Fist of all, I am not a nurse, so I hope it's ok to be here.
I have had three children and am pregnant with my fourth due in about 7 or 8 months. I was induced with my first. Didn't really want to be, but did what the doc said. Really wanted a natural birth, but ended up with pitocin and an epidural.
During the first pregnancy I questioned why I would need an IV. He said it was standard procedure. I was diag positive with group B strep, so I assumed I had to get the IV for the antibiotic.
Second birth, my water broke at home. Basically just did what the doctor said. Got my IV and my epidural. Had the baby in about 10 hours.
Third birth, went into labor and they had to break my water. Got an epidural (because by this point, that's just what happens.) and had the baby in about 7 hours. The only complication was some mec in the water when it broke. She had the cord all twisted up around her. Not her neck though.
Now, I have this overwhelming feeling to do things differently with this one. On top of wanting to go as natural as possible, I didn't like the way the nursery worked at my hospital. They gave my first and third babies sugar water without my consent and I had to fight them to even get my babies in my room when I wanted them. My second would have been that way as well, but there were tornadoes that weekend and we spent the majority of the time together in a hallway in waiting room chairs. He had no trouble nursing but my other two did. hmmmm
So after this book I've written...here are my questions:
1. Is an IV really necessary when you first go in? I always feel like a sick person dragging this thing around. They always tell me to stay in bed.
2. Do you think it's possible to try for a more natural birth at this hospital, or should I drive 45 minutes or more to a different place? The alternative place has l/d rooms with tubs and private suites and the baby rooms in with mom the whole time.
3. On the same note, do you think since I am more educated and experienced I can just have this baby where I have before and just "make" them give me my kid?
The place I usually go is just more convenient because my parents live close by and will have my other kids. That's really all that's making me question this move.
Any opinions and advice are welcome from all of you experienced nurses!!
I am still a student but I can give you some voice of experience. :) My first birth was a c-section after a horrible cascade of interventions to speed up my labor. I was told that my pelvis was too small and I'd never have a lady partsl birth. They kept me strapped to the bed the whole time and took my baby away after the surgery. They do allow vbacs so I considered going back there. Plus, the had a Level III NICU and could handle pretty much any emergency. After a lot of thought, I realized that i wanted a better birth experiece. I didn't need to settle or fight with staff after the birth of my second baby so I switched hospitals. I walked, used the laboring tubs, ate, drank, used the shower, used the birthing ball and finally pushed out baby #2 without a single drug in my system for labor augmentation or pain relief. It was exactly what I wanted.
1. Is an IV really necessary when you first go in? I always feel like a sick person dragging this thing around. They always tell me to stay in bed.
NO!!!! You do not need an IV. My midwives' back up doctor wanted me to have an IV since I have a single layer closure on my uterus which *may* increase my risk of a uterine rupture slightly. However, I talked to him about my risks and the fact that I was confident about my decision so I only agreed to a hep-lock. It would take seconds to attach the IV in the event of an emergency.
2. Do you think it's possible to try for a more natural birth at this hospital, or should I drive 45 minutes or more to a different place? The alternative place has l/d rooms with tubs and private suites and the baby rooms in with mom the whole time.
Its possible but why put up the fight while you are in labor? It's a vulnerable time for any woman. I drove an hour to birth in a hospital that knew how to support the birth I desired.
3. On the same note, do you think since I am more educated and experienced I can just have this baby where I have before and just "make" them give me my kid?
You can try. They really shouldn't be doing anything without your consent. But again, why try to fight them?
I highly recommend birthing with a midwife who is more likely to listen to your birth preferences. Also, a doula can help help advocate for you.
It sounds like the hospital with the tubs and the private rooms is the way to go as they seem a little more of a relaxed atmosphere. Uaually in that type of atmosphere, the staff are a bit more receptive to the pt's wishes. Wanting to have your baby with you continuously is not unreasonable. Moms who breastfeed often request this along with requesting that their infants don't receive pacifiers or sugar water/formula. As long as baby nurses well and the baby's blood sugar is within normal limits, supplimentation is often not needed.
Intravenous access is necessary during childbirth especially if you have a history of beta strep. However you can request an INT or Heplock where the IV is capped off but available for use as it will enable the nursing staff to administer the necessary antibiotics. The INT will allow you some freedom with getting up to the bathroom w/o having to schlep the IV pole and all with you. You may not need an epidural however if you do need one an IV is a must in which case the IV solution is easily hooked up to the INT/heplock.
I always ask the couple if they have any special plans or requests for their delivery and do my best to accomodate them as long as the circumstances permit.
As both a 3 time mom and an OBGYN nurse, your post touched me. I want to recommend that you do as all of the others have suggessted and have a good talk with your DR. That said, I would also like to suggest a few things myself.
1) Understand that your ultimate goal and that of the staff at the hospital you decide to deliver at are the same: a healthy baby and mommy. I agree with allowing an INT(intermittent IV) or saline lock. No, IV fluids are not necessary. However, as someone who has already delivered 3 times, you are at a slight risk for increased bleeding. Additionally, labor is VERY hard work (DUH). Your uterus, as a large muscle, will require hydration if your labor is long. Athletes know the importance of remaing hydrated and birth is more work than any sport in the Olympics. It's not a good idea to take in your fluids by mouth in a case an emergency c-section is needed. Additionally, if baby gets into distress, one of the easiest and least aggressive interventions we perform first is to give you a fluid bolus, allowing more blood and oxygen to get to baby. This may be a good comprimise to "give" on.
2) This next point is sure to push a lot of buttons but I feel that it bears addressing. If you come to the hospital to have your baby, you are asking for the expertise and experience of the staff that works there. It is possible to have a baby elsewhere. If you truly don't want the interventions of nurses (whose decisions won't always gel with the fairy-tale idea of birth) then perhaps you should consider other options for your delivery. This sounds a little harsh, but keep in mind that you tell the mechanic which tires to put on your car, not HOW to put them on. The more information we have on the status of the baby (from a fetal monitor) the better we can deal with a potential crisis. I counsel parents who have suffered the loss of their babies and also lost my own 8 years ago. This is a tragedy that no one should have to feel. I feel that being hooked up to a IV and a fetal monitor for 12 hours is more than a fair trade whenever my DR. hands me my baby and I can hear that first sweet cry.
3) Finally, let me address the issue of rooming in and supplementing. I always tell my moms that I am there to work for them. You are their employer. If a nurse tells you that your baby needs to go to the nursery, ask them if whatever need to be done can be done at the bedside. It's not always convienent, but nearly every care given to a healthy infant can be performed at mom's side in her room. At my hospital, we cannot move the hearing screen machine from the nursery. But it is placed right next to the window and mom or dad can watch the entire time. Also, I don't know any DR. who would perform a circumcision in mom's room. (You wouldn't really want to be present for that anyway!) If a nurse tells you that the baby must recieve sugar water, ask her what your baby's blood sugar is and what the acceptable limits for your pediatrician are. Ask if the baby is not symptomatic that you be allowed to breastfeed and then have the blood sugar rechecked. Despite what some popular organizations like to say, most healthy term infants should have no problem latching onto the breast after a 1 time use of an artificial nipple.
Thanks for seeking out the opinions of nurses and for allowing us the opportunity to open a dialouge with you. It shows a respect for our experience and knowledge and also that you are smart enough to get educated about your delivery options. I hope that your delivery is a joyous occassion. God bless you and your little one.
Let's say a pt refuses a hep lock and pt is informed of dangers, ect., and everything is well-documented. Then god-forbid, later on during labor/delivery something terrible happens (you fill in the blank, crash c/s needed, abruption, ect.) and the nurses are unable to insert an IV after several attempts, and pt or baby has a negative outcome. Can the nurse/hospital be sued due to the nurses being unable to insert an IV fast enough?
2) This next point is sure to push a lot of buttons but I feel that it bears addressing. If you come to the hospital to have your baby, you are asking for the expertise and experience of the staff that works there. It is possible to have a baby elsewhere.
Possible, yes, but not always practical.
For a lot of people in a lot of places, hospitals are the only option. In my state, there is 1 CNM who does home births, and she lives 3-4 hours away. And there is a freestanding birth center 1.5 hours from my house. That's it. My wish for my state is that CPMs would be allowed to practice home birth (make it legal, then you can regulate it), and home births would not be so frowned upon. I have a friend who delivered baby #1 at home with a CPM who technically breaks the law every time she catches a baby. I wish that weren't so.
Let's say a pt refuses a hep lock and pt is informed of dangers, ect., and everything is well-documented. Then god-forbid, later on during labor/delivery something terrible happens (you fill in the blank, crash c/s needed, abruption, ect.) and the nurses are unable to insert an IV after several attempts, and pt or baby has a negative outcome. Can the nurse/hospital be sued due to the nurses being unable to insert an IV fast enough?
You and I both know that you can be sued for anything nowadays. Does this suit have a strong leg in court? That depends on how well you document and the laws in your state. Was deposed on a similar case years ago.. VBAC who refused to sign a consent that had "possible c-section" written on it. Would only consider VBAC. Her uterus ruptured. Her husband signed a consent, told us to cut her. Mom and baby both lived, but mom lost her uterus and baby has severe neuro defecits. Guess whose fault it is? Not the mom's... according to a jury. This area of medicine is fraught with what I consider to be sometimes unneccessary risks. I'm pretty sure that mom wanted a healthy baby more than she wanted to avoid another section. But, you can only educate a patient and then do your best to support them while hoping for a good outcome. Sad story, huh?
Let's say a pt refuses a hep lock and pt is informed of dangers, ect., and everything is well-documented. Then god-forbid, later on during labor/delivery something terrible happens (you fill in the blank, crash c/s needed, abruption, ect.) and the nurses are unable to insert an IV after several attempts, and pt or baby has a negative outcome. Can the nurse/hospital be sued due to the nurses being unable to insert an IV fast enough?
Any time a baby is born dead or damaged, you can bet there will be a lawsuit. It really doesn't matter if there is a basis for it or not. Show a damaged or orphaned baby to a jury and no matter the facts of the case, everyone wants to throw money to the family. You can't really blame them, it's tragic and the money comes from the insurance company so no one loses anything--or so many lay people think.
Nurses do get sued, but not as often as the hospitals and the docs--our pockets aren't as deep. Good documentation is essential. In this kind of case you'd want to document completly her understanding that refusal could result in damage or death of baby and or mother. If nurses cannot get an IV in, document how long each person tried and how long it took to get someone else to try--anesthesia, a doc to do a cut down, or whatever. Even though good, complete, thorough documentation is our best defense agains a law suit, it isn't always enough. As long as Americans believe that if things don't go just as they are supposed to go, someone must have made a mistake, that's how it will be.
1. Is an IV really necessary when you first go in? I always feel like a sick person dragging this thing around. They always tell me to stay in bed.
2. Do you think it's possible to try for a more natural birth at this hospital, or should I drive 45 minutes or more to a different place? The alternative place has l/d rooms with tubs and private suites and the baby rooms in with mom the whole time.
3. On the same note, do you think since I am more educated and experienced I can just have this baby where I have before and just "make" them give me my kid?
The place I usually go is just more convenient because my parents live close by and will have my other kids. That's really all that's making me question this move.
Any opinions and advice are welcome from all of you experienced nurses!!
Blessings,
Tammy
No you definitely don't need an iv for normal labour. I work in Australia where only women who have significant risk factors have a cannula placed. We manage perfectly fine with women who bleed or need an emergency CS and don't have IV access. And as far as I'm aware our national rates of PPH are similar. We certainly don't have women dropping dead from PPH because of a lack of IV access. Its a furphy that one!!
If you had GBS previously this is not an indication to have antibiotics again unless you are proven GBS or have risk factors such as 18 hours of ruptured membranes, a high temp in labour or you are in prem labour. My advice would be to have a swab in the last 5 weeks of your pregnancy to prove or disprove your GBS 'status'. The CDC has guidelines on GBS which are evidence based.
Have a serious talk with your dr. and if your gut feeling tells you he ain't supportive run to the nearest midwife. Labouring womena are vulnerable and can be talked into anything!:twocents:
:twocents:
rbytsdy
350 Posts
I am still a student but I can give you some voice of experience. :) My first birth was a c-section after a horrible cascade of interventions to speed up my labor. I was told that my pelvis was too small and I'd never have a lady partsl birth. They kept me strapped to the bed the whole time and took my baby away after the surgery. They do allow vbacs so I considered going back there. Plus, the had a Level III NICU and could handle pretty much any emergency. After a lot of thought, I realized that i wanted a better birth experiece. I didn't need to settle or fight with staff after the birth of my second baby so I switched hospitals. I walked, used the laboring tubs, ate, drank, used the shower, used the birthing ball and finally pushed out baby #2 without a single drug in my system for labor augmentation or pain relief. It was exactly what I wanted.
1. Is an IV really necessary when you first go in? I always feel like a sick person dragging this thing around. They always tell me to stay in bed.
NO!!!! You do not need an IV. My midwives' back up doctor wanted me to have an IV since I have a single layer closure on my uterus which *may* increase my risk of a uterine rupture slightly. However, I talked to him about my risks and the fact that I was confident about my decision so I only agreed to a hep-lock. It would take seconds to attach the IV in the event of an emergency.
2. Do you think it's possible to try for a more natural birth at this hospital, or should I drive 45 minutes or more to a different place? The alternative place has l/d rooms with tubs and private suites and the baby rooms in with mom the whole time.
Its possible but why put up the fight while you are in labor? It's a vulnerable time for any woman. I drove an hour to birth in a hospital that knew how to support the birth I desired.
3. On the same note, do you think since I am more educated and experienced I can just have this baby where I have before and just "make" them give me my kid?
You can try. They really shouldn't be doing anything without your consent. But again, why try to fight them?
I highly recommend birthing with a midwife who is more likely to listen to your birth preferences. Also, a doula can help help advocate for you.