Read the full article for more information to help you make an informed decision about having a hep-lock. The article sites other research. I encourage you to read the article in it's entirety, but here is a part (for you cliff note readers)
If you change your mind and decide you want an epidural, most anesthesiologists want you to have a fluid bolus prior to the epidural and you will become “more high risk” with an epidural and need the IV
There is an overall 2.9% risk for post-partum hemorrhage (the risk is much less if you have a vaginal delivery and no risk factors), in which case an IV will need to be inserted for fluids, Pitocin (which can also be given in a muscle injection), and (very rarely) blood products
If you do get really thirsty or tired and can’t hold anything down, you can be given IV fluids for a bit of a boost
If you do decide you want a saline lock, Dr. Shannon recommends, “Get it placed earlier in labor when you are more comfortable, as you may desire or need IV medications later on (such as for nausea, pain, or hemorrhage) when placing an IV may be more difficult (of course, Pitocin can be given by muscle injection if necessary for post-partum hemorrhage).
Risks of having a saline lock:
It hurts to have the IV placed, and some women find it uncomfortable and distracting during their labor
It may cause bruising or small amount of bleeding at the IV site
The vein can become inflamed (phlebitis) which can cause redness and pain (risk = 7-10%) (Rickard et al. 2010)
If the IV is used for medication or fluids, these may leak out of the vein and into the tissues, also known as extravasation (risk = 30-33%) (Rickard et al., 2010)
Infection at the IV site resulting in a severe bloodstream infection (risk = 0.1%) (Maki et al. 2006)
Having a saline lock might make it easier for your doctor or nurse to initiate unnecessary interventions, like IV fluids or Pitocin for augmentation
The saline lock could be viewed as a symbol that the woman is “sick” and a “patient” instead of a healthy woman giving birth, and this symbol may have consequences for the woman’s mindset for giving birth– and may also adversely affect caregivers’ attitudes towards the laboring woman (Newton et al., 1988)
In the end, I think it comes down to this. There is little-to-no evidence for the use of a saline lock during an un-medicated labor. However, there are risks and benefits to having the saline lock. The ultimate decision for whether or not to have a saline lock should come from you. If you want one and feel safer or more comfortable by having a saline lock just in case it is needed for medications or IV fluids, then that is your right to make that choice. If you have reviewed the risks and benefits and feel that you do not want a saline lock, then that is your right to make that choice. You are a consumer, and you have educated yourself on the risks and benefits, and you do have a say in this matter!
In Bradley classes you will learn that delayed cord clamping is beneficial for the baby. Delaying the cord clamping allows for the baby to get the proper blood volume and additional iron. The link below is a scientific study of the benefits of the delayed cord clamping (in this case only 45 seconds!) for premature infants, delivered by cesarean. Not only was it found safe, but beneficial.
If you don't want to buy and read the entire study: Conclusion Delayed cord clamping of 45 s is feasible and safe in preterm infants below 33 weeks of gestation. It is possible to perform the procedure at caesarean section deliveries and it should be performed whenever possible. It reduces the need for packed red cell transfusions during the first 6 weeks of life.
When you say the term “birth plan,” there are two general reactions: 1) “That’s a really good idea. If you are sure you do or do not want certain things under certain circumstances, it’s helpful to write it out so your midwife, nurse, and doctor are aware,” and 2) “Birth plans are pointless. You can’t plan birth. Just go with the flow.” Since I’m writing a birth plan, I’m obviously in camp #1, but I can understand what those in camp #2 mean when they say you can’t plan birth. It’s a natural process, things don’t evolve according to a chart, and sometimes, emergencies happen.
That being said… This is my body and my baby. I have a right to make informed medical choices. And, quite frankly, I need to write a birth plan because the statistics regarding what commonly occurs in a hospital are not in line with my personal preferences regarding childbirth. For example, in 2004, the episiotomy rate was 24.5% (an episiotomy is a surgical incision of the perineum). I would rather use midwifery techniques to prevent tearing (massage, warm compress) or tear naturally than get an episiotomy (here’s why). I want to be 100% sure that my midwife, nurses, and doctor are aware that I do not want an episiotomy preformed unless it is a true emergency.
I feel the need to preface the rest of this post by saying that my opinions about my ideal birth are just that… My opinions on my ideal birth. I’m not trying to preach about what other women should do or judge other choices. Personally, I have always found it interesting to read about what women decide to do and why, even if they do something I would not choose for myself, so that is why I am sharing.
As I sit down to write my birth plan, I’m trying to integrate as much as the Bradley Method as possible. I am waiting to write a complete summary post on the Bradley Method (probably post-baby), but I really love it so far and would recommend it to any expecting momma, even if you want an epidural, because the 12-week program gives you and your partner so much confidence regarding birth. Bradley Method teaches natural childbirth techniques, and 90% of Bradley women who have a vaginal birth do it without medication – a pretty good success rate!
The #1 rule of the Bradley Method is not to go to the hospital too soon. Basically, the later you arrive, the less chance of medical intervention (such as pain medication and drugs to speed contractions; remember, Bradley mommas are trying to avoid these things). We are taught a variety of physical and emotional signposts to know when we should ideally go to the hospital. Under normal circumstances, I’ll be laboring at home for as long as I can stand it and is safe – I really don’t want the Husband delivering the baby in our bedroom – and then my birth plan will kick in.
I’m not ready to share my final birth plan quite yet (if you’re interested in reading the draft, feel free to shoot me an email at caitlinjboyle at gmail.com), but here are some highlights. Note that all of these items have been approved by my midwife; I can’t say that every doctor, midwife, nurse, or hospital would allow these things, but mine do. Most of these items are in line with Bradley Method teachings, which is why I’m including them:
Caitlin plans to have a medication-free labor. Please do not offer her an epidural. She does not want any drugs to speed along labor (i.e. Pitocin). If there is an issue, and you believe these medications are necessary, please discuss it with Kristien.
Caitlin would like to labor out of bed and would like to be encouraged to try different laboring positions. She may want to deliver out of bed.
If water has not broken by the time Caitlin arrives, water should be allowed to break naturally. Breaking water should be discussed with Kristien first.
Kristien would like to announce the gender of the baby to Caitlin. Please do not spoil the surprise!
Please do not clamp or cut cord immediately. Wait at least three minutes prior to clamping or cutting. (Side note: here’s why.)
Please allow the placenta to come out naturally (no pulling or Pitocin injections, please). We will be signing a medical release so we can take the placenta home. (Here’s why.)
Baby should be placed on Caitlin’s stomach or chest immediately for a minimum of two hours of skin-to-skin contact.
I imagine that, at this point, many of you are thinking, “Dude, if you don’t want them to do anything to do, why aren’t you delivering at home or in a birthing center?” Good question! Ultimately, I truly understand that although I can write a birth plan, I cannot plan birth, and scary things do happen. For me, the best place to be in that scenario is in the hospital with doctors and nurses who can help. If there is a true medical emergency, I will trust these people to make the appropriate choices for me – screw the birth plan.
Another remark that I commonly hear about birth plans is that the birth doesn’t really matter that much. All that matters is that the baby comes out, healthy and safe. While I do think the ‘bottom line’ is true, I do believe that the birth matters, not only in regards to the physical health of my baby, but also for my emotional health. The birth process does matter to me. It doesn’t have to be perfect; it doesn’t have to follow my exact birth plan. But I know this will be a transformative moment in my life, and I want the space around that moment to be one of positivity. Leaving the hospital with our little boy or girl will be the most amazing thing in the entire world. But if I can walk out those doors feeling protected, respected, happy, and healthy… then that’s just icing on top of the cake.
During the 12 weeks of instruction students get in my Bradley classes, we cover choices and options they have regarding their birth. During the week we cover variations and complications, couples are often surprised to know that just because their birth veers from their natural birth plan, doesn't mean they stop having a say in how things go! Parents should be able to give informed consent to all aspects of the birth. In class, we learn how to do that and cover many of the options parents have. I'm sharing on the blog an article that helps parents who have learned they must have a planned cesarean section. It may be disappointing, and a little scary, but when done for the mother's or baby's safety know that you have done what was necessary.
Don't forget that the American College of Obstetricians and Gynecologists (ACOG) now states, "Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including some women who have had two previous cesareans."
A couple of weeks ago, consumer reports released an article titled "What to reject when you're expecting"
Find it here:what-to-reject-when-you-re-expecting
It is lengthy, but worth the read. The points are: 1.A C-section with a low-risk first birth 2. An automatic second C-section 3. An elective early delivery
4.Inducing labor without a medical reason
5. Ultrasounds after 24 weeks
6. Continuous electronic fetal monitoring 7. Early epidurals 8. Routinely rupturing the amniotic membranes 9. Routine episiotomies 10. Sending your newborn to the nursery
I appreciate the statistics and studies they show to back up the points. As Dr. Bradley would say, "research is catching up to the Bradley method" (Husband Coached Childbirth). The Bradley method has been saying these things since the beginning!
This article comes from a natural mom's blog and she is sharing her personal choices for pregnancy and birth.I like this article because it reminds you of things that you need to consider and make decisions about. I agree with most of her points, and encourage you to use informed consent when making your own choices. Consult with your own doctor and your own research.
Remember- you become a parent with choices to make from the time you are pregnant (and hopefully even before conception). Don't be afraid to do what feels right to you, even if that means questioning a doctor.!
