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IV glucose vs liberal oral intake

Posted Dec 29 2009 8:50am

We've changed the care practice at work (for now, just with one MD group) to start a continuous piggyback of D5LR fluids in addition to the regular IV fluids (LR) to all laboring women that are not diabetic.

We are still utilizing plain LR for boluses for pre-epidural fluid loading and for intrauterine resuscitation (when the fetus is in distress). D5LR will not be used as a bolus at any time.

Why D5LR? Because women are exhausted after long labors, and it has been decided that we need to give them IV glucose (D5LR) to maintain a regular glucose (energy) level during labor. There was a study linked to the policy/guideline change, but I do not have it readily at hand to share with you. Will post it in the near future though, after I have a chance to read it.

I question this new care practice. What about "allowing" women open access to fluids and light snacks during labor? What she is craving/having the urge to eat or drink will usually help dictate what her body really needs to fuel itself during labor. I recall eating ice cream in early labor, and craving protein: it was what my body needed at that moment in labor. Once I hit active labor, I didn't want anything more than little ice chips. Then again, I had rather short active labor phases. I simply didn't require very much in the way of glucose intake during active labor. I had stored it up in the early labor phase, where I ate and drank whatever my body craved.

Even though we (nurses) are caring for women ("patients") in a hospital birthing unit, we are forgetting how to truly care for laboring women. We are continuing to medicalize what is a rather normal, instinctively driven process. Why must we feel the need to continually interfere with a process that works well on its own?

I absolutely agree and feel that when we do need to intervene, we should intervene appropriately. However, utilizing D5LR in a normal labor is not an appropriate intervention. We need to get back to our natural roots: less intervention!

Seeing more interventions to a natural process has definitely opened my eyes (even more!) to why I am becoming a nurse-midwife.
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