Epidural + Hypoglycemia

Sun0408, ASN, RN · May 20, 2012

Not OB here but if they can't eat or drink, we push dextrose then start D5 or D10.

futurehomebirthcnm · May 21, 2012

Not everyone who eats/drink in labor is going to vomit, and even if they do, they still get nourishment/hydration from whatever they consume. Hospitals that follow the mother-friendly childbirth initiative allow freedom of eating/drinking as desired. Midwives will even encourage it even if the mother doesn't feel like it just so she doesn't lose energy and hydration, both of which are needed for adequate contractions.

bagladyrn, RN · May 21, 2012

My answer would depend on the "degree" of gestational diabetes - is the patient insulin dependent, or just diet controlled? Is she on an insulin drip or hourly accuchecks? If insulin dependent I'd be aiming for more controlled adjustment of sugars which you can get more readily with measured amounts of glucose solutions via the IV. Is a very macrosomic infant anticipated? If so and there is an increased possibility of the need for operative intervention for CPD I'd adhere more closely to the NPO/ice chips only.

If a diet controlled GDM with an estimation of normal size infant, or a multip with a pelvis already "proven" for a large size infant I'd be comfortable giving p.o. juice - after running it by the provider, of course.

futurehomebirthcnm · May 21, 2012

True CPD almost always is a retro-diagnosis--it's extremely rare to be able to definitely say a mother cannot birth a baby before it happens. It's not medically sound to withhold nourishment and fluids by mouth on the basis one _might_ have a cesarean.

bagladyrn, RN · May 21, 2012

Of course it is, but one can anticipate the possibility or probability of certain conditions under certain circumstances - e.g.: mother under 5 ft tall with insulin dependent diabetes and an estimated fetal weight over 9 lbs. with poor control of blood sugars throughout the pregnancy. (And yes I've seen these deliver lady partslly - we're talking probability here)

That's just one example of why I might hold off on p.o. except for ice chips. And I would explain to the patient my rationale for doing so.

VICEDRN, BSN, RN · May 21, 2012

As an er nurse, I can tell you that using d50 amps is a short lived solution. Won't be but less than an hour before you are going back for another. Cranberry juice on an empty stomach is not the greatest choice. Apple juice is less acidic and I would have given the patient two crackers first. (unless of course you have no plans to feed patient at all)

Elvish, BSN, DNP, RN, NP · May 24, 2012

as an er nurse, i can tell you that using d50 amps is a short lived solution. won't be but less than an hour before you are going back for another. cranberry juice on an empty stomach is not the greatest choice. apple juice is less acidic and i would have given the patient two crackers first. (unless of course you have no plans to feed patient at all)

i don't think i've ever seen d50 given for hypoglycemia in l&d. (from my med-surg days, though, i agree with you on d50 in general. i hated it.) although i am personally in favor of letting people eat and drink in labor, most providers will not be thrilled with a patient having crackers on board. this has less to do with obs and more to do with anesthesia in my neck of the woods, so it is probably going to be apple juice or d5lr iv.

BellsRNBSN · May 25, 2012

Thank you for your responses! If I have a situation like this in the future, I will try IV dextrose first.

And ideally, I would love for my laboring patients to eat and drink anything they want, but as a hospital employee, I have agreed to follow hospital policy, which includes certain diet restrictions for moms in labor (especially when my moms have epidurals!).

MySonIsAdorable · May 30, 2012

What about popsickles? I don't know about this area too much but I remember my doctor allowed me to have popsicles and when I forgot them at the house the unit had some on hand. Wouldn't hurt to ask the PCP.