May 20, 2009
First, Do No Harm: Another Reason to Ditch Routine IVs in Labor
By: Amy M. Romano, RN,CNM | 0 Comments
In the latest Listening to Mothers Survey 83% of women reported having intravenous (IV) lines in labor or birth. This number is probably not surprising to many of us - IV's are part of the routine package of care in most settings, even for low-risk women. Their ubiquitous place in modern obstetrics renders them practically invisible. And although the American Society of Anesthesiologists revised its guidelines in 2007 to encourage clear fluids in labor - which would presumably eliminate the need for IVs in most cases - the practice of routine IVs appears to be continuing unabated. Why? Because the medical model presumption is that it's nice to have that IV access just in case an urgent complication is lurking around the corner. And besides - IVs are relatively harmless, right?
Wrong. In 2007, I was part of a team that conducted a systematic review (PDF, see p. 34S-36S) of the research on IV fluids in labor. We found that IVs can cause anemia and that they reduce colloid osmotic pressure - which can lead to swelling in the tissues or lungs (pulmonary edema) of both the laboring woman and her infant. In addition, not all IV fluids are created equal: IV fluids with glucose in them were associated with low blood sugar in newborns, and salt-free fluids increased the likelihood of potentially serious electrolyte imbalances. The body of research also confirmed -common sense 0 that women find IVs uncomfortable and that IVs limit mobility. Finally, we failed to find a single study that supported the notion that IV access improves outcomes when urgent problems arise. Despite this nearly universal belief, no one has in fact studied the question.
This week I happened to see two different bits of news blip onto my radar that raise other troubling concerns about the rampant use of IVs on maternity wards. Both pieces looked at possible harmful effects of the chemicals that may leach out of the plastic IV bags and tubing. A recent NPR story reported on an ongoing study looking at sexual maturity in teenagers who were exposed to high levels of phthalates as infants in neonatal intensive care units. The phthalates came from intravenous lines, including those used for extracorporeal membrane oxygenation (ECMO). The Wall Street Journal posted a short blurb about an animal study showing that another chemical found in IV bags and tubing, cyclohexanone, can trigger health problems in the hearts and neurological systems of the rats that were exposed. We can not - and should not - extrapolate the findings of these studies to possible effects on laboring women and their newborns. But they add new fuel to an already compelling case to do away with IVs whenever safely possible. With no evidence that their routine use is beneficial, a small but consistent body of evidence that they can cause harm, and important questions unanswered, a change in practice is long overdue.
For more information about potentially harmful chemicals used in health care settings and ways to reduce the environmental impact of our health care system, visit Health Care Without Harm. Along with other great resources, HCWH published a booklet with the American College of Nurse-Midwives called Green Birthdays (PDF) in 2001.
Citation: Goer, H., Leslie, M. S., & Romano, A. (2007). The Coalition for Improving Maternity Services: Evidence basis for the ten steps of mother-friendly care: Step 6: Does not routinely employ practices, procedures unsupported by scientific evidence. Journal of Perinatal Education (16)1, 32S-64S.
TagsInterventions New Research Safety Do No Harm Labor/Birth Research for Advocacy IVs