Hospital IV policy

[ice_chick]

It is the policy of the hospital I will be delivering at for all VBAC patients to have an IV. I plan on refusing the IV due to the fact that it is extermemly uncomfortable for me, that goes for a hep lock also & if I am going to be drinking/staying hydrated on my own & don't plan on receiving any drugs, then why do I need it? Can anyone tell me what kind of opposition I can expect to receive by refusing the IV & how I can argue my side? Also, I need to convince my husband that just because it is hospital policy, it does not mean I am putting the baby or myself at risk by refusing it. Anyone have any ideas? Thanks

[maxmama]

The argument for a hep lock for VBACs is that it speeds up the time needed to get you under a general anesthesia for a UR. It can take awhile to get an IV in, and if you don't have access it does delay a section. But the chances of a UR are very small. So it comes down to what you're comfortable with.

[pampered_mom]

I have seen a posting on another list awhile back with some observations on common practics like that - I think it was done by a midwife. I always got a kick out of it because it talks about a paramedic and his wife who were taking the hospital tour. The staff giving the tour were talking about the IV and how it would be put in when they were admitted to the hospital.

The paramedic was incredulous and couldn't understand why they would need to do so. Emergency medical workers have to put in IVs all the time in an emergency situation - in the field, in the dark, and under worse conditions - but the hospital staff can't do it in an emergency, in a brightly lit room, with a patient that's only lying back/sitting down in the hospital bed? I'm not so sure that I would be comfortable if a hospital is unable to put an IV in under those circumstances!

[bradleybirth2mom]

Get a heplock but refuse the IV line. If they have to stick you later for true dehydration, your veins may be sunken and it will be very difficult. I got a heplock and went nearly all of my labor without an IV until postpartum---just regular fluids, no glucose or drugs---it was a natural birth.

[bradleybirth2mom]

If I were you, I would get a heplock but refuse the IV line---just have someone there to support you by refusing interventions. If they have to stick you later for true dehydration, your veins may be sunken and it will be very difficult. I got a heplock and went nearly all of my labor without an IV until postpartum---just regular fluids, no glucose or drugs---it was a natural birth.

[bradleybirth2mom]

If I were you, I would get a heplock but refuse the IV line---just have someone there to support you by refusing interventions. If they have to stick you later for true dehydration, your veins may be sunken and it will be very difficult. I got a heplock and went nearly all of my labor without an IV until postpartum---just regular fluids, no glucose or drugs---it was a natural birth.

[maxmama]

I have seen a posting on another list awhile back with some observations on common practics like that - I think it was done by a midwife. I always got a kick out of it because it talks about a paramedic and his wife who were taking the hospital tour. The staff giving the tour were talking about the IV and how it would be put in when they were admitted to the hospital.

The paramedic was incredulous and couldn't understand why they would need to do so. Emergency medical workers have to put in IVs all the time in an emergency situation - in the field, in the dark, and under worse conditions - but the hospital staff can't do it in an emergency, in a brightly lit room, with a patient that's only lying back/sitting down in the hospital bed? I'm not so sure that I would be comfortable if a hospital is unable to put an IV in under those circumstances!

That's great, but having put in IVs in hemorrhage situations and for emergency sections, it does delay the process no matter how fast it is. It's going to take several minutes to put in an IV and several more minutes to get anesthesia. That's basically all the allotted time before brain damage in the case of serious UR. And then you still have to cut and get the kid out. Not a risk I'm willing to take, and I know how good our nurses are at putting in IVs.

[kelly1827]

I have seen a posting on another list awhile back with some observations on common practics like that - I think it was done by a midwife. I always got a kick out of it because it talks about a paramedic and his wife who were taking the hospital tour. The staff giving the tour were talking about the IV and how it would be put in when they were admitted to the hospital.

The paramedic was incredulous and couldn't understand why they would need to do so. Emergency medical workers have to put in IVs all the time in an emergency situation - in the field, in the dark, and under worse conditions - but the hospital staff can't do it in an emergency, in a brightly lit room, with a patient that's only lying back/sitting down in the hospital bed? I'm not so sure that I would be comfortable if a hospital is unable to put an IV in under those circumstances!

I think that paramedic might have been me (if the medic were the pg mom).....dh (an EMT) and I were the bane of the tour leader's existance! We agreed to a HepLock, but only because I don't have the "juiciest" veins, and they might have a bit of trouble getting a large gauge IV into me anyway. Birthing pts who get IVs usually get an 18G or larger, in anticipation of transfusion. In the end, after all the stress of calling the MCH Nurse Manager to question things that were represented in the tour as "non-negotiable" and worrying that we'd have to fight during my labor to have our birth plan respected, we had an incredibly hands-off yet supportive staff who respected our wishes and worked with us. They essentially said, "This is the bare minimum we have to do (which we had already ok'd) and after that you just want to do your own thing with your doula and midwife, right? Let us know what you need". Everything went really well (except that dd was a compound presentation with her arm across her body, but that's not under their jurisdiction :wink ) and we are looking forward to our newest dd's birth at the same hospital very soon.

And just for the record, yes, a medic in a fairly busy service is usually pretty darn capable with an IV, because we have to be -- most of the time there is only one other IV certified person with us, if that. There's no one sitting at the desk, no IV team or anaesthesia resident to call. But, I've known some really skilled nurses and some less than skilled medics. It all depends who you get. Either way, though, in a hospital setting there should be someone working any given shift wearing the IV Princess crown....:lol

[pampered_mom]

That's great, but having put in IVs in hemorrhage situations and for emergency sections, it does delay the process no matter how fast it is. It's going to take several minutes to put in an IV and several more minutes to get anesthesia. That's basically all the allotted time before brain damage in the case of serious UR. And then you still have to cut and get the kid out. Not a risk I'm willing to take, and I know how good our nurses are at putting in IVs.

And the window of time necessary to put in an IV on the scene of a severe car accident or something of equal emergency isn't? To be honest if it takes as long as your insinuating at the hospital you'd labor at, I don't think that I'd be laboring there VBAC or not.

[jen6]

For what it is worth, my experience in discussing my wishes for a VBAC with hospital staff is that if you throw them a bone, they will leave you alone. Pardon the rhyme. What I mean is that a heplock, though invasive, is minimally so and gives them a sense of security. It is also a relative small compromise that gives you ammunition to fight against a bigger one. Just my opinion........not a medical person.

[maxmama]

And the window of time necessary to put in an IV on the scene of a severe car accident or something of equal emergency isn't? To be honest if it takes as long as your insinuating at the hospital you'd labor at, I don't think that I'd be laboring there VBAC or not.

Three minutes isn't excessive to get a line in. But it's also half the time allotted before anoxia. Fetuses don't have the reserves adults do, particularly in terms of blood volume.

Induction of anesthesia routinely takes 2-3 minutes. Add that to the time to get the line in.

All this, of course, is AFTER a UR has shown itself in fetal distress, AFTER you've physically gotten to the OR (which can take several minutes by itself), AFTER the primary surgeon and first assist have been assembled (they're not standing there all night waiting for someone to rupture, you know), AFTER the OR has been opened. It's not like they do the section in your room, you know.

The fastest I've ever seen a crash section done was six minutes from decel to baby, and that's well under the community standard time limits. And she had an IV.

Why not just have the hep lock there and available? It almost certainly won't get used, but if it's needed, you'll be very glad it's there.

[mamabadger]

For what it is worth, my experience in discussing my wishes for a VBAC with hospital staff is that if you throw them a bone, they will leave you alone. Pardon the rhyme. What I mean is that a heplock, though invasive, is minimally so and gives them a sense of security. It is also a relative small compromise that gives you ammunition to fight against a bigger one.
I agree. To answer your original question, I think you can expect a lot of opposition if you refuse the heplock altogether. There will be nagging, there will be dire warnings about how you're endangering your baby. Hospital birth being what it is, sometimes a little bargaining can help your cause. Make sure everyone knows that you consider it a major concession. I'd stand firm on the IV, though, since it actually interferes with your ability to move freely in labour.

[ice_chick]

See here's the thing, while I understand the advice on why to get the heplock, I am not giving birth in the hospital because of what measures they might be able to take should something go wrong. I am only going to be there since DH is not on board with a homebirth. I plan to stay home as long as possible & so I hope to avoid this altogether. If I were to have a homebirth, the IV would not be an issue & so I think my feelings & opinions should be respected if I say to them I do not even want a heplock. I can understand that for some it is no big deal, but for me the issue with the IV is not the lack of movement, but the fact that there is a needle in my arm. The same applies for a heplock. I cannot get to my comfort level when I have something sticking out of my arm whether it is attached to something or not. If I were having a "normal" labor, not a VBAC then it is not their routine to put an IV in & then what happens if something went wrong & I needed an emergency c/s in that case? Why is that any different? Has anyone actually refused an IV & heplock & what were the ramifications? What can they actually do to me? They can't kick me out of the hospital. Will they give me less than the standard of care? I just need the midwife to be there to catch the baby, I really don't want anything else from them. I was hoping for a little more support from this thread & not just the same deal about the heplock, but oh well. It's my body & I just have to keep reminding myself of that.

[logan&jordansmommy]

I think everyone was just trying to give advice on what you can do to appease them but not get the IV. But if you are not ok with that, don't do it! They can not make you do anything that you don't want. I think the only ramifications are they don't treat you as well because you aren't doing what they want. But it sounds like you are ok with that, so stick with your plan. Just be ready to "fight" them. Do you have a doula? She can always help too.

I think it also depends on your dr or mw. I know my mw just told me she had a client come in at 8 cm and the nurses were running all over trying to get hooked up to monitors, iv's etc but she told them to leave her alone.

Good luck!

[mamabadger]

See here's the thing, while I understand the advice on why to get the heplock, I am not giving birth in the hospital because of what measures they might be able to take should something go wrong. I am only going to be there since DH is not on board with a homebirth. I plan to stay home as long as possible & so I hope to avoid this altogether.

I was hoping for a little more support from this thread & not just the same deal about the heplock, but oh well. It's my body & I just have to keep reminding myself of that.

I agree with everything you say, actually, but you asked how much trouble the hospital staff would give you about refusing. From my experience, they'll badger you relentlessly. A lot of women do make concessions in order to get everyone off their back, but there's no reason you have to do that if you feel strongly about it.
Your plan of going into the hospital very late in labour would probably be more helpful than anything else you might do. If you don't want an intervention they like to perform, this keeps them from having an opportunity to do it.

Good luck!

[stayathomecristi]

See here's the thing, while I understand the advice on why to get the heplock, I am not giving birth in the hospital because of what measures they might be able to take should something go wrong. I am only going to be there since DH is not on board with a homebirth. I plan to stay home as long as possible & so I hope to avoid this altogether. If I were to have a homebirth, the IV would not be an issue & so I think my feelings & opinions should be respected if I say to them I do not even want a heplock. I can understand that for some it is no big deal, but for me the issue with the IV is not the lack of movement, but the fact that there is a needle in my arm. The same applies for a heplock. I cannot get to my comfort level when I have something sticking out of my arm whether it is attached to something or not. If I were having a "normal" labor, not a VBAC then it is not their routine to put an IV in & then what happens if something went wrong & I needed an emergency c/s in that case? Why is that any different? Has anyone actually refused an IV & heplock & what were the ramifications? What can they actually do to me? They can't kick me out of the hospital. Will they give me less than the standard of care? I just need the midwife to be there to catch the baby, I really don't want anything else from them. I was hoping for a little more support from this thread & not just the same deal about the heplock, but oh well. It's my body & I just have to keep reminding myself of that.

Understood and I agree with you. Your feelings on this should be respected and are important. If you were having a homebirth, this wouldn't be a consideration. If you were not a VBAC mama, this wouldn't be a consideration, therefore (at least in your mind and mine) it is not necessary. You make a very good point when you say that if an IV is not required for a "normal" birth, and an emergency happened that this is no different.

You asked about experiences and in my case I did not have a heplock for my VBA3C. Upon arrival at the hospital it was requested and I politely declined. No one even brought it up again after that. Having said all of that, I had an incredible team of people set up for my birth and all of them understood what I wanted and needed from the birth. They all knew ahead of time that I would probably refuse a heplock and they respected me. This is not the case everywhere and you may have to be assertive about it if it's important to you.

[grumpyshoegirl]

I agree with Mamabadger. Under the Emergency Medical Treatment and Labor Act in the US (EMTALA), a hospital MUST admit you and MUST abide by your treatment decisions if you arrive in labor. The act was originally written to prevent hospitals from denying emergency care to patients who couldn't afford it, but it can be used by VBAC moms too. If you wait until active labor to show up, the phrases you want to use are "I do not consent" to x, y, z, and "Under EMTALA..."

If you don't want to be harassed about routines that you really don't consent to, just wait.

In my VBAC research, the magic number I've heard for emergency c/s in the event of UR is 17 minutes. Can you make sure you're 17 minutes or closer once you go into labor?

[pampered_mom]

All this, of course, is AFTER a UR has shown itself in fetal distress, AFTER you've physically gotten to the OR (which can take several minutes by itself), AFTER the primary surgeon and first assist have been assembled (they're not standing there all night waiting for someone to rupture, you know), AFTER the OR has been opened. It's not like they do the section in your room, you know.

Wow...so many things. First of all - having had a c/s myself, I'm very clearly aware of where a c/s takes place and what happens during the procedure. Secondly - fetal distress is not the only indicator of u/r, but that of course assumes that the mother hasn't been messed around with by the medical staff. Third - you make this all sound like such a dire situation as a result of the VBAC u/r risk, but we also need to consider that if the amount of time necessary to perform an emergent/emergency c/s on a VBAC patient is as long as you are insinuating - I don't think ANYONE should give birth there!!

Why not just have the hep lock there and available? It almost certainly won't get used, but if it's needed, you'll be very glad it's there.

For precisely this reason - it's there and available. One thing that many of us here have learned is that once you agree to one intervention it's usually only one of a long line of many that will be paraded past you. As I'm sure maxmama and others have discovered - I'm not for "throwing them a bone" in hopes of them leaving you alone or "allowing" you to have the birth you want. In all reality, them "letting" you have the heplock is what they feel is "throwing you a bone" to get you to be more receptive to what they're intentions are for your birth. I hate to be so cynical, but unfortunately that's many times the reality. It's what your consent to "hospital policy" says about you that's dangerous.

ice_chick, you wrote:
The same applies for a heplock. I cannot get to my comfort level when I have something sticking out of my arm whether it is attached to something or not.

Kudos to you for knowing yourself so well!!! :clap
You are absolutely right - it's your body and you have EVERY right to refuse ANY medical treatment. I've been criticized for calling docs "hired guns" before, but in all reality, that's what they are. You (and most often your insurance company) are paying them for their services. The health care system would be better served by more people questioning why certain tests/procedures are needed instead of just going along with whatever the doc wants to do. Think of all the money that could be better used if the number of unnecessary c/s decreased to what the WHO acknowledges is a more accurate number - 10-15%!!

If I were having a "normal" labor, not a VBAC then it is not their routine to put an IV in & then what happens if something went wrong & I needed an emergency c/s in that case? Why is that any different?

You're right, it shouldn't be any different! Unfortunately, they see you as a ticking time bomb so they tend to react accordingly. (Although in some hospitals I would venture that they "require" at least a heplock for all laboring women - again they see birth as a very dangerous enterprise were it not for their intervention)

What can they actually do to me? They can't kick me out of the hospital. Will they give me less than the standard of care? I just need the midwife to be there to catch the baby, I really don't want anything else from them. I was hoping for a little more support from this thread & not just the same deal about the heplock, but oh well. It's my body & I just have to keep reminding myself of that.

I'm sorry that you didn't feel like you got enough support from this thread!!! I wish that you had felt more supported, but know that you aren't alone. I'm certain that there are many others on this forum that feel the same way you do as well as many other c/s mamas elsewhere. PPs have affirmed that they can't kick you out of the hospital - they do have to provide care, they're legally required to do so (thankfully!!). Will they provide less than the standard of care? It's certainly possible. Is it possible that they may be verbally abusive? Possibly - they're human. Is it likely that they may bad mouth you (if not to your face, behind your back)? Possible.

I think it would be wise to anticpate these things when considering laboring/giving birth in the hospital. Certainly first on your list should be becoming well versed in your legal rights. ICAN's website/whitepapers has information to help you do so, www.ican-online.org. Second on your list is to make sure that you have a birth plan - not necessarily one that you will give to your care provider, although that would be wise. This would be more for you and your support team (husband, doula, wise friend, etc) so they know what your wishes are and how best they can support you in labor. I would certainly suggest trying to go in with at least two support people, possibly one of which is a doula.

Third, be ready to fight. I hate to say that because no one should have to fight their way through labor/birth. It's very possible they may approach you about the heplock and when you refuse leave it be, and if that's the case then what a wonderful surprise! BUT, if they react differently at least you've mentally prepared for that part!

I know you said that you would like a homebirth, but your dh is not on board. What ways can we support you in that? Is there a possibility that you think he may be more open to it given more information or?

At the very least, :Hug . Just remember - it's your body, your birth, your baby. Stay strong!!

[maxmama]

Wow...so many things. First of all - having had a c/s myself, I'm very clearly aware of where a c/s takes place and what happens during the procedure. Secondly - fetal distress is not the only indicator of u/r, but that of course assumes that the mother hasn't been messed around with by the medical staff. Third - you make this all sound like such a dire situation as a result of the VBAC u/r risk, but we also need to consider that if the amount of time necessary to perform an emergent/emergency c/s on a VBAC patient is as long as you are insinuating - I don't think ANYONE should give birth there!!



In case you didn't know, community standard in the OB literature is 30 minutes from decision to incision. VBACs are not required to take place in a hospital with 24 hour OB or anesthesia coverage, so six minutes from decel to baby is pretty damn good. The basic logistics of moving a patient from one room to another and accomplishing the physical acts required to perform a section are limited by physics, you know. Since doctors aren't magicians, able to suspend basic facts of the universe, as I'm sure you know.

Second, true fetal distress has been repeatedly validated as the most reliable indicator of UR.

Third, UR is rare. That wasn't the issue. The issue was whether an IV could be inserted quickly if needed. Yes, it can, but quickly isn't enough were one to be dealing with catastrophic rupture.

[pampered_mom]

In case you didn't know, community standard in the OB literature is 30 minutes from decision to incision. VBACs are not required to take place in a hospital with 24 hour OB or anesthesia coverage, so six minutes from decel to baby is pretty damn good. The basic logistics of moving a patient from one room to another and accomplishing the physical acts required to perform a section are limited by physics, you know. Since doctors aren't magicians, able to suspend basic facts of the universe, as I'm sure you know.

Maxmama - I'm not an idiot - I'm rather well versed in these things.

Second, true fetal distress has been repeatedly validated as the most reliable indicator of UR.

Emphasis on the "true fetal distress" part vs the oodles of times fetal distress is diagnosed only to be determined that it was bogus. PLUS - I would trust a mother's take on what's happening with her body over the flawed interpretation of the blips created by a machine.

Third, UR is rare. That wasn't the issue. The issue was whether an IV could be inserted quickly if needed. Yes, it can, but quickly isn't enough were one to be dealing with catastrophic rupture.

You yourself have admitted that it can be inserted quickly - that's the point.

Sorry, ice_chick to hijack your thread here! :wink

[jen6]

I think the issue that is emerging is where and when you want to fight your battles. Having had a very interventionist birth the 1st time, and planning a VBAC this time around (EDD July 15, 2006), I understand the idea of a medical slide and what it means. I am not saying that you should do ANYTHING you feel uncomfortable with, it is absolutely up to you and what feels right for you, obviously. I think that is an implicit assumption. All I am trying to convey is that there is a reality to a hospital birth and having people supporting you or people fighting you. I do believe that if you have the right support team around you that a lot of this discussion becomes mute. But reading between the lines, my DH was also really against a homebirth, and it has been a long process getting him to a place where he is going to be an asset in managing the hospital staff. We have also made sure to stack the deck in our favor with a great OB and an experienced doula. Just make sure you have someone who will take on the battle so you don't have to, because getting your adrenalin up in birth is the last thing you want. For me, a heplock is a HUGE compromise, but it is the only one I am willing to make. For me, I don't feel like it is getting on the slide from last time, I see it as a way to avoid the slide. Might not make sense to others, but it really is how I see it. Also, talking to the midwife manager ahead of time and giving her our wish list has helped us be clear with where we stand on their protocols and hopefully will avoid confrontation at a time we should be focused on the impending arrival of our baby. Is this an option for you? Is you DH, or your primary labor support, prepared to do battle? If so, it sounds like you are pretty clear on what you want. Good luck.