Excerpted from Birth as an American Rite of Passage
Description and Official Rationale
The fluid administered from a plastic bag on a high stand through a tube inserted into the laboring woman's arm is supposed to compensate for the food and drink she is denied during her four- to thirty-hour labor, to correct or prevent the occurrence of ketosis, to facilitate the administration of analgesics and pitocin, and to prepare for epidural analgesia. Keeping the IV line open is also viewed as important, "just in case" blood is suddenly needed or other emergencies arise. (This need, however, could be easily satisfied by the use of a heparin lock, which also keeps the vein immediately available.)
The sugar and water solution administered through the IV presents potential hazards to both mother and child, especially when, as is common, dextrose is used in place of glucose (found naturally in the body). Dextrose is a refined sugar with deleterious physiological effects: it rapidly elevates blood sugar content, causing a temporary energy rise, but this too-high elevation causes the pancreas to secrete more insulin, resulting in a rapid drop in blood sugar and a sudden energy slump. When dextrose is administered intravenously for many hours, the result can be internal physiological havoc, which the patient will experience as exhaustion (Abrahamson and Pezet 1977).
Even IV solutions containing glucose can cause problems. Studies comparing laboring women allowed to drink oral fluids with those intravenously fed have found that the latter often suffered from fluid overload (Cotton 1984; Gonik and Cotton 1984). Researchers consistently noticed that the amount of IV fluids received was more than double what was ordered during labor, and four times more than was ordered during delivery. As IV fluid levels are increased, a drop in colloidal osmotic pressure occurs--that is, too much fluid begins moving in and out of the woman's body tissues, a situation that can lead to electrolyte imbalance, cardiac arrhythmia, and pulmonary edema (fluid in the lungs).
Indication of still another potentially significant risk of glucose administration during labor comes from another field. In a series of studies comparing pain tolerance of both diabetics and healthy subjects after glucose infusions, Morley et al. found that "a 50 g glucose infusion resulted in a significant decrease in both the threshold level of pain and the maximal level of pain tolerated, as measured by reponses to electrical pain induced by a Gass stimulator" (1984:79). Although the diabetic experimental subjects had a lower pain tolerance than the healthy subjects, both groups demonstrated marked decreases in their ability to tolerate pain after glucose infusions. These results suggest that the glucose administered through the IV during labor may actually reduce the birthing woman's ability to tolerate pain.
Risks for the infant include severe hypoglycemia after birth, which can result from the excessive insulin production generated by the baby's pancreas in response to the high blood sugar levels developed in its circulatory system by the large amounts of dextrose and/or glucose, which rapidly cross the placenta from the IV bag (Grylack et al. 1984; Jawalekar and Marx 1980; Kennepp et al. 1980; Lucas et al. 1980; Mendiola et al. 1982; Rutter et al. 1980). In addition, both 5% and 10% glucose or dextrose infusions have been implicated as possible causes of neonatal jaundice (Kennepp et al. 1982; Rosengren and De Vault 1963a; Singhi et al. 1982). In the above studies, women who drank oral fluids only maintained their colloidal osmotic pressure levels better than women with IVs, and their babies had fewer problems with hypoglycemia, jaundice, and weight loss.
Moreover, because the IV solution usually contains no protein, it does not replace the protein expended during labor, and so throws the woman's system into "negative nitrogen balance--a condition of starvation" (Birnbaum 1977:107). In addition, puncturing the skin's protective layers increases the chance of a hospital-induced infection. Maintaining the sterility of IV devices is not easy; in one study, when 411 IV devices were cultured, 47 (11.4%) were colonized with bacteria (Larson et al. 1984).
Hospital-induced infections are particularly dangerous for two reasons. First, they involve organisms that can survive in a hospital environment and that have become immune to standard treatment. Second, mother and child have never been exposed to this danger before and therefore have no established defense to the infection. The result is a greater chance of infection in the hospital that is more difficult to eradicate. Birnbaum 1977:106
According to Birnbaum, himself a physician, "the conservative estimate of iatrogenic disease developing after hospital admission is 25%" (1977:105).
Other types of risk are also imposed by the IV. The awkwardness of walking around pushing an unwieldy metal stand while trying not to get the cord tangled up is often a major factor in a laboring woman's decision to remain in bed. When IV use is prolonged, the patient can develop phlebitis, the pain of which can linger for weeks (Jones and Koldjeski 1984; Newton et al. 1988).
Well I was determined to walk around in spite of that IV, and when I needed to go to the bathroom I swore I would do it myself, in the john like a human being. So there I go down the hall in my slippers, pushing this huge heavy thing. I managed to get it inside the bathroom by holding the door open with my foot, but there was this little ridge or curb thing in front of the stall and I couldn't get the IV stand over it. So I had to leave it outside with the door open, but the cord (sic) wouldn't reach all the way to the toilet, so there I am, trying to position my bottom over the toilet, leaning as far forward as I can with my arm out in front of me as far as it will go, not to mention having a contraction at the same time--and all I could think was, "If only Robbie could see me now!"
I explained to the labor nurses that I wanted to have a natural delivery.... One of them wanted to give me the IV right away and that was the one that panicked and lost the heartbeat when I changed position and gave me the oxygen and wanted to insert the fetal head monitor and all that, and the other one let me delay as long as possible on the IV. And so she was willing to work with me and understood what I wanted to do. The other nurse did not, because she came in and said, "Why isn't your IV hooked up? I'm going to hook it up right away." And I said, "No, no, the other nurse is going to do it and she said we're going to wait, and she said "Oh, no, you shouldn't wait." She really wanted to put it in because she said I had really nice veins.... [several hours later when it did get inserted] I didn't like it one bit.... I wanted to be able to get up and go to the bathroom, and with the IV somebody had to walk you there and walk you back. I thought I was perfectly capable.
The intravenous drips so commonly attached to the hands and arms of birthing women make a very powerful symbolic statement: they are umbilical cords to the hospital. The long cord connecting her body to the fluid-filled bag places the woman in the same relation to the hospital as the baby in her womb is to her. She is now dependent on the institution for her life and is receiving one of the most profound messages of her initiation experience: we are all dependent on institutions for our lives. But this message is all the more compelling in her case, for she is the real giver of life. Society and its institutions cannot exist unless women give birth; yet the birthing woman in the hospital is shown not that she gives life, but rather that the institution does.
© Robbie Davis-Floyd PhD, Used with Permission
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