hospital birth: heplock, cord clamping - Mothering Forums

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#1 of 34 Old 05-16-2006, 08:21 PM - Thread Starter
 
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hi to anyone who has a hospital birth.

-has anyone ever avoided a heplock during the whole time they were in the hospital? i know that i can tell them "no" but is that unreasonable in a hospital? i'm afraid they will stick something in it without asking like pitocin or a big old bag of fluids when i'm already drinking fluids. i do understand their reason for wanting to do one- during my miscarriage i had a really hard time so i had to go to the hospital and i got treating like a pin cusion (i think i was deydrated?).

-has anyone delayed cord clamping in the hospital? how long did you delay? did they put the baby on your chest right away?
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#2 of 34 Old 05-16-2006, 08:44 PM
 
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I avoided the hep lock by just saying no. She gave me a hard time & I startled her by saying that I understand if things went badly they would just shove the large bore needle in my neck. She asked if I was a fan of TV ER shows - haha. Cord clamping was delayed 5 min or so. I picked up my own baby & put him on my chest. I told them not to touch him. They loved me.
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#3 of 34 Old 05-16-2006, 08:58 PM
 
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1. It's next to impossible for anyone to put anything into a hep lock without you noticing. First it needs to be flushed, then the line connected, then the rate adjusted. You'd notice. We only use hep locks if the woman is GBS positive and needs abx, if she chooses an epidural, if she's very dehydrated and unable to keep fluids down, or if we're running pit. In any case, we discuss the options thoroughly before starting.

Ask for lidocaine for the start and an 18-gauge maximum catheter.

2. We routinely delay cord clamping until it stops pulsing and the baby always goes straight to mom's belly. The exception is an unresponsive baby, with or without meconium.

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#4 of 34 Old 05-16-2006, 09:05 PM
 
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I needed IV fluids big time..part of the reason I went in to begin with.....I was a week over, stalled at almost 6 cm for over a day so I got a tad of pit..just a tad, enough to start things up again...whew......that pit....whew...LOL So, I got the heplock....

DD's cord stopped pulsing while she was on my tummy trying to nurse.....My MW had no issues with it and neither did the nurses....they were quite happy with my choices....I had low lights, whispers...very Leboyer....dd even got her bath in warm water right then and there...I got to help...It was wonderful.
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#5 of 34 Old 05-16-2006, 09:56 PM
 
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1. I was unable to avoid the hep lock. A friend was able to avoid it, but the baby was crowing when she arrived at the hospital, so there really wasn't time

2. It's been my experience that most CNMs will give lip service to delayed cord clamping, but are often clamp-happy and will give 'emergency' excuses for why the cord needs to be clamped immediately. Reminding your care provider of your preference for delayed clampling while the baby is crowning is probably your best bet (although it would be difficult to remember to do this)

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#6 of 34 Old 05-16-2006, 09:57 PM
 
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I tried to avoid the hep-lock. I declined it three times and signed an AMA. They put one in while I was pushing because her HR dropped when I wasn't pushing. The nurse who put it in was very skilled and got it in quickly. As soon as it was in her HR was fine. But my adrenaline really kicked in and she was born 3 minutes later.

We wanted to delay cord clamping but we were ignored.

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#7 of 34 Old 05-16-2006, 10:10 PM
 
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I work in a very weird hospital, don't I?

What reasons are given for immediate cord clamping? Why would everyone get a hep lock? Where is the evidence for these policies?

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#8 of 34 Old 05-16-2006, 10:52 PM
 
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At my last birth (a different hospital/city/state than my first one), I had a CNM and she didn't even mention putting in an IV. I hadn't really talked about it one way or another and was going to ask if it was necessary if it came up, but it never did. I thought about it after my son was born. Also, I birthed him on hands and knees, so he was at first on the bed under me, but I quickly turned arouns and he was handed to me. She did not clamp the cord until it stopped pulsating, again, I didn't really think about it at the time--I was a bit distracted--it was just what was normally done.

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#9 of 34 Old 05-16-2006, 11:03 PM
 
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I had dd at a hospital and had to fight just to get the heplock vs. a regular IV. That said, you would notice if anything were to be given to you via the heplock.

We had only lip service paid to delayed cord clamping. I even specifically asked when they started to clamp the cord if it had stopped pulsating and got an 'Oh, sure' (or maybe 'oh, of course,' my memory is a little hazy - you get the jist of it though). I've since actually told someone that if they want delayed cord clamping, to act as though they want a lotus birth. After all, you can always tell them you 'changed your mind' and cut it. Barring that, tell them you want the placenta to have delivered before the cord is cut. I think that's about the only way you can guarantee it, at least in the majority of hospitals. (Hopefully, there are some exceptions!)

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#10 of 34 Old 05-17-2006, 01:26 AM
 
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I have been told that I have no choice but to submit to a heplock and 1 1000ml bag of fluid, nothing by mouth until after the delivery. I'll also be tied to the bed on CFM: and people wonder why i'm planning a UC with such great options as that!

Seriously?
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#11 of 34 Old 05-17-2006, 02:48 AM
 
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The hospital I birthed at does not require a heplock - they only use an IV if you actually need something delivered IV.
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#12 of 34 Old 05-17-2006, 02:50 AM
 
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I had an IV because I chose to have an epidural. However I did tell them to delay the cord cutting and my request was respected. I asked him to wait until it stopped pulsing. He asked me to inspect it if I wanted and asked my permission before setting it up for dh to cut. It was only a few minutes. The placenta came out right away. The whole birth was really, really good. All my wishes were respected. Even things like no pit shot to prevent bleeding which she was going to give right after the birth automatically. No cream in the eyes, no bath. I even pulled her out myself!

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#13 of 34 Old 05-17-2006, 02:57 AM
 
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My last birth was an NCB in a hospital and I did not have a heplock. I just told them right away I wasn't going to have pain meds and didn't want an IV. They said ok and I assumed they'd want me to have a heplock but they didn't. They said no need if I didn't want pain meds. This hospital was very mainstream yet they still were 100% cool with non intervention per my wishes.

The delayed cord clamping was something I was a little concerned about b/c I had discussed it with one of the OBs at my practice and he said he didn't understand the point and didn't seem to want to accomodate this but thankfully he wasn't the one to deliver ds. Turns out it was a non issue anyway because ds was born with a very tight double nuchal cord that had to be cut off before he was all the way out. I'm hoping I can FINALLY have delayed cord clamping with #3!!!!
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#14 of 34 Old 05-17-2006, 03:03 AM
 
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2. We routinely delay cord clamping until it stops pulsing and the baby always goes straight to mom's belly. The exception is an unresponsive baby, with or without meconium.
boo hoo for me, ds was unresponsive and had meconium. I've given birth twice and neither of my babies have been able to go straight to my belly. This is my DREAM...I want this so badly with the next one!!!!!!!!!!!!!!!!!!!!!!! Sorry had to vent

~Erin
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#15 of 34 Old 05-17-2006, 08:38 AM - Thread Starter
 
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thanks for the responses.

i think i am going to put in my birth plan no iv and not mention hep lock. if they want to do one we can discuss it then. i will find out from my midwife if it is hospital policy or what. with my son i had a hep lock and yes they put something in without me noticing. i just given birth to my son. JUST PUSHED HIM OUT. i was shaking, crying, barely even noticed jason was on my chest i was so out of it. with the NEXT contraction i pushed the placenta out and the next thing i heard the nurse say was hey dr i started a pitocin drip. it is policy there. i dunno i was just so exhausted but not bleeding to death by any means. then i became very concerned about jason...is he ok? someone tell me if he is ok? that i forgot about the pitocin drip. but it did bug me once i went to rest and they wouldn't take it out.

i want to ask the midwife about the cord clamping b/c it would seem like that would require their cooperation. if they could even delay clamping 2-3 minutes that would help a lot i think. my husband said don't put it in the birth plan if it aint gonna happen, but i feel like no matter what the dr/midwife thinks, might as well put it in there and try!

the labor part of my plan is really short.
-pls don't offer pain meds (will ask as needed)
-prefer to be free to move around (no iv, cont monitoring)

the pushing section is medium size: placenta delivered naturally, avoid lithotomy position, spontaneous bearing down

but they rest is really long...especially the part about baby care. i would like to shorten it. it says stuff like delay newborn procedures, no hep b, no circ (do i need this in there?), prefer early discharge, hold baby right away, breastfeed right away, no pascis/bottles, rooming in. my doula is going to help me with it. which is good b/c i need help ha.
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#16 of 34 Old 05-17-2006, 09:03 AM
 
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I had a doula client not have a heplock. She had severe allergies to pain killers and anitbiotics, several different kinds. Her doctor decided the best way to avoid a problem was to simply NOT give the nurses anywhere to stick anything. Everything went perfectly fine.
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#17 of 34 Old 05-17-2006, 09:47 AM
 
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Originally Posted by Hayes
I had a doula client not have a heplock. She had severe allergies to pain killers and anitbiotics, several different kinds. Her doctor decided the best way to avoid a problem was to simply NOT give the nurses anywhere to stick anything.
Just to set the record straight, a nurse can't stick anything into a woman without a physician's order. Don't blame the nurses for giving stuff--let the physicians take some personal responsibility!

Why ask for an 18 gauge, maxmama? It's about the biggest; why not go a little smaller with a 20; a little less irritating, and you can still get blood through it in an emergency. Do you have some other reason for favoring it? I'm seriously asking, I'm not a knowledgeable about IV therapy as I would like to be, I was wondering if I am missing out on a little secret!

In our hospital, floor nurses aren't trained to do a large bore in the neck--so if you hemorrhaged and they couldn't get a peripheral in, you'd be screwed. Your choice, most assuredly (the birth center that I work in doesn't even do routine saline locks, I'm totally cool with that). But just don't unrealistically think you can rely on this as a last gasp effort--if IV therapy isn't available (like at night, or they are on another floor and can't get there in time) you won't get a large bore in your neck in time.
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#18 of 34 Old 05-17-2006, 09:58 AM
 
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I birthed 4 times in 10 years (1990-2000) at the same hospital birthing center, and never had a hep lock, no IV - I don't remember even being offered pain meds. The last two were waterbirths - they won't allow you to be in the tub if you're on an IV.

Cord clamping was different each time. The first two times, it was clamped/cut almost immediately; but the last two I had a MW who delayed about 5 minutes or so.

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#19 of 34 Old 05-17-2006, 10:15 AM
 
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just wanted to point out that not getting a heplock won't prevent them from giving you pitocin afterwards without your knowledge. Even though I didn't have a heplock, the nurse gave me a shot of pitocin in my leg after baby was out. In her defense, my dh says she did ask me first but I didn't even know she was in the room, I was totally in a zone and focused 100% on my son who was being resuscitated at the time. The next time(if I birth in a hospital again) I will make sure someone is watching out for that.

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#20 of 34 Old 05-17-2006, 11:24 AM
 
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Quote:
Originally Posted by lorijds
Just to set the record straight, a nurse can't stick anything into a woman without a physician's order. Don't blame the nurses for giving stuff--let the physicians take some personal responsibility!

Why ask for an 18 gauge, maxmama? It's about the biggest; why not go a little smaller with a 20; a little less irritating, and you can still get blood through it in an emergency. Do you have some other reason for favoring it? I'm seriously asking, I'm not a knowledgeable about IV therapy as I would like to be, I was wondering if I am missing out on a little secret!

In our hospital, floor nurses aren't trained to do a large bore in the neck--so if you hemorrhaged and they couldn't get a peripheral in, you'd be screwed. Your choice, most assuredly (the birth center that I work in doesn't even do routine saline locks, I'm totally cool with that). But just don't unrealistically think you can rely on this as a last gasp effort--if IV therapy isn't available (like at night, or they are on another floor and can't get there in time) you won't get a large bore in your neck in time.
I favor an 18 because it's frequently policy to put in a 16 or even a 14 (this is an anesthesia preference). It's ridiculous, because you can run blood products through a 20 or even a 22 if you have to, but an 18 is often a good compromise between policy and comfort. That's why I said to ask for an 18, maximum.

I agree too that docs set up way too much friction between patients and nurses by trying to "protect" the patient from those stupid nurses. As the PP said, I can't give a damn thing without an order, and I am also legally required to check each order against allergies and appropriateness of both treatment and dosage. In a lot of ways, it's the worst of both worlds, since I can't make orders, but I'm legally responsible if I carry them out and they're wrong.

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#21 of 34 Old 05-17-2006, 12:17 PM
 
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Originally Posted by maxmama
I favor an 18 because it's frequently policy to put in a 16 or even a 14 (this is an anesthesia preference). It's ridiculous, because you can run blood products through a 20 or even a 22 if you have to, but an 18 is often a good compromise between policy and comfort. That's why I said to ask for an 18, maximum.
Thanks for the info. Good to know!
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#22 of 34 Old 05-17-2006, 03:32 PM
 
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Originally Posted by nichole
but they rest is really long...especially the part about baby care. i would like to shorten it. it says stuff like delay newborn procedures, no hep b, no circ (do i need this in there?), prefer early discharge, hold baby right away, breastfeed right away, no pascis/bottles, rooming in. my doula is going to help me with it. which is good b/c i need help ha.
Doesn't sound to me like you need much help.

We'll definitely talk more about some of the things that are "protocol" around here....
Hope you are well!
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#23 of 34 Old 05-17-2006, 07:07 PM
 
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I haven't read others' responses, so forgive my being short on time.

My hospital left it completely up to me about the heplock. I did have one with both of my births, but they put it in my forearm instead of my hand, and it didn't hinder my moving around at all. I needed iv antibiotics after my 1st birth-long placenta story- and my second birth I was dehydrated due to a bladder infection. So I was glad to have the heplock there, because being stuck when I was calm and in a good place was fine. But they were fine with which ever way I wanted it.

We also delayed cord clamping with #2, and again, no problems. The doc asked when I was ready to cut the cord, and after making sure it was done pulsating, we proceeded. No problem.

I also refused suctioning and rubbing the baby after birth, the hep B, the eye ointment, circumcision and bathing until the next day!!! Needless to say the staff was accomodating and very kind. I had two great deliveries and am planning another one!!! Good luck!!!
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#24 of 34 Old 05-17-2006, 07:14 PM
 
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I did not have a heplock since I arrived at the hospital 37 minutes before dd was born.

We wanted to have delayed cord clamping as well, but that didn't happen for us. The day before dd was born, I went in to see my OB and she agreed to put it in my chart by the following day. The OB that delivered me was unaware of the plan and clamped the cord before me or dh even thought to say anything. Oh well...

I think most hospitals/doctors are amenable to reasonable requests. I wish you luck!!!
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#25 of 34 Old 05-17-2006, 08:17 PM - Thread Starter
 
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Originally Posted by zoe398
Doesn't sound to me like you need much help.

We'll definitely talk more about some of the things that are "protocol" around here....
Hope you are well!
i'm doing well :
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#26 of 34 Old 05-17-2006, 08:36 PM
 
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I did not have a heplock with my second hospital birth. (had an epi with the first so that came with an IV) They insisted on taking blood to type and cross match in case of emergency but that was it. I'd actually planned to get the heplock but I arrived at the hospital somewhere between 8 and 9 cm so I wasn't feeling exactly cooperative.

The nurse was going to do the heplock but as soon as I said "no" that was that. I actually didn't mind the idea of it but I just didn't want to be messed with at the time.

My midwife said that she usually would have waited longer to clamp the cord but since we were doing cord blood collection she had to do it sooner than she would have otherwise. Not sure how long her "normal" wait is but we'd talked about it ahead of time and decided that for us it was worth it to do the cord blood collection instead.

The only thing that was said about pitocin was that since I hadn't had any they wanted me to nurse ds as soon as possible. Of course since I wanted to do that anyway that was fine with me.

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#27 of 34 Old 05-17-2006, 11:26 PM
 
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Originally Posted by lorijds
In our hospital, floor nurses aren't trained to do a large bore in the neck--so if you hemorrhaged and they couldn't get a peripheral in, you'd be screwed.
Actually IM (intramuscular) pitocin would be given if there was not an open vein. I've seen it done (without consent of the patient, in a non-emergency). Incidentally this is the same way pit is given postpartum by homebirth midwives (those who carry it).
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#28 of 34 Old 05-17-2006, 11:28 PM
 
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I wasn't refering to the administration of pit; I was referring to fluids and, if necessary, blood administration to keep your blood pressure from bottoming out and your organs from failing in the very, very rare event of a massive hemorrhage.
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#29 of 34 Old 05-18-2006, 02:48 PM
 
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I've had 2 hospital births -

The first hospital would not let me say no to the hep lock (I specifically had no hep lock on my birth plan, and I asked to sign a waiver, even), nor did they delay cutting the cord. In fact they whisked my daughter away to the warming table immediately after she was born. This was under an OB's care with no doula.

The second hospital was smaller and more close-knit, and I had a midwife there this time. I had no hep lock and had a small delay in cutting the cord...maybe 3 minutes or so. Nobody gave me any trouble about it.

So from my experience, it 1) depends on the hospital and how strict they feel about their stupid policies, and 2) depends on who is in charge or advocating for you and your labor.

SAHM to Melinda (Oct '03), Jacob (Aug '05),  Alex (Apr '08), and baby.gif Malcolm (Sept 29, '11)

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#30 of 34 Old 05-18-2006, 03:41 PM
 
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I had 2 hosp. births. The 1st was my 2nd preg. DS 1. (dds were homebirths 1 & 4) I tranfered to the CNM's care 6 wks before edd. (military move) She seemed nice & open to my plans, I thought I had my bases covered.... When it came time for the delivery she was awful. The only thing she respected me on was no IV. She cut & clamped immediately (she let my husband shorten the cord, it was already cut) and then did heavy duty cord tractioning for the placenta. (The list of interference & coercion could go on, but this isn't my thread ) DS #2 (birth #3) I had another CNM (much better but still clueless) my labor was progressing fast & the nurse was insisting on an IV (she hadn't read my plan) so we compromised on a hep. which she put in my hand & really hurt while I was moving around. (incidentally this was that nurse's first nat. cb she had ever seen. sad.) CNM wasn't very interested in waiting on the cord either. It might have been a minute. She did let my husband help catch the baby though. In my experience you have to be really prepared & really fight & advocate for yourself. Neither of which I did very well. You can just say NO but be prepared for a lot of fighting.
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