Here we bolus alot, but I think it is because basically all of our patients here are dehydrated (in Phoenix). It is pretty standard to start an IV and give like 500 right away, then turn it down to 125/hr (on gravity tubing, unless PIH is present/suspected or similar higher risk for fluid overload). Then, our patients get boluses as part of fetal in utero resusitation. We also routinely give 1-2L boluses immediately before epidurals.
I trained at a tertiary care center, with a very well known and respected perinatology group. They were very big on IV fluid bolusing (again, unless PIH present/suspected). And, we were all very cognizant about the risks and s/s of pulmonary edema. We rarely saw it, and when we did, it was usually either a sick mama (not getting big boluses anyways), or someone with some underlying problem that was previously unknown. But, we measure urine output on anyone with an IV and routinely evaluate cardio/pulmonary status if indicated.
I'm totally comfortable with that.
I worked a travel assignment at a tertiary care center in NY, where they did things very differently from most everyone else. They didn't give boluses, even before epidurals! And, most every patient ended up having late decels needing ephedrine after the epidural placement. Drove me nuts!
But 4500ccs in 6 hours on a stable labor patient, without a bad strip...that seems like quite alot, though! I could see that if the suspected a bad strip was due to hypovolemia or poor placental perfusion. But your average labor patient? yikes!