Professor Steer, BJOG editor in chief recommends …”doctors and midwives monitor how much water women drink during labor.” (Drinking Water During Labor Carries Risk)
Either the author of the above article or Professor Steer overlooked a couple of important nuances from Dr Vibeke Moen at the Sweden’s Karolinska Institute where the study he references was conducted. He states hyponatraemia, an imbalance of electrolytes, is not uncommon following labor. Not during labor, following labor. That means something occurred during labor whose resultant effects are found in the immediate postpartum.
Let’s not allow the medical folks to obfuscate the hydration in labor issue. Some real scenarios involving extreme labor:
“Scientific studies have looked at the best ways or most appropriate ways of replenishing the body with fluids under the extreme of conditions of heat and dehydration (Castellani et al, 1997, Marish et al, 2001, Kenefick et al, 2000). Castellani et al (1997) investigated athletes who were not acclimatised to temperatures of above 35oC, and submitted them to 2 bouts of exercise, which would be similar to that of a footballer in the midfield. In between they were rehydrated only once with either IV, oral ingestion or no fluid replacement after being dehydrated by 4% of body weight. It was found that there was no difference in performance between those that were rehydrated orally or by IV. They also found that oral and IV were equally effective as rehydration treatments. There was no difference between the treatments in regards to the way in which the bodies handled body temperature and fluid losses.
Marish et al (2001) found that oral hydration rather than IV rehydration resulted in athletes reporting less thirsty, feeling cooler and not as physically tired. Kenefick et al (2000), also found no added benefit of rehydrating the body using IV as opposed to oral hydration in mildly dehydrated individuals (persons had lost 4.5% of body weight as fluid loss) prior to competition. This group investigated the ability of the body to maintain body temperature and handle fluid losses. Casa et al (2000) found similar results to Castellani et al (1997), however also showed that the body and skin temperature was lower in those that orally rehydrated themselves as opposed to the use of IV.
In summary, all the studies reviewed showed no added benefit of using IV rehydration methods, as opposed to oral hydration in mildly dehydrated individuals before and during a match. There was no benefit in regards to sporting performance, body temperature and fluid control. In fact the benefits of oral hydration included persons feeling not as thirst [sic] and more comfortable in regards to feeling less exercise and heat stress (feeling tired and hot). Oral hydration if consumed in the required amounts is adequate to meet the needs of all footballers. IV rehydration should only be used under medical supervision and advice at times of severe dehydration, heat and exercise stress.” ~ Jeanette Fiedling, BSc, MHN; Oral vs. Intravenous (IV) Hydration
We admit a labor cannot be determined from the onset that it is going to last a specific amount of time, have a specific intensity, etc. is unlike a football match (American or otherwise) having set periods and a clock that winds down (or up). Well, scratch that last comparison on the clock. Another nuance here, dehydration is caused when the rate of fluid loss is greater than its intake of fluid. Too much fluid intake can also cause the same symptoms of dehydration because either situation causes an imbalance of electrolytes, minerals as well as causing a change in body temperature.
As medical practitioners it is vital that they be well trained to know the clinical definition of dehydration. As someone licensed to enact medical procedures upon our bodies it is vital to the consumer that the practitioner be attentive and act only when necessary. It is very easy to alleviate mild dehydration, drink water. Obstetricians are making a really huge leap here equating dehydration with hyponatraemia and it’s no surprise that they are doing so.
“One problem would seem to be that some clinicians experience difficulties in investigating the causes of hyponatraemia. It is here where the clinical biochemistry laboratory and chemical pathologist can play an important role in facilitating optimal patient care. Interestingly, Saeed and colleagues showed that rarely did patients with severe hyponatraemia have their urine osmolality or sodium checked.1 In such cases, it is difficult to see how the cause of the hyponatraemia could be clearly established. This of course is of fundamental importance, because the management of hyponatraemia should differ according to its aetiology.2–4 ” ~ The Investigation and Management of Hyponatraemia; Journal of Clinical Pathology
Here’s another nuance from the study Professor Steer:
”Women should not be encouraged to drink excessively during labour. Oral fluids, when permitted, should be recorded, and intravenous administration of hypotonic fluids should be avoided. When abundant drinking is unrecognised or intravenous fluid administration liberal, life-threatening hyponatraemia may develop. The possibility that hyponatraemia may influence uterine contractility merits further investigation.” (emphasis by Independent Childbirth)
Why the brouhaha over IVs in labor, really, docs? Is it really that critical to you to win the argument over whether or not a woman consents to an IV? Serious psychological turf issues here. Think about it, what are the two first protocols a woman will need to make a decision about when arriving at the hospital in labor? The vaginal exam and the IV.
Consenting to both, declining both or consenting to one and not the other, each scenario is the beginning of a scoreboard. If she is allowed to ‘get her way’ from the start, all the other items an individual practitioner will decide are important may face a “no” from mom, too. The latex gloves are off.
“At one time, a myth became prevalent that drinking lots of water each day was a healthy habit.” ~ Professor Philip Steer
I had no idea that the belief in drinking lots of water each day is healthy is actually a myth. How much is “lots?” There are ounces, liters, but lots? Okay, but when you have an IV in place Professor Steer, how can you tell if you really are thirsty? You go on to cloud the issue for your colleagues,
“However, recent research shows clearly that in general, one can trust one’s natural body messages, and that we only need to drink more when we feel thirsty.”
According to you, are we laboring women capable of taking care of ourselves by laboring naturally and spontaneously so as to recognize thirst all by ourselves or aren’t we?
A word of wisdom for birth practitioners, the same one for mothers: don’t say no to everything. Say no only when you mean no. That way when it’s really important the “no” will truly stand for something and capture our attention.