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Monthly Archives: August 2014

What Impact Can IV Fluids Have on Mother, Baby and Breastfeeding?

 A Quick Look.

images (4)Written by guest author, Jacqueline Levine

Having IV fluids is a medical procedure. It’s meant to restore normal body fluid balance when there’s blood loss or dehydration, but the Listening to Mother’s Survey1 reports that 83% of women have IV in labor. Having a routine IV , as so many do, isn’t risk-free.2 An excess of IV fluid can dilute red blood cells and other components of the blood like clotting factors, so that less oxygen gets to the uterus and less to the fetus, increasing the possibility of post partum anemia or hemorrhage3,4.
Too much fluid can overcome normal pressure in blood vessels, and fluid goes where it shouldn’t. The mother’s and/or baby’s lungs can become “wet”5. Large amounts of fluid given quickly (a bolus) can interfere with the activity of the uterus.6 The type of IV fluids given can have unhappy effects as well, such as hyponatremia which can cause seizures, and symptomatic hypoglycemia in the baby7,8,9. Plastic IV lines may “off-gas” phthalates and other chemicals that are harmful. This list is brief. There are lots of studies that show harms from routine use of IV. Even the safety of “normal saline” has come under scrutiny.10 And the effect of IV administration lasts well into the days after the mother is disconnected from her hanging bag of fluids.
Fluid has weight, of course; haven’t you heard that helpful little reminder, “a pint’s a pound the world around”? If a laboring mother gets bag after bag of IV fluids, odds are that her baby will be born with an inflated birth weight. Breastfeeding success is often measured by how quickly the baby regains its birth weight after the normal weight loss in the first week or so. What exactly might that baby’s normal birth weight have been? What does it mean to the motherbaby pair when of them both are full of extra fluids? Water moves everywhere in the mother’s body and aside from ankles and wrists and fingers and toes that can be swollen like sausages, breasts and nipples hold water as well. A swollen breast with taut skin makes latching difficult. This scenario is often the beginning of early nursing troubles10: the transition from colostrum to mature milk may be delayed in a water-swollen breast, and a newborn may not able to achieve a deep latch so he can’t get sufficient food and cannot stimulate the breast well. Supplementation comes next. We know it and the studies show it. There are remedies to those situations…good support for mother and baby… but best-evidence, optimal maternity care is the answer.
Supplementation frequently comes next. We know it and the studies show it. There surely are remedies to the problem of swollen breasts, like Reverse Pressure Softening, and methods to build up milk supply, and ways to support better positioning for a baby who is having latch difficulties..
But the overarching answer is for mothers to be aware of best-evidence, optimal maternity care, and to understand their rights as patients to refuse routine interventions. By avoiding IV fluids except for compelling medical reasons, mothers will be able to avoid the negative consequences of fluid overload to their babies and themselves, and give themselves a chance at better breastfeeding beginnings.

Jacqueline (Jackie) Levine, LCCE, FACCE, CD(DONA), CLC is committed to providing a continuum of care for underserved women at PlannedJackie-Levine Parenthood, on Long Island, NY, where she has provided free Lamaze education, birth and breastfeeding support to all the women in her classes for the last 9 years. She is a guest lecturer on Childbirth in the US at CW Post, has worked for CIMS, contributed to the Lamaze e-newsletter Building Confidence Week-by-Week , all after her 30-year career as a designer in the garment center. Jackie is a recipient of the Lamaze Community Outreach Award, mother of three and Grandmother of five.” Science & Sensibility

 
References:
1-DeClerq E, Sakala C, Corry MP, et al. Listening to Mothers ll: Report of the Second National US Survey of Women’s Childbearing Experiences. New York: Childbirth Connection
2-Wasserfstrum N. Issues in fluid management during labor; general considerations. Clin Obstet Gynecol 1992;35(3):505-13
3-Carvalho JC, Mathias RS, Intravenous Hydration in obstetrics. Intl Anesthesiol Clin 1994:32(2):103-15
4- Carvalho JC, Mathias RS,Senra WG et al. Hemoglobin concentration variation and blood volume expansion during epidural anesthesia for cesarean section. Reg Anesth1991;16(1S):73
5-Gonik B., Cotton DB.,Peripartum colloid osmotic changes; influence of intravenous hydration. American Journal Obstet Gynecol1984;150(1):99-100
6-Cheek, T.G., Samuels, P.,Miller, F., Tobin, M., Gutshe, B.B. Iv load decreases uterine activity in active labor. Journal of Anaesthesia 1996;77:632-635
7-Stratton JF, Stronge J, Boylan PC. Hyponatremia and non-electrolyte solutions in laboring primigravida. Eur J Obstet Gynecol Reprod Biol 1995;59(2):149-151
8-west CR, Harding JE. Maternal water intoxication as a cause of neonatal seizures. J Pediatr Child Health 2004;40(12):709-10
9-Nordstrom L, Arulkumaran S, et al. Continuous maternal glucose infusion during labor; effects on maternal and fetal glucose and lactate levels. Am J Perina. Am J Perinatol;1995;12(5);357-62
10-http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Normal-saline-is-not-normal-may-be-harmful/ArticleNewsFeed/Article/detail/776186?ref=25
11-Chantry CJ, Nommsen-Rivers LA, Peerson JM et al. Excess Weight Loss in First-Born Breastfed Newborns Relates to Maternal Intrapartum Fluid Balance. Pediatrics 2010

Fire Them

1654409_772290742834062_2112665148391680840_nIt is most important for you to feel completely comfortable with, and even trust, all those who are around you during your labor & birth.
If you don’t, your labor can be impacted by your emotions.
I have seen this happen. I have seen a good labor come to a halt because the woman did not like or was intimidated by those who were caring for her.
If you are feeling the least bit uncomfortable, fire whoever it is that is causing your discomfort.
That’s right! Fire them!
I don’t care if it is your nurse, your doctor or midwife, even me, your doula! Fire them! You have that right!
Even if you are in the middle of your labor…you can fire them!
Then replace them with someone else…
Feeling comfortable with your team is that important!

No…thank you!

No Thank you

The Latch On Song

In honor of my friend, who has left us all too soon, and in honor of her passion to promote breastfeeding…

Janna Melsness; CNM, MSN, MPH, RN, BSN

January 28, 1981 – April 5, 2015