Friday, November 27, 2009

Re-post: Down with the I.V. league

Been busy with Thanksgiving fun. Here's a re-post of a piece I wrote almost exactly two years ago:

“You’re thirsty? Do you want some more ice chips?” Most women laboring in U.S. hospitals, no matter how thirsty or hungry they may be, must resign themselves to sucking and munching on ice. I munched my way through that rite of passage with my first baby. Enduring labor and birth has been compared to enduring and completing a marathon. Both feats are extremely physically taxing, but you would never expect a marathon participant to run without drinking or consuming any kind of fuel. Hospitals across the country expect laboring women to do just that, but is this deprivation really necessary?

When a patient must undergo general anesthesia for emergency surgery, there is a risk of stomach contents being inhaled into the lungs (also known as “aspiration”). Hospitals ask women to refrain from eating or drinking in order to reduce the risk of death from pulmonary aspiration. Even with these precautions in place, however, there is no guarantee that a woman’s stomach will be empty in the event that she needs general anesthesia. The risks of death from pulmonary aspiration are miniscule—1 in 1,250,000. Furthermore, deaths from pulmonary aspiration in these situations have more to do with anesthesiologists’ errors than whether a woman has had food or fluids recently. It is very uncommon for a laboring woman to require general anesthesia. Most of the problems arising in childbirth can be recognized and addressed without such extreme measures being taken.

What do hospitals offer as a “substitute” for food and drink? Intravenous fluids (IVs). Yes, IVs provide fluids, but quite often they provide too much, particularly when mother is given a “bolus” (large amount of fluid) before receiving an epidural (an attempt to prevent the blood pressure drop often resulting from epidural anesthesia). Fluid overload resulting from IV fluids can lead to other complications, among them:

* Fluid in mother’s and baby’s lungs.
* Diluted blood, leading to anemia and decreased oxygen supply to the uterus and fetus.
* Newborn jaundice, as excess fluid causes baby’s red blood cells to burst and release bilirubin (yellow product of red blood cell breakdown).

Aside from these issues, an IV will also hinder a laboring woman’s ability to move while in labor. Movement, particularly in early labor, is an effective way to cope with the pain of contractions. Lying strapped to a pole and a monitor in a bed will increase a laboring woman’s discomfort greatly. Additionally, when a laboring woman remains lying in a bed for an extended period of time, labor will not progress as effectively as when aided by movement and gravity.

I remember how strange it was to me when I came home from the hospital after my first baby was born and found that my legs and feet were swollen with fluid for a few days. I had heard plenty of pregnant women complain of swollen ankles and feet, but I had not experienced any swelling while pregnant. It surprised me to see swelling afterward. I also noticed swelling in my face and hands in the pictures taken of me just after my daughter’s birth. I can’t prove that it was the result of I.V. fluids, but I feel fairly confident they were to blame. Here's a picture of me in my swollen post-partum state...Lovely, eh?

When I gave birth to my second child, I chose to see a group of nurse-midwives who delivered at a small community hospital where they had, finally, convinced administrators to allow laboring women to drink. Instead of being given an I.V., I received a “hep-lock” which is simply an I.V. needle inserted in a vein but without the fluids. They like to have an “open vein” in case of an emergency. I spent less than three hours of my labor in the hospital because I had already progressed to about 6 centimeters upon arrival, and my labor progressed quickly afterward. I think I took a few sips of water when I felt thirsty, but not a lot. It was wonderful, however, to not be tied to the I.V. pole. I was also pleased to notice that I experienced no swelling afterward. Here's a much less frightening post-partum picture...
Not every laboring woman will be given the option to bypass IV fluids. Some hospitals have strict policies, and women who are induced, given narcotics or epidurals, or a c-section will have no choice but to submit to an I.V. Every intervention alters the birth process, however, and the more interventions, the more complicated the birth process becomes. I encourage women to avoid unnecessary interventions and trust the process of birth. Seek out care providers who honor and respect the birth process and will advocate for your right to experience birth as you wish, including eating and drinking if you choose. You and your baby are worth the effort.

For more info, see the "Evidence Basis for the Ten Steps of Mother Friendly Care."

3 comments:

OrganicMama said...

Good post, Busca. I was COMPLETELY swollen with my first delivery - after an I.V., pitocin and an epi.
Also, I can't prove this is related by my daughter looked swollen as well and weighed 9lbs 7oz. She dropped weight dramatically in the first few days - down to 8lbs 2 oz - and I've always wondered if it was really water weight.

My second time, at home with a great midwife, I looked pretty darn good afterward. No swelling and my baby was smaller too (8lbs 4 oz). She did not look puffy like my first daughter.

Of course, I can't prove that's what happened but I can say I felt SO MUCH BETTER the second time. Not sloggy - either from drugs or an I.V.!

OrganicMama said...

p.s. I ate and drank when I was hungry or thirsty in both my labors. My body knew when it needed nourishment.

I often wonder if women who aren't allowed to eat lose strength simply because they're worn out and hungry!

Mother Earth said...

Great information. I always recommend that couples who are going to birth in the hospital sneak food and drinks in and eat when no one is looking. Because what are they going to do? Arrest you? Throw you out? But the IV thing--ugh. Great post. How do we change things, though?