I need input on HEP locks please

[nova22]

I gave my OB my birth plan a couple weeks ago and she said everything was fine. Yesterday she brought it up again, and said the doctors were concerned that I wanted to completely waive an IV *OR* a Hep lock. I really don't mean to be noncompliant on purpose, I have reasons for every single thing on my birth plan. I've researched everything, looked for pros and cons of every little thing, and if there was ever a question about which one was better I've trusted my instinct. I DON'T WANT a hep lock sticking in me the entire time I'm laboring at the hospital...they're uncomfortable and distracting, and cause stress to the point that I can't concentrate on my labor and baby, but instead this big hunk of stuff hanging out of my arm. I told her I would think about it - which I am - but I am having a hard time coming up with anything to think about.

The OB said her concern is that this is my 3rd baby, and after 2 babies the mom is more likely to hemmorage (sp?) after birth. I have never heard that before but I'm not discounting her, at leat not yet...does anyone else have any information on that? And, a friend suggested trying to compromise by saying I'll get a pitocin shot if I start bleeding heavily. Any advice/experience/facts about that? Finally, what is the deal with the Hep lock anyway? She said in an emergency they can hook it up to an IV more quickly, but it seems like when I had an IV for a non-birth-related thing (not an emergency) they were able to hook it up pretty darn fast. I can't imagine them hooking up any faster, and that was just a routine sort of thing. Is it really necessary to have a Hep in place?

Sorry this is so babble-y...any input would be appreciated.

[mamacatsbaby]

I was also told by the docs that the Hep lock was something they felt uncomfortable about me not having. What they said to me was that in the event of an emergency they did not want to risk me having collapsed veins and that slowing down the placement of an IV. Good luck with your decision Amanda, though it seems you have your mind pretty made up! We have the same reasons for not wanting one and I will probably still say no.

[mamanurse]

It's true that it can be difficult at times to start an IV. However, if your OB is worried about hemmorhage after the delivery of the baby. Most meds given for postpartum hemmorhage can be given IM (intramuscular) instead of intravenously. If there is an emergency, the meds can first be given IM and if necessary an IV can be started for IV meds later on.

[Wittyone]

Not in your DDC but wanted to comment...many docs will tell you that a hep lock is a good idea *in case of an emergency* but think about people coming in off the street into the ER - none of them have hep locks and the staff manages to start emergency IVs routinely. As mamanurse pointed out, if necessary, all emergency OB meds can be given via other routes while the IV is getting started. I work in a free standing birth center and it is the rare mama who already has a hep lock in place before she bleeds - our first line med is an IM pitocin shot, and then if that is not enough we can do a Methergine shot or Misoprostol/Cytotec tablets in the rectum (this is a case where cytotec-induced mega uterine contractions is a *good* thing!). If we were moving in the direction of using Methergine or Cytotec you bet we'd be placing an IV, but that can all be done quickly if needed.

As for being higher risk for a bleed b/c this is your third baby...statistically you may be at a slightly higher risk, but your personal risk has much more to do with your personal situation - have you bled heavily in the past, do you have excess amniotic fluid and therefore an overstretched uterus, how long and exhausting is the labor (long tough labor can make the uterine muscles tired and less efficient post partum)? All of these factors are *much* more relevant than the simple fact that this is your third baby! Most important is to get that baby skin to skin and on your breast ASAP after the birth...that will stimulate your natural "pitocin" (oxytocin) and drastically decrease your bleeding risk.

Good luck mama - you have nature and common sense on your side

[lilsishomemade]

I did have a heplock placed with my last, but that was for other reasons. I get pretty nauseus during transition, and also dehydrate pretty quickly, so I was okay with having one to replace fluids if need be. However, if this was NOT the case for me, I'd have refused one. Especially if they do bother you like you mentioned (I also am not bothered by them). Pitocin IM is available, and also works quickly. I've started IV's in seconds in an emergency situation, even on dehydrated people under stress, especially when I was in good practice (it takes practice to hit veins well ) so I wouldn't buy into that "in case" stuff.

In my situation, I asked for it so that if I needed fluids, I wouldn't have to be stuck while in the middle of hard labor. If they're worried about after delivery, then you don't have to consider it Good luck, sounds like you've done lots of research!

[Peppamint]

Personally, I think that your "risk" of hemorraging would be based more accurately on your own history and your own hemoglobin levels etc. I have a friend who has hemorraged with both of her births but my other friends have had 3+ babies and never hemorraged once.

[Mamatoto2]

I did not have a hep loc or IV for birth #1 and I did hemorrhage a bunch. They were able to get an IV in me (which was not used to deliver meds to stop the hemorrhage, but for fluids- I was given pit and methegrine -sp? as injections). I also had plenty of IVs and heplocs post partum as I hemorrhaged again 2 days later, had lots of transfusions, drugs, etc. I didn't find the heploc to be problematic or cumbersome. It's just a little plastic thingy taped to your hand essentially.

so....I will have a heploc for this delivery. I'll have mine protected/secured to allow me freedom of movement in and out of the birth tub. It was suggested by the midwives because when you hemorrhage your body's natural response is to constrict the veins to conserve blood, which makes IV insertion more difficult. I was told that IV access is important so that fluids can be given quickly (I think this is to keep your blood pressure from plummeting, but don't quote me on that). Of course, this is a reflection of my personal history of a severe PP hemorrhage. I'm not really sure the degree to which the risk of hemorrhage increases for 3rd births or later, so I'm not sure how much that would weigh into my decision.

That said, I am NOT consenting to an automatic pit injection after the delivery because it makes sense to me to LOOK first to see if the bleeding is excessive rather than assuming that it will be-I hemorrhaged due to retained placental fragments last time, and pit wouldn't have/didn't change that.

[minimunklemama]

sorry to crash your board but this caught my attention..
I actually just change docs because of this.I HATE needles,when the going gets tough and I start to fantasize about meds I remind myself the size of the needles (not to mention all the other reasons I don't want drugs,but needle get me back to my place!! )
anyhoo..my doc said the exact same thing as yours,this is my third too,and I have never had a problem with bleeding.I thought exactly the same as another PP,if they need to give you something that bad then they can give you a shot.don't let them bully you into having it.the doc refused to budge and I didn't want to worry about that(he also wanted monitoring on a regular basis) as well as birthing the way I wanted so I just told him I would have to find another doc.he said I would have a tough time finding a doc who would do it without.well next stop on the list I found an amazing doc that said "fine,no heplock,or IV and stay in the shower as long as you want!!"
needless to say,she is hired and I am a more reaxed mama that is going to now try and enjoy the rest of this pregnancy.
stick to your guns mama
good luck,

[girlsmamma2]

I think your doc is doing the traditional scare tactics and it seems starting to back peddle on your birth plan. THis is just the first thing, so i'd keep an eye out for anything else they want to hedge on. Why don't you talk with them and tell them the things you WILL agree to, like pp's said shots etc, if you did start to hemorrage. this would show them you know more than the typical patient and also make them feel like they have some power? (in their minds anyways!!! lol)

my first birth was a hospital but i waited so long to go to the hospital, she was crowning by the time we got there. I wanted very little time left for them to do anything to me or baby. The nurse had a very hard time finding a vein on me, stuck me like 5 or 6 times and then gave up after dh said no more. i think it depends on the nurse if they are good at getting in an iv, but that said, my dd just spent 3 days in the hospital for a bladder/kidney infection and she had an iv. I HATED THAT THING. I was constantly worried about it coming out or hurting her. the first one she had went bad. that was a full IV but i think the hep lock, is as you say, just as distracting. Also I think the OB thinks if you beg off on that, that is their first line of getting meds into you if they need to. It may mean on a bigger picture that they don't believe in your actual ability to labor naturally. So ask them, for a natural labor why would it be necessary and wouldn't a shot be more immediate after birth if really needed? I'd make them explain it, not you.

good luck. stand your ground mamma!

[nova22]

Thanks all for the advice
The weird thing is, throughout this entire pregnancy my doctor has been really laid-back about everything. She always prefaces what she says with "You have the right to refuse ANY procedure that you are not comfortable with, but I am supposed to ask you if you want blahblahblah". It was actually HER suggestion that I waive the GTT several weeks ago, and I was all ready for a big argument. But, at my last appointment, she announced her pregnancy (yay for her!) and her mannerisms are very different. She's in her first trimester and her husband lives on the opposite end of the country...she got pregnant during a vacation she had with him recently...and I'm sure her emotions are in a turmoil right now. She wasn't acting like herself at all. This was the first appointment that my husband was able to attend, and afterwards he said "She doesn't sound quite as 'natural' as you made her out to be!"

ANyway, all babbling aside, I am going to bring up the intramuscular shot suggestion, and also look into some even more natural/herbal remedies for heavy bleeding. And no, I have no history of difficulties during or after labor, and after reading your responses I'm more confident about a safe delivery/recovery this time around as well.

[JuicyPakwan]

I just had to agree with the pp that bleeding should be based on personal risk rather than stats. I lost 4 c blood with dc#2. I changed my diet and added a few extra supplements and not a drop with #3. And the IV it depends on the skill of the person. I have really bad veins hard for most people to stick however last time I was in the hospital they got it in in about 15 sec flat (not that I even needed it but whatever).

[girlsmamma2]

Anakna4, can i ask what you did in your diet to help bleeding and what supplements you took?

[Boobiemama]

I had one w/ my last birth, baby #6, because the nurse at the birth ctr was obviously concerned w/hemorhage. It hurt a bit going in, but didnt bother me during labor. I had nothing the birth before, but I didnt mind this time, as I knew i had a higher chance of more bleeding.

[JuicyPakwan]

girlsmamma2-With my first I was ever so conscientious about my diet I was working at a health food store had money and was very good. However with #2 I gave up sort of and ate whatever gained alot was hit and miss with my supplements etc.. SO back to #3 after bleeding so bad with my 2nd (it was a homebirth and bleeding was controlled with pressure and shepherd's purse although I transfered several hrs later for and IV and cath as I couldn't sit up without fainting my poor dh had to carry me to the car) I really just cleaned up my diet eliminating junk, white sugar/flour etc. I also took 4 cayenne capsuls a day in the last trimester and starting with 8 in the beginning worked up to 20 alfalfa tabs a day. I also drank my RRT religiously which I haven't this time not sure why but it makes me gag with this pregnancy. I felt alot healthier and more energy more like with my first pregnancy. I will however always be prepared for another bad bleed.

[LadyButler]

Originally Posted by Anakna4

...starting with 8 in the beginning worked up to 20 alfalfa tabs a day.

I was just going to jump in and suggest the alfalfa tabs.