shot of something very quickly, something that I didn't really want but it was just the transition phase talking.

[LaurenAnanas]

Originally Posted by lucy_v

So, with the understanding that yes, there may be some chance that I'll want/need medical intervention, they are suggesting that I get a heplock, the reasoning being that since they'll have to take my blood when I get there, then they'll only have to stick me once, in the event they need to give me---or I ask for---drugs. This seems to make sense to me, and DH thinks it's a sound argument. But I just don't know enough about it---and I'm inclined to not fully trust their motives---to feel confident in agreeing to it just yet.

Why would they have to take your blood when you arrive at the hospital as planned, in labor, to deliver? I have never heard of this. I guess they might have to do it in certain emergency situations, but as a routine event?

Also, I don't think you can "take" through a heplock, only "give."

[mediumcrunch]

I would just decline it if I were you. Just in case you decide you want pain medication really isn't a sufficient reason to have a line in place. L&D nurses, generally, are really really good at getting IV's started and if they have trouble the OB anesthesiolgist should be able to get one in very quickly also. If you decide to opt for pain medications or something else occurs in labor where an IV would be a good idea (vomiting to the point of dehydration, C-section, hemorrhage) it is really no great shakes to start an IV.

[mediumcrunch]

Originally Posted by LaurenAnanas

Why would they have to take your blood when you arrive at the hospital as planned, in labor, to deliver? I have never heard of this. I guess they might have to do it in certain emergency situations, but as a routine event?

Also, I don't think you can "take" through a heplock, only "give."

You can pull back a blood sample through an IV catheter when it is placed before any fluids are started. Once anything other than a normal saline or heparin flush is pushed through the line it is unusable to get blood samples.
It is usually routine to do basic blood work upon admission. Most anesthesiologists won't place an epidural without knowing a woman's platelets among other things.

[LaurenAnanas]

Thanks for the info, I did not know!

[Katsmamajama]

I really don't think they're trying to push drugs on you as much as assuring you that if you change your mind, they won't tell you, "tough luck, lady, you said natural, too late to ask for drugs!" My MW team is very supportive of natural birth, but they wouldn't withhold medical interventions, and they did the same thing to me-- they agreed to, and were supportive of my original plan for a natural birth, but also let me know that there was an anesthesiologist on the floor if I needed it.

I opted to get my heplock put in first thing when I delivered in November. I wanted to do it when I was willing/able to sit still, because I couldn't stand to be immobile during contractions early on. It wasn't a hinderance to me, except for getting in the tub because of keeping it dry.

Maybe I got off lucky with my MW, because I had a good timespan between breaking down and saying I wanted my epidural, and getting it-- and they also checked, double checked, and even the anesthesiologist double checked to make sure that yes, I DID want this and it wasn't just transition or a bad contraction. They didn't just walk around with drugs in their pockets to inject me before I said "please," if you know what I mean?

Put it in your birth plan if you'd rather not have a heplock right away, and make sure your DH is well-versed in what you want. You can always change your mind when you're in there!

[MegBoz]

Don't get it.
Another reason to get it is that in the event of a hemmoraghe, it can be difficult to get a vein as the vascular system collapses. (so said my Mom, who's a nurse.) But, this is so astoundingly unlikely! (So unlikely as to be laughable!) So this is NOT a reason to get one, IMO.

Also, mine was in the back of my hand & stuck out beyond my first row of knuckles, so when I was pushing on my hands & knees, I wanted to be on my fists instead of palms (easier on the wrists), & I couldn't with it in the way.

Having it isn't a huge problem, but it's totally unnecessary & just annoying, so I say don't do it. It WAS hospital policy at my hospital, but that doesn't not mean you can't decline.

[mediumcrunch]

Originally Posted by LaurenAnanas

Thanks for the info, I did not know!

no problem. wish i didn't have to know that from experience (mine and dd)
now a central line or PICC you can use for blood samples for the duration although most facilities only let nurses and docs (not phlebotomists) pull back from central and PICC lines.

[RoadBuddy]

I had one. It was a "pick your battles" kind of thing...I didn't want to use up all my goodwill with the hospital on fighting against the heplock when, for me, there were bigger things to refuse later.

It was presented to me as an in-case-of-emergency kind of thing - not for drugs but if I needed some sort of emergency treatment and time was of the essence. I don't think that's likely, but I guess it could happen, and the heplock didn't bother me.

[woodchick]

Originally Posted by RoadBuddy

I had one. It was a "pick your battles" kind of thing...I didn't want to use up all my goodwill with the hospital on fighting against the heplock when, for me, there were bigger things to refuse later.

It was presented to me as an in-case-of-emergency kind of thing - not for drugs but if I needed some sort of emergency treatment and time was of the essence. I don't think that's likely, but I guess it could happen, and the heplock didn't bother me.

This was what I did during my first labor. I HATE IVs with the passion of a thousand burning suns, but I wanted to be 'nice'. So I allowed them to put an IV in- they needed to call an IV specialist because I was such a bad stick. It was as horrible as I thought it would be to get it in and then I was super conscious of it the whole time. It was not what I wanted to focus on during my laboring!

Without lots of details, I finally agreed to have IV fluids at the very end of labor. I was full on pushing when they discovered that the IV had moved and was no good and they'd have to do another one. It was HORRIBLE but they got it in fine and all was well.

So, with baby #2 I said NO HEPLOCK loud and clear to anyone who would listen. I argued long and hard and was able to avoid an IV all together. I figured that if the nurses could put one in while I was pushing last time they could certainly handle putting one in during an emergency this time (should one arise).

My second labor was so much better without the IV hanging out of my arm.

Just my story- two unmedicated, hospital births. One with heplock one without.

[dkenagy]

I've never consented to a heplock. Now, last time I was induced due to pre-e; total shock because I've never had BP issues--pregnant or not. This time, they are pushing me to accept the heplock in the event I go to term and spontaneously go into labor, in case I have an emergency-- I don't want them wasting precious minutes getting an IV in if my baby's life is on the line, do I??? Of course not, but what an unlikely event! My retort to the dr was that people don't go driving down the freeway with a heplock in place just in case they get in an accident and paramedics are usually able to get that IV in in time to save lives... and how much more likely am I to get in a wreck on the way to the hospital than for my baby to suddenly develop life-threatening issues?
I'll be refusing it if I get that far this time!

[SashaBear]

Yep if you have a heplock or IV in, those doctors and nurses will put stuff into that you don't know about. I'm pretty sure I had pitocin after labor even though I didn't need it. And I still don't know what was put in my IV right before my c-section.

[Sk8ermaiden]

Originally Posted by dkenagy

My retort to the dr was that people don't go driving down the freeway with a heplock in place just in case they get in an accident and paramedics are usually able to get that IV in in time to save lives... and how much more likely am I to get in a wreck on the way to the hospital than for my baby to suddenly develop life-threatening issues?
I'll be refusing it if I get that far this time!

Several years ago I read somewhere - I think it was a doula's blog - about a husband and wife doing a hospital tour. The wife asked if she could refuse a heplock, and the nurse made a snide comment about how she didn't want them struggling to place an IV if her baby was dying, now did she?

Her husband is an EMT, and said, "Really? You mean to tell me that I can place an IV in the hand of a person upside down in a totaled car, at night, in the rain, but you can't do it here in your shiny hospital in the best medical conditions?"

I always loved that.

Actually on topic, I had an IV in labor. It was perfectly placed in the back of my hand and I couldn't even feel it.

My best friend had one kind of in between her pointer finger and thumb and she HATED it.

I would get one next time, but I have bigger battles to fight.

[wbg]

My hospital births were not in the US, but we were never offered IVs or heplocks as standard. If you needed one, it was given at the time.

So I would refuse it, unless medically necessary at the time. Based purely on my personal exeprience. In a true med emerg, they can get in the IV in no time at all.

Having one ready and waiting seems like an invitation to use it!

[wombatclay]

As a vbac, a heplock was a small "trade" for me. In both cases it was well placed (side of the arm, above the inner wrist), and with my first vbac it was hooked up to an IV after she was born because I had significant pph and also needed extensive repair. So in that case it was handy. With my second vbac it wasn't used and was removed shortly after the birth.

I think that if the only reason given is "to make it easier" then I'd totally pass. If, on the other hand, you are needle phobic, or a hard stick (so you want their best person under the best circumstances), or have a condition where immediate access to a vein may be important, then go ahead. They wont be able to give you anything through the heplock without you (or your support people) noticing... it's taped down to your hand/arm and to inject something they're going to be right in your face. Unlike with an IV where they can add something to the IV bag several feet away from you.

I don't think a heplock is the first step on the slippery slope, but it is an intervention and can be annoying and painful. If you don't need one or want one then you shouldn't feel like it's a "must". And maybe use it as a chance to explore your care provider's opinions a bit more? If they say "of course a heplock" maybe come back with a "why?" and discuss some of the great opinions raised in this thread... it may bring up other issues or concerns, and places where your support people will need to be particularly vigilant.

Happy birthing!