IV/Heplock question

[linaee]

Hello,

So I ahve begun teaching my first series for hospital clients who want a natural birth. I am trying to lead them to work with their OB's to talk about options in the sweetest way possible. One of the mamas went to ask about not having an IV and the DR said, "Well, that's fine. Then, if your veins close up during labor, we'll just go in through your neck."

I understand that this is a scare tactic, but can any of you tell me what would cause her veins to close up like that? She really wanted to know why...not just be reassured that there was very little chance that would happen.

By the way, they decided to compromise and give her a heplock instead of an IV. Sometimes you have to pick your battles...

Thanks for any insight...

[redpajama]

(Someone correct me if I'm wrong.)

You're right, that is a scare tactic. But I believe the concern is with volume shock. In the (unlikely--especially if they don't have a portal in to her veins through which to send things like pitocin) event that, for example, her uterus ruptured and she began bleeding really profusely, she could go into volume shock from so much blood loss, which could cause her veins to collapse and make it difficult or even impossible to administer an IV.

[applejuice]

If she hemmorhages terribly, then her veins will collapse and the phlebotomist will not be able to find a vein.

Of course, if the doctor is stupid enough to let a hemmorhage go so long that her veins do collapse and she goes into shock, then he is really incompetent and she needs to find another doctor soon.

Yes, it is a scare tactic.

An aside: if a hospital patient wants a natural birth, they need to stay home. But that is not what you asked, so I will not say it.

There is nothing natural about an intravenous feeding or a heplock. Frankly, the reason hospitals have so many "emergencies" is because they let complications go for too long, and then they panic and rush around. There is always time if a caretaker is diligent and paying attention to the mother and constantly watching vital signs of the mother and baby.

Your clients will be picking and choosing between many battles before they become parents. Thank you for doing your job well.

[NZmumof2]

[QUOTE=applejuice;8824354]

"Of course, if the doctor is stupid enough to let a hemmorhage go so long that her veins do collapse and she goes into shock, then he is really incompetent and she needs to find another doctor soon. "

Hope I quoted right I'm newish to this. I am a doctor and I don't agree with this one. I attend births in a small rural hospital and certainly we don't routinely use iv lines in labour. We practise natural birth all the time in our hospital unless someone needs urgent emergency intervention which is extremely rare.

But have you ever seen a post partum haemorrhage? Think very forceful tap turned on under pressure. A woman can lose her entire blood volume in three minutes. In a big hospital that is often less time than it takes the doctor to run to the delivery room. It isn't neglience that causes women's veins to collapse from post partum haemorrhage it is the incredible speed with which it is possible to bleed out.

As a practitioner it is one of the worst feelings to watch a woman bleeding like that (not a patch of course on being the woman or her loved one). Luckily it seldom happens. At our rural hospital there is no blood for transfusion and it would take at least an hour to get to the base hospital where there is. We have yet to lose a woman to a PPH because using pitocin, ergometrine, carboprost and bimanual compression (not in that order)can buy enough time to get to a big hospital. One day though someone will probably just keep bleeding and there will be nothing I can do.

It is true in a life threatening situation if I couldn't get a line in an arm etc I'd go for the neck, never had to in the labour situation, but those veins are so big they don't collapse easily and are very useful to resuscitate someone.

Anyway I'm not advocating for the heplock but just saying I don't think it takes incompetence to have a woman's veins collapse from PPH, it just takes a PPH.

Anna, cruchy rural doctor, mother to Bede 7 and Emmett 3, expecting another in Jan 08, partner to Leah for 10 years.

[Violet2]

Also, wouldn't dehydration make an IV hard to place? Particularly in a hospital where nothing was allowed by mouth other than ice chips? (I don't know about you, but I don't think I could adequately hydrate myself on ice--takes too long for it to melt.)

I tend to be a hard stick and dehydration magnifies the problem. I've had IVs that took 13 tries with several different nurses/phlebotimists/docs and I've had blood draws where they actually gave up. So...?

Now, if I know about the stick in advance and am allowed to drink, I really guzzle my water and then sit with my left arm lower than my heart so the blood can pool and fill out the veins.

So, for me, during labor, I'll take the heplock. It'll just be easier all around.

V

[applejuice]

Originally Posted by Violet2

Also, wouldn't dehydration make an IV hard to place?V

Yes, and so can injudicious use of pitocin.

It isn't neglience that causes women's veins to collapse from post partum haemorrhage it is the incredible speed with which it is possible to bleed out.

How about the preceding cascade if interventions as pain medication, overuse of pitocin, and over-reliance on monitors? A woman in labor should be able to feel an abruption, for example, unless she has been numbed up from a epidural she reluctantly agreed to.

I've had IVs that took 13 tries with several different nurses/phlebotimists/docs and I've had blood draws where they actually gave up. So...?

You already know that you have a problem, so get a heplock. Since you have a problem, does that mean everybody needs to have a heplock/i.v. because you do?

[chandasz]

Good luck to her with a natural childbirth with this dr..... If I had a dr. who was this combatative and nasty-- I would RUN.

My guess if she had true PPH (VERY unlikely with an unmedicated and uncomplicated birth)-- she's not going to care if they put a main line in her neck as she will be in shock and likely losing consciousness.

I would perhaps ask her dr. how often he's had PPH to this degree with patients and then maybe wonder why he has this happen. Scary doctor.

Anyone who uses scare tactics on a pregnant mother should be FIRED

[Violet2]

Originally Posted by applejuice

Yes, and so can injudicious use of pitocin.



How about the preceding cascade if interventions as pain medication, overuse of pitocin, and over-reliance on monitors? A woman in labor should be able to feel an abruption, for example, unless she has been numbed up from a epidural she reluctantly agreed to.



You already know that you have a problem, so get a heplock. Since you have a problem, does that mean everybody needs to have a heplock/i.v. because you do?

Ummm, some of those quotes aren't mine. Just the first and last one.

And to clarify, I don't have the time or inclination to tell people what to do. However, if dehydration makes an IV difficult, perhaps that should be factored into the decision as to whether or not a heplock is a good idea. Since I have had such extreme bad experiences, for me it's an easy decision.

V

[applejuice]

Originally Posted by Violet2

Ummm, some of those quotes aren't mine. Just the first and last one.

And to clarify, I don't have the time or inclination to tell people what to do. However, if dehydration makes an IV difficult, perhaps that should be factored into the decision as to whether or not a heplock is a good idea. Since I have had such extreme bad experiences, for me it's an easy decision.

V

I know. I never attributed them to you.

Why extend your personal problem to others? That is the problem with hospitals, they treat everyone the same using the worst case scenario.

[Snookler]

I took the heplock at the hospital for my first birth because I figured I was going to be so particular in other areas, I didn't want to strat off with an argument with the staff in the first five minutes.
In retrospect, this made it way too easy for them to come on in and put stuff in there. Oh, you look like you need a little fluid. oh, I think things aren't progressing, lets have some pitocen. In retrospect, if they'd had to take the time to put in a line when they thought these things were needed, it may have bought me a few minutes to advocate on my behalf.
I guess it all depends on what you feel comfortable with.
Today I certainly wish I lived in rural New Zealand.

[applejuice]

In retrospect, if they'd had to take the time to put in a line when they thought these things were needed, it may have bought me a few minutes to advocate on my behalf.

Very true.

I am in a metropolis that has a population larger than seven million people. Many do not speak the de facto national language. Putting in an intravenous line is the norm for more than one reason, so why question it? That is why I am so passionate about routines.

[GinaRae]

The doc sounds like the type I had last time. I asked for no episiotomy, he was very obviously ticked off, and he manually stretched me so hard, I had tiny tears all over that were worse than the episiotomy I'd had!

Anyway, I've been thinking about the heplock thing should I end up in the hospital. Then again, I assume if I end up there, it's an emergency.

[Violet2]

Originally Posted by applejuice

I know. I never attributed them to you.

Why extend your personal problem to others? That is the problem with hospitals, they treat everyone the same using the worst case scenario.

Wow. I'm not extending my personal problem to anyone. My understanding was simply that during labor sometimes it is possible to become dehydrated. And since I've had hard sticks when low on fluid, I questioned whether that too might be a reason.

I have no idea how my simple post has made it appear that I want anyone to do anything or why you seem intent on razing me about it. Repeatedly. Please stop.

V

[linaee]

Originally Posted by applejuice

An aside: if a hospital patient wants a natural birth, they need to stay home. But that is not what you asked, so I will not say it.

Your clients will be picking and choosing between many battles before they become parents. Thank you for doing your job well.

We have talked about both of these points in class. Thanks. One big reason I am doing these classes is because I had a hospital birth the 1st time around and had AWFUL childbirth classes, so I was extremely unprepared. I know I have already given them more info than I ever got, and we are only on the 3rd class this week. I am lucky enough to teach at a freestanding birthcenter, so I do know all about natural.

Thank you all for your input. I obviously hit a nerve, which I guess I knew I would, but not to the degree that I did.

The hardest part of the CBE process is all I can do is give them the info...and then, what they end up doing is up to them. But then, that's what informed consent is all about, huh?

Thanks again for all the input.