Routine IV Fluids in Labor - What to Know

For many who are in labor and giving birth in a hospital, an IV with hydrating fluids is part of the routine package. IVs are given to prevent dehydration (having insufficient fluids in the body) during labor and birth, which can cause increased interventions and complications. If your pregnancy and birth is low risk and you are not receiving other interventions like an epidural or pitocin, however, IV fluids may be unnecessary and in fact, cause harm. The American Congress of Obstetricians and Gynecologists (ACOG), the World Health Organization (WHO), and the American Society of Anesthesiologists (ASA) all recommend offering and encouraging fluids by mouth to laboring people in place of a routine IV. And yet, many people still routinely receive IV fluids in labor and birth.

What's the big deal with inserting a routine IV and restricting fluids?

Lamaze has long advised the following:

• Routine IV use restricts movement, decreases confidence, may over-hydrate mothers and may contribute to low blood sugar in newborns.
• Restricting eating and drinking in labor depletes a woman's energy when she needs it most.

Recently, the resource site Evidence Based Birth published a revised review of current research on the use of routine IVs fluids in labor called "Evidence On: IV Fluids During Labor." The author, Rebecca Dekker, PhD, RN, APRN, reviewed more than 25 different studies that assessed the use of IVs and various outcomes. Dekker looked at the evidence for IV use; the difference between IV fluids and oral fluids (drinking) vs. oral fluids alone; comparing IV fluids given at different rates; and how IV fluids impact breastfeeding. The review of studies found the following conclusions:

• Evidence is beginning to show that dehydration is related to a longer labor
• Adequate hydration may shorten labor by 30 minutes
• People drinking without the use of an IV or people drinking freely and receiving an IV delivering fluids at less than 250mL/hr may need to be encouraged to drink more to stay hydrated
• People not allowed to drink freely and who receive IV fluids at 125 mL/hr are at increased risk of a longer labor (by 1.5 hours) and cesarean
• More research is needed to see if it's possible for a person to drink enough by mouth to achieve the shorter labor and reduced cesarean rates as those receiving 250 mL/hr of IV fluids
• Despite possible benefits from high volumes of IV fluids, evidence is beginning to show that the practice can lead to an artificial drop in baby's weight and painful breast swelling, both of which can negatively impact breastfeeding

What are key takeaways helpful to know as you approach your due date?

• Hydration in labor is very important
• A routine IV, unless used due to complications or with medications, may not be necessary and can restrict movement and cause breastfeeding issues
• Hospital policies that restrict fluids by mouth are not evidence based and not in line with professional guidelines from ACOG or ASA
• Encouragement to drink frequently to stay hydrated is helpful for those who are not receiving an IV or who are receiving an IV of fluids less than 250 mL/hr
• A saline lock, which provides access for an IV if it is needed, is one way to compromise in a hospital setting

I encourage you to read through the complete research review at Evidence Based Birth, which also includes real life stories from women who have both received IVs during labor and birth, and those who have not.

As with most preferences and concerns about labor and birth, it's essential to have frequent discussions and an open dialogue with your chosen care provider. Find out -- before arriving at the hospital -- what their policy and preferences are for IV fluids and hydration. Do they align with professional guidelines? Do they align with your preferences? Visit your chosen birth place -- hospital or birth center -- and learn about their routines and policies. Are they evidence based?

Taking a childbirth class during pregnancy is a great way to learn effective communication strategies for communicating with your care provider and support staff during labor and birth, as well as learning ways to find comfort and keep labor progressing, including staying hydrated.

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