There are those with good phlebotomy skills and those with lousy ones.
This doc clearly has no faith in his own skills or his team’s.
Way to go, doc.

uh, no, IMI will NOT do it. I disagree with the idiot doc above’s comment, but if you are losing blood, IMI will do bugger all. Why? Because it requires adequate blood flow to be absorbed, and if you are losing blood, you are not going to HAVE adequate blood flow.

Place the IV when it is needed. Not before.

::applause:: You took the words right out of my mouth, chingona!

Yep. This one does

WTH? The WTH is that some women, while not afraid of natural childbirth, really don’t like needles. Doesn’t matter if the gauge is small or larger, needles kinda suck. Then there’s also the thought that that IV places us one step closer to the doctor trying to coerce us into pitocin or some other intervention that we don’t want and don’t need.

So what exactly is the big deal with leaving things the hell alone until it is actually needed? You *can* place an emergent IV, so do it when it is actually emergent, not before. Might also be a good idea to not mess with things that are going well, just slower than you’d like. If you don’t mess with stuff, there’s less likelihood that we’ll need emergency services.

But surely you agree that the mother ought to be able to make an informed decision, knowing the risks, to either allow placement of a hep-lock or not.

The mother does legally have rights over her own body, and she deserves the correct information, given respectfully, in order to make her informed decision.

There isn’t anything wrong with a saline lock IF the mother wants one. IF it’s needed. Why should I be hooked up the second I walk through the door?

I had my daughter in the hospital with an OB and a Hep-Lock or IV was NEVER mentioned. It wasn’t needed. If a situation were to arise where I needed one, obviously I would consent. Being in labor is not that situation.

If it were truly an emergency and I was hemorrhaging I sure hope the OB knows there are other, faster actions to take other than worrying about an IV.

And to play the death card? Really? Especially with my three year old in the room? Classy.

For what it’s worth, my original OB said she would prefer I had a Hep-Lock, but we discussed it and she was respectful of me not having one. There are different ways to approach the topic.

Well, for one thing, the last time I had an IV line, though they’d unhooked me from the saline drip, the nurse felt free to come up to me and start injecting something into the port WITHOUT FIRST ASKING MY PERMISSION. I had to jerk my hand away and tell her NO. When I asked her what it was, it turned out to be a drug that was inappropriate for my particular situation. The doctor (I happened to be in the ER) had cherry picked the symptoms to pay attention to…I had come in for exhaustion and shortness of breath, but because he could *make* me experience some dizziness by forcing my head all the way to one side (just try it, it’ll make you dizzy on a normal day) he decided to treat me for that. I felt like I was too exhausted to keep my eyes open or head up, and was feeling short of breath, and he wanted to give me a sedative for the “dizziness.” Right. When I was *this* close to blacking out.

When a woman is in “labor land” she doesn’t always have the presence of mind to protect herself like that. This site is replete with stories about women receiving medications (pain relief or otherwise) that they did not consent to…through their IVs or saline locks when they’re zoned out/using Hypnobabies/in the middle of a contraction/pushing/otherwise BUSY giving birth.

I don’t need to feel vulnerable when I’m giving birth. I don’t need to have something ELSE to protect from people who don’t always remember (or bother) to ask permission first. I don’t need to have tape all over my hand and wrist and a needle sticking into me. (I don’t even wear sunglasses because I hate having something on my face, and I cut all the tags out of my clothes…an IV stuck INTO my skin bothers the snot outta me.) That’s why, if I’m healthy and low risk and baby’s fine and everything’s going swimmingly…
I won’t get an IV. I won’t get a saline lock. Keep an eye on me, remind me to keep hydrated, etc., by all means. But no “just in case” measures unless it looks likely that I might actually benefit from them.

By the way…
“You are going to have an unmedicated birth and you are crying like a little girl over a 20 gauge jelco? WTH?”

…*I* get to pick what bothers me, not you.

Well, I’ve had 5 babies, 4 without saline locks, and one with–due to GBS. So let me explain a bit.

I’m not scared of needles–I’m a regular blood donor. BUT…having a saline lock in labor, while not the end of the world, is a major PIA. When I had mine in I kept hitting it on stuff that was sitting in the hospital hallway when I was walking around. When I went into the Jacuzzi I had to keep that arm up out of the water. When I did “hands & knees” it hurt BIG time.

Like I said, not the end of the world…but it was a PIA. And seeing that I didn’t need it with 4 of my births, I was happy to go without. If risk factors had developed that would have indicated I was at more risk of needing an IV, I would have allowed a saline lock to be placed. But as long as I was low risk, there was really no need.

The big deal is that a friend was told they were just giving her the IV in case and giving her a saline drip when in fact they gave her pitocin without her permission thorugh that IV and it ended in c-section partially due to the pit drip. I would also have NOT been allowed out of bed with the IV due to our hospital policy or in the shower either and that is where I wanted to labor so to you it might not be a big deal, but it was to me. I hemorrhaged with my first and got a shot of pit because it was quicker and I STILL DID NOT get the IV “just in case” with my second. BTW I did NOT hemorrhage with the second either.

I’ll cry like a little girl over whatever I want, kthx.

I’ve had 4 uncomplicated unmedicated home births, and no sticks of any kind. I’d have been pissed if anyone tried to stick me FOR NO REASON “just in case”. ever hear that part about how anxiety and stress can slow labor? well, some people have needle anxiety. I’d have been nauseous, possibly passed out, if I had to labor with a needle stuck in me.

My ADD makes me hyper stimulated. I can deal rather well with deep muscle pain, but an IV/Hep-Lock would have driven me insane. I’d have picked at the tape, touched it, fiddled with it, been pissed at it, and likely taken it out. I’ve been a blood donor and then a Red Cross platelet apheresis donor for years. I know what it is to sit for 1-3 hours with needles in my veins. I refused the Hep-Lock, because I knew what it would do to my coping skills.

Ah, yes. “Every labour and birth is dysfunctional, a true medical emergency, until proven otherwise in retrospect, so we must treat all labouring mothers like invalids and trauma cases just in case this labour results in trauma. Active management is key. All hospital routines and obstetric policies are for the good of the patient. All that matters is a healthy (i.e. living) baby. You don’t want a dead mother or a dead baby, do you? Because that’s what happens when mothers put their selfish birth fantasies and cravings ahead of the routines WE know are best for everybody.”

I call bullshit.

And given the miniscule chances of severe trauma from blood loss happening during labour or after birth – chances made even more miniscule when routine interventions such as overaggressive Pitocin augmentation, manual traction of the umbilical cord, stress-inducing starvation of the mother, episiotomies, etc are avoided – yes, I’ll take my chances of being the woman with the invisible veins after severe blood loss. The odds are in my favour.

No, then again I’m glad I wasn’t in the car the day my first husband had his accident. When your time is up your time is up. None of us get out of this life alive. The doctor was reacting in an emotional manner and skewing the truth. And apparently he did it in front of a 3 year old. I wouldn’t want him anywhere near me every again. The point isn’t the lock. The point is the doctor pulled the dead mommy card to coerce the patient. If he can’t conduct himself in a professional manner during a meet and greet I sure don’t want to have to “keep an eye on him” during Labor and Delivery.

But yet, how many women have you seen suffering from severe hemorrhaging? Probably, in the general scheme of things, not that many. And now, because a small percentage of women do hemorrhage in labor, we are all treated as if we *all* will, even though the risk is still low. That’s how so many interventions have become commonplace – because now everyone is treated as “high risk” even when they aren’t.

Jujebes, I can find a vein in a 12yo boy half upside-down in a car, while hanging in the window and Im not even a doctor. I call BS.

Yeah, but that’s what interoseous is for, those rare times you can’t get the stick but MUST move fluid volume into the patient. Hurts like h$1l, but if you’re truly dying…

And how many of those have you seen relative to the percentage of ER patients who come in with non-critical complaints and end up hemorrhaging? Even people who come into the ER with blood loss in process (say, a miscarriage) don’t get an automatic heplock at the door.

Not to mention that many OTHER “standard” hospital procedures increase the risk of hemorrhage, and if this woman was declining them, she’d be even less likely to have a hemorrhage.

All your comment serves to illustrate is how consistently pregnant women receive blanket treatment based on worst case scenarios, (almost) no matter how rare. And that they are irrationally and unscientifically treated as ticking time bombs more so than almost any other kind of patient.

In the scheme of things, a heplock is not the worst intervention out there. I’d (maybe) have it if I HAD to be in a hospital and they INSISTED.

The bigger issue is that a woman made a reasonable request and has been met with the most extreme possible scare tactic. Real respectful. Real responsible.

correction: That said, there’s no real reason a woman needs an IV the second they walk in the room, or at all for that matter.

Exactly. Instead of blame the patient for the lack of wanting an IV and treating every pregnancy and labor situation as a dire emergency, perhaps the nurses/staff on the floor should be better able to get a stick quickly.

I came in to deliver my last child and was fully dilated with a breech baby. Automatic c-section. After about six tries, the only person who could get a needle stick on me was the anesthesiologist himself.

*applause*

even if just cos it made me giggle

But other stuff too.

More applause! Competent caregivers can get an IV in quick when it is needed.

You really should rethink having and IV or hep-lock because somethings things happen.” would have been true. Uttering the words death/dead/die or stillborn in order to get the patient to comply is offensive. Why don’t you get that? Besides, what is the point of doing it in advance if it might fall out and then you have to do it again. What if they do it 6 times over the course of an 18 hour labor and then never even needed it? As you said automatic IV’s are overkill. So, let mom decide.

Let’s see, person-who-won’t-even-give-a-name:
I wound up with an appendectomy (also unnecessary, but that’s another story) AND enormous bruises on both arms AND the backs of my hands. Which were nearly as painful, healing, as my surgical incisions. To wind up with bruises and more bruises just in case I might start bleeding at some point in the future? Not a worthwhile trade-off. See, I’m an adult who can make decisions for my body that my care providers ought to respect, even if they disagree. Threatening me with dying of a hemorrhage? Not one bit respectful (or realistic, for that matter).

Nope. That thought occurred to me, too. I’d be terrified to have fuzzy or jubejubes tending me anytime, but especially during a birth. They seem to have significantly more emergencies than the statistical norm. I’d actually be worried they are causing these emergencies from an overblown hero complex combined with some sort of narcissism. They have to be the savior at every birth, so they make sure something goes drastically wrong that they can fix. Scary.

I’m not wondering. I’m imagining. It’s not pretty.

Lol. That’s what my mom said I should’ve asked this OB when she made the comment.

I don’t think they’re experiencing more emergencies. I think what happens is that every doctor occasionally experiences a situation where the crap hits the fan (I’m sure that’s a scientific/technical term) and the doctor has to act immediately to save the patient’s life.

Afterward, the doctor goes over the situation in his or her head repeatedly, looking for ways he or she could have handled it better. If the woman was bleeding out, the doctor may think, “If she’d had a heplock, it could have been handled faster,” and they make an effort not to make the same “mistake” again.

Jerome Groopman goes over this psychological tactic in his book How Doctors Think. He says that this is a key reason why doctors often overtreat patients (he never discusses obstetrics, btw) because the doctor is haunted by a bad outcome in the past and wants to make sure that never happens again.

Bad outcomes that happen *because of* the doctor’s precautions are therefore considered justified because the doctor has insulated himself/herself against guilt should the terrible thing in the past ever happen again. In other words, by accepting Fuzzy’s helpock, you’re medicating the doctor.

Groopman interviewed doctors and would say, “What’s the best experience you’ve had as a doctor?” and would get a sentence. Then then he’d say, “What was the worst?” and the doctor would stop, stare off into space, and then talk for five minutes about a terrible situation and what he or she does ever since in order to prevent it, even if there was nothing the doctor could have done to change things.

It’s because at heart, doctors are human.

Midwives can fall into the same trap. The midwife I used wanted me to bake my baby’s clothing at 250 degrees in the oven because she once had a baby who nearly died from spider bites because there were spider eggs in the baby clothes. (Fortunately my baby arrived before I had to come up with an excuse as to why I wasn’t going to be baking the baby clothes.)

But doctors see higher-risk women on a regular basis and therefore they probably DO see more emergencies than a midwife will, and in the environment where they’re surrounded by high-tech equipment, they may feel more pressure to act on perceived emergencies.

But overall it’s a memory flaw. The bad experiences stand out far more than the good and the fear overpowers the confidence.

Maybe the fact that midwives know they can call on backup makes them a little more able to trust birth. In the doctor’s case, s/he knows there’s no one else. They’re not going to transfer a mom to a SuperDuperHospital if she crashes at the hospital, and the doctor is relying on the nursing staff to detect a problem in time for the doctor to race to the hospital in time to fix it.

Because the doctor sees himself/herself as the final line of defense, maybe the doctor is more primed to always think in crisis-mode, and yes, the hospital system is set up so as to ensure as many crises as possible. Not intentionally, but having one nurse monitor three laboring women via electronic monitors that are of no proven value, while the doctor is either working in an office or at home sleeping, is not for the benefit of the laboring mother.