As a post-partum and labor and delivery nurse, it was a normal part of my day to keep my patient’s IV fluids running through their labor. On my side of the bed, it was standard of practice to give moms 1-5 liters of fluid during their labor, due to being on bedrest, induced, treated for high blood pressure, or choosing an epidural. More fluids were required for moms who needed cesarean sections, or if their baby’s heart rate dropped. In short, many areas of normal birth circulated around giving IV fluids.
Some moms desired to drink water or juices by mouth and were allowed by their provider to drink during labor. Others were only allowed ice chips, per the protocol outlined at the facility where I worked in 2013. All of this was standard operating procedure; and I never thought twice about why or what the concerns of it could be. In your birth experience, did you receive fluids? Do you know how much?
Today, as I recertify for my IBCLC- International Board Certified Lactation Consultant license, I have been updating on the standards of practice in labor and delivery. All of that information plays a part in how baby-mom couplets will successfully breastfeed. In my studies, this IV fluid in labor scenario came up. It blew my mind – that something so consistently used in labor and birth could affect breastfeeding so dramatically. In reading through my course, I have learned that fluid a mom takes in via IV fluids may influence her baby’s weight loss. This will create a need for supplementing baby. And then supplementing a baby from the very earliest times will create a mom who feeds her baby less, and often a mom who makes less breastmilk because her baby is at the breast less. Does this resonate with how your breastfeeding experience went?
From the article: Evidence On: IV Fluids During Labor
However, they found greater weight loss in the infants born to the people who received >2,500 mLs of IV fluids. They also found a higher volume of IV fluids in the mothers of the infants who had lost >10% of their weight. This suggests that once a mother receives around 2,500 mLs or higher of IV fluids, newborn weight loss is affected (Watson et al. 2012).
This may mean that after receiving around 2-1/2 liters of IV fluid through a labor and birth, the baby may take on a portion of that weight. Their weight at birth and then 24 hours later may be a false representation of their actual weight. Providers supplement baby based on these weights – if the baby’s weight is more than it would be if the mother had not had as much IV fluid, then the baby is being supplemented based on skewed information.
This study is brand new from 2016. Changing policy in hospitals and birth centers to reflect less IV fluid in labor and birth won’t be easy – it will take many more long-term studies with lots of participants. Labor, birth and post-partum periods are very emotionally charged times in a family’s life, so getting participants to work with folks doing a study may be a challenge. I believe we will see more information coming out on excess IV fluid challenging early breastfeeding practices as it becomes more common information. Would you be willing to ask your provider about the true need for supplementing your baby if the need for supplementing came up?
In my practice, if I see a baby weighing less than 10% of birth weight at 24 to 48 hours, I will ask about how much IV fluid had been used during birth. My scope of practice is to support the baby-mother couplet in their desire to breastfeed. If I have thoughts to share with the provider about the weight variation in a baby, I would discuss my findings as well as more information for the provider to make the best decision for the baby. Ultimately, it is a baby-mom couplet that can choose for themselves what they feel is the best for them both with the knowledge they are given.
I look forward to more information on IV fluids affecting breastfeeding practices in the future. My hope is that this new information can help expecting parents make informed choices during labor regarding IV fluids, or can help parents reflect on their post-partum experience if their breastfeeding goals weren’t met.
Jeri Pleticha, RN, IBCLC has been a childbirth educator in the Seattle area for 14.5 years. She’s was a doula ,as well as a labor, delivery and post-partum RN at a prestigious hospital. This hospital was the first breastfeeding friendly hospital in the USA, with the Mother-Friendly Childbirth Coalition. She became a lactation consultant there and currently lives north of Seattle, but hopes to make the Inland Northwest her home soon.
- ImprovingBirth Coalition – Home, http://www.motherfriendly.org/
- Scott, Joanne W. “Code of Ethics for International Board Certified Lactation Consultants.” Journal of Human Lactation, vol. 12, no. 4, 1996, pp. 344–345., doi:10.1177/089033449601200449.
- Dekker, R. (2017, August 30). Evidence on: IV Fluids During Labor. Retrieved September 01, 2017, from https://evidencebasedbirth.com/iv-fluids-during-labor/