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Sunday, June 26, 2011

Risks and Benefits of IV's or Saline-Lock During Labor

Reasons for having an iv in labor include hydration for women and for the "just in case emergency".  I'm not going to address the hydration issue in this post, as I feel like there is plenty of evidence out there that already discusses the idea that women really don't need an iv for this reason.  You can find a good post on that here, though, if you are interested.

What I do want to look at are the risks and benefits of at least getting a saline-lock for those just in case emergencies that could happen during birth.  The reason you would want to have easy and quick access to your veins, is because you may hemorrhage.  This is one of the main reasons women have historically died during childbirth.  The idea that we need it for medication does not sit well with me because one of the first drugs we turn to during a hemorrhage is cytotec or methergine. Both of these are not given through an iv, but rather in pill form into the woman's vagina.  The other main thing we do is crede. This is where the uterus is manual pressed on from outside the woman's body to help it decrease in size, and therefore stop bleeding.  So, the real reason is if you would need blood fast.

Here's some numbers and stats regarding the need for blood transfusions following birth:
Overall blood transfusion rate for all pregnancies: 0.31%
Overall blood transfusion rate for normal vaginal deliveries: 0.28%
So out of 1000 women 3.1 would have a hemmorhage requiring a blood transfusion.
Out of that 3.1 women, 61% would have had identifiable risk factors before labor and another 39% would have developed risk factors during labor.

So, out of 10000 women 31 would have a hemmorage requiring a blood transfusion.  Out of that 31, 19 would have known risk factors for having a hemmorage.  That leaves 12 women out of 10,000 that would need a blood transfusion without any known risk factor.  Of those 12 women, we don't know how many of those would have had problems with immediate iv access, but my bet is, most of them would be able to get an iv in pretty quickly once the need had arisen.

If that was the end of the story that may be worth the risk of getting a saline lock at least.  If 12 women are going to need  a blood transfusion, you may as well not be one that is stuck without an iv, right.  Unfortunately, it's not quite as simple as that because iv's carry medical risks of their own.  Which is something that no hospital or doctor I've worked with discusses with their patients.

Now, I want to talk about some of the risks of an iv, because to me, that is what should be discussed when a woman is asking about whether or not she should get an iv.

Local complications(these tend to be less severe and easier to treat):
Hematoma: blood that leaks into the tissues surrounding the iv.
Phlebitis: Inflammation of the vein
Thrombophlebitis: Inflammation and swelling caused by a blood clot
Infiltration and extravasation: Liquids being administered into the surrounding tissue instead of the vein.
Local infection: site gets infected where the iv was inserted(approx. 2/1000 people).
Venous spasm: contraction of vein leading to a temporary stop in blood flow

Systemic complications(these can be more severe and even life threatening):
Septicemia: infection that is caused by microorganisms in the blood and can affect the whole body.
Catheter embolism: a piece of the catheter from the iv that breaks off and travels through the circulatory system

I couldn't find a lot of good research for the stats on iv complications and what they imply, but I did find one small study that may help give us an idea of what kinds of choices we are making should we choose to have an iv.

Most minor and major complications happen in the forearm, hand, and wrist.  84% experienced minor complications.  16.5% experience major complications.  Most of the major complications were in women who were 50 or older.  Major complications included septic thrombophlebitis, hematomas resulting in skin necrosis, infiltration related complications some which resulted in skin necrosis, compressive nerve lesions, digital stiffness, and compartment syndrome.

Putting this into numbers(I actually think the numbers are way smaller than this, but just going from this research paper):

Those who will get a major complications under 50 years of age are 1.65/100 women-that's just a little more than 1%.
This is 16.5/1000
 or 165/10000.

Problems with applying this to the labor and delivery room:  We are mostly dealing with healthy, young women, and this research was small, which makes it hard to know if these numbers are what is real or not.  Also, typically the incidence of major complications goes up as the amount of time with the iv in goes up.  It all leads to a very difficult picture to decipher.  Even if this is way over the amount that it should be, it shows you 
that there could still be some serious side effects of having an iv.

In other studies, the rate of minor complications was around 35%.

My opinion: until we have some clear research into the complications of iv insertion and laboring mothers, we need to quit assuming that having one is in the best interests of mothers and allow them to make that decision  based on their own choice of what they consider the most risky.

1 comment:

Doula Jenna said...

thanks for this. i'm working on a post of my own on routine procedures for hospital births and came across this post when searching for info related to IV placement during labor. i thought i'd share that i witnessed at a birth that i was attending- veins infiltrated twice (once in each arm) and finally the anesthesiologist was paged to administer a new line- he gave mom the option of starting the IV in her foot or her neck... she chose the foot :) she needed one due to epidural being administered... but what a sight it was to see an IV running into her foot! just thought I'd share.

Birth is a Journey: Does it have to be life changing?

  • One woman might have to climb on an overfilled boat, risking her life and nearly dying as she escapes over the ocean to come to this land. This experience could certainly be life altering. It may very well color the rest of her life, positively or negatively. (I overcame this amazing struggle and here I am triumphant! OR Holy crap, that was SO hard I don’t know if I can go on! By the way, neither response is “right”. No one would judge the woman with the 2nd response.)
  • One woman may buy an airplane ticket, sit on a comfortable 747 and fly to America with a nice smooth flight and landing. She is happy to be in America. Those welcoming her are glad she is here safe and sound. She may only travel by plane 2-4 times in her life, so it is pretty memorable. But the journey itself probably wouldn’t be life changing; it would simply be a journey.
  • One woman may learn to fly an ultra-light plane to lead a flock of geese into America teaching them to migrate. This experience could certainly be empowering and life altering.