IV During Labor – Do you NEED IV fluids in labor and delivery?

It is a standard practice in most US Hospitals to order an intravenous line (mostly referred to as an IV — pronounced eye-vee) for a laboring woman. However, is this an entirely safe practice? Why do you need an IV in labor and what will it do to help your body during such an important time. What are the pro’s and con’s of having an IV (and is there a safer alternative)?

First off — who am I, and why do I know this? Hi, I’m Hilary — The Pregnancy Nurse 👩‍⚕️. I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind Pulling Curls and The Online Prenatal Class for Couples. 🩺​ I’m excited to give you some tips on if an IV needs to be on your birth plan.

Why do they give you an IV during labor?

Essentially an IV gives us a port into your veins should we need one. This can be used in variety of ways. Some may be an emergency, and some are just routine in labor per your unit’s standards of care.

Things you need an IV in for during labor:

• IV antibiotics — most often given for positive GBS, and oral antibiotics aren’t effective removing that danger for your baby
• Induction — most often a medication called pitocin is given, and for an induction it is run through an IV
• Epidural — In order to have an epidural block placed, the anesthesiologist will require an IV line (sometimes you get low blood pressure that we need to use fluids & medications for).
• Pain Management – Beyond the epidural you may want IV pain relief
• Other medications. There are other medications, like magnesium sulfate (given for preeclampsia) even medicine to STOP contractions, or vomiting that an IV is very helpful for.
• Baby — If Baby’s heart rate goes down for some reason during labor, it is a good idea to have an IV in place to help give you fluids or possible other treatments.
• Prevent Dehydration — while most people can freely drink (and sometimes eat) while in labor, some aren’t able to take in enough fluids and an IV can help support that. Dehydration can slow down labor or prevent vaginal birth. Usually they give about 125 ml/hour of IV fluids during labor.
• Cesarean Section — any patient having major surgery will need an IV for medications and replace fluid lost. No matter if you’re having a spinal block placed or general anesthesia. A routine IV can come in handy should there be an emergency cesarean birth.

Pro Tip: You may have specific risk factors that may give you a good reason for an IV — so be sure to talk to your healthcare provider about that.

Things you need an IV in for AFTER you give birth:

• Replace fluids from blood lost
• Pitocin infusion to help your uterus cramp down and not bleed
• Blood administration (not done frequently but it happens)
• IV antibiotics — or other IV medications
• Pain medicine most often used with a Cesarean

Most people don’t know this, but the IV is MORE necessary after you have a baby. At least HAVING a line. You are at a high risk of hemorrhage during those first few hours after the baby is born. The IV gives us access to give you fluids, medication to help you uterus clamp back down or other needs.

I know a lot of people are more afraid of the IV (and possibly also the epidural) more than actually giving birth. That’s why I always recommend taking this so I can make it much more simple and less scary!

Routine Placement of IV during Labor

Most hospitals have this as just a routine of care. Most of the places I have worked, the IV is placed soon after admission by your healthcare provider, and we also try to get lab work at the same time so you only have to be poked twice.

That being said, patients can have a say in IV placement. Just because hospitals have a routine use of IV’s, doesn’t mean you have to. Obviously, the items mentioned above have to have an IV placed, but if you aren’t having any of those things (you plan to labor without an induction or medical pain management) you can likely refuse the IV.

The American College of Obstetricians and Gynecologists (ACOG) does recommend possibly limiting IV fluids and encouraging oral hydration (drinking)

I talked about this in my routine things you might want to refuse podcast with Dr Fran:

And, if you like podcasts, I also have one on labor supplies.

Can I refuse an IV During Labor?

Yes, you can always refuse anything during labor. But, keep in mind that none of the things that require an IV will be able to be done.

Women who hope for a low-risk natural birth with no pain medications or Pitocin CAN have a labor without an IV.

You also run the risk of having a postpartum hemorrhage that we waste time placing the IV (and once you start to bleed out, placement of the IV is a lot harder).

Just make sure you understand the risks and the benefits of having an IV in labor.

Also, keep in mind if you refuse it in early labor, you CAN get it as you have more labor progress. You can make an informed decision at any point.

So, I want to address some of the pro’s and con’s of IV in labor:

Pro’s and Con’s of an IV During Labor

Pro’s of an IV in Labor

The main one is quick access to your veins. Labor and delivery patients can lose blood faster than most traumas brought into the OR because of the huge amount of blood supply to the uterus during and after labor.

Providers want that placed just to mitigate that risk, so we are able to run fluids or blood replacement quickly should the need arise.

Of course, the other pro’s are the things mentioned above. Pain medications, inductions, medications. Those are all big pro’s of an IV.

Con’s of an IV in Labor

Some people feel like it is more “medical” as you are chained to fluids in your bed. You feel more helpless and less empowered.

As with any time skin is broken there is a chance of infection, or blood clots with an IV (although very rare and hopefully your IV won’t be in long enough to be super problematic).

There is pain with the IV placement, and a lot of people have anxiety about needles that can be difficult to overcome.

Frankly, it’s just super annoying. It makes it harder to hold your baby sometimes, and it often aches if we run fluids quickly. Every time I get an IV I am reminded how annoying they are.

Pro Tip: If you are nervous about the IV work on meditation and relaxing techniques to try and calm yourself during stressful times. We do some breathing exercises in my prenatal class.

Grab my positive pregnancy affirmations right here:

Does the IV hurt during labor?

In a word, yes. I definitely never tell patients it won’t hurt.

A few things that make it “hurt” less:

• The needle is always removed from an IV (at least in labor), so just a flexible tube is left in your arm
• Labor RN’s are pretty great at putting in IV’s and we try to be as mindful as we can about placement and what will be less annoying for you during the process

Often the IV will be pretty annoying initially. Often we run fluids through you quickly to rehydrate you, or prepare for an epidural. This makes your vein a little unhappy, however once those things are done — we slow it down and it gets better.

Pro Tip: One of the most important things you can do is to keep moving your hand when the IV is in so that it helps fluids keep moving through your body. Often, patients keep their hands stiff which doesn’t help. However, different positions may allow your IV to infuse better than other positions.

Pro Tip #2: If your IV is really hurting, be sure to tell your nurse. This doesn’t assure that we can move it, but we should keep an eye on it to make sure it’s not problematic.

Many people wonder about a local anesthetic for the IV placement, however it is not used frequently. If it is something you’d like talk with your provider ahead of time. However, some people find the local to be more painful than the actual IV stick (and it can hurt the nurse’s attempt at the IV placement).

It really is tips like this that make the IV less painful and easier to tolerate. I have tips like this about LOTS of things in here.

Labs Taken During Labor

Most providers order labs upon admission to the hospital. These labs most often include:

• CBC
• Blood Type (in case you need blood)
• RPR (to check for Syphilis at delivery)

There may be other labs (like those to check for preeclampsia) that your healthcare provider might order based on your individual circumstances and needs.

Ok, let’s talk about the actual placement of the IV:

IV Placement During Labor

The IV placement in labor is similar to anywhere else in the hospital.

1. The medical staff (most often a registered nurse) will look at the veins in both arms and hands to determine a good spot (feel free to give input, but most often it is best to let the provider pick what feels best for them). This may also include them tapping your arms and feeling the veins quite a bit — all of that is normal.
2. They will clean the spot
3. They will insert the needle into your arm trying to insert it into your vein
4. They will get a “flashback” of blood when they are in the right spot. Until that flash comes they may have to move and adjust the needle — which they are aware is painful, but it is often necessary
5. Once they are in the vein, the needle is removed, leaving just a flexible thin tube in your arm.
6. Then they might take labs if required
7. Then they hook up fluids to the IV (or flush it with fluids if you are going to have a saline lock — more about that below)
8. They will place a plastic transparent dressing over the IV (so they can make sure the site of the IV is staying healthy).
9. They will apply a lot of tape to make sure that the IV doesn’t move as you move around during labor
10. They remove all the trash and equipment from your bed.

Note: In L&D the nurses try to get the largest IV catheter in as they can. That way they can quickly run fluids and blood if necessary. Most often they try for an 18 gauge.

While your nurse will try to place it in the most comfortable position that they can. If the place they put it is really bothering you, ask your provider about it.

IV placement can be extremely easy on some patients, and extremely difficult in others. It is a skill a nurse takes a lot of time perfecting, but it is a SKILL.

I also have a very helpful Youtube Video where I go into this more.

Sometimes PARTNERS have a worse time with the patient, so make sure to get your partner prepared too:

Saline Lock vs IV During Labor

A saline lock (some people still call these heparin locks, but don’t use heplocks anymore) is just the plastic tubing going into your arm. It hangs out there until we need it, fluids are not hooked up to it.

This gives you the benefit of us having access to your vascular system without you having to be hooked up to the IV.

It’s a nice, happy medium and I am always happy when patients who can choose this method. If you don’t have any of the things you need an infusing IV for — this is a great option.

Most often, we hook up the saline lock to pitocin after delivery of the baby to help reduce blood loss, but that is up to you as well (the pitocin could also be given as a shot as well).

Also, as the birth process progresses, a saline lock allows us to hook it up at any time. Most pregnant women really don’t need infusing fluids during the first stage of labor anyway. Many refuse it until their bag of waters breaks.

What is the IV Drip Given During Labor?

Most often hospitals use an infusion of Lactated Ringers.

While this isn’t actually water (aka, just H20), it is basically water. Actual water would hurt a lot because it is not the same osmolality as your blood and tissues, so minerals are added to make it stable for you.

Sometimes they run a 0.9% normal saline drip or sometimes they run a dextrose drip if they feel like you need some sugar.

Do you love information like this from “the nurses’s station”? Join me in here to make birth SO much less scary!

How long does the IV stay in for labor?

It depends on your hospital’s policy. Most places use the IV to run Pitocin for a couple of hours after baby is born and then they may remove it or possibly saline lock it to continue to have access.

Of course, the IV is still up to you. If, at any point, you’d like it removed talk with your healthcare team so they can make sure you understand the risks and benefits and help take it out if you prefer.

What does an IV do during pregnancy?

Some people get an IV during their pregnancy. Most often it is due to severe “morning sickness” in which they’re just becoming too dehydrated.

However, with an intense illness, or a stomach flu or food poisoning the baby just takes SO much fluids you can feel SO much better after a couple of liters of IV fluids. I am a big fan of them. I had 2 bags of IV fluids with my second baby and it was a life saver, I couldn’t believe how much better I felt afterwards.

IV Fluids & Breastfeeding

Studies are showing that a large amount of fluids given during labor can cause edema in the breasts which can make them painful (decreasing your likelihood to breastfeed). It can also make the baby a bit more full of fluid, which will enhance their weight loss after birth (even though it’s not an actual problem, they’re just getting rid of the excess fluids).

I think they are trying to mitigate IV fluid use during labor more. Often fluids are run quickly during labor as our patients are young and we want to make sure they are hydrated for any potential blood loss.

Having a saline lock (as I mentioned above) and decreasing your interventions that might need extra fluids (as well as keeping up with drinking water during labor) is a good way to mitigate this risk.

Pro Tip: Take a breastfeeding class before your delivery — this class has one included!

IV During Labor FAQ’s

Conclusion: Do I need an IV during Labor?

Ultimately, the decision to have an IV during labor is up to you. I would encourage you to talk with your provider about it as you head towards your due date.

Personally, I would advocate for you to at least get a saline lock. That is because I have seen blood literally pouring out of patients and I was grateful that placing an IV wasn’t on my plate at that time. Your care providers will have a lot of relief with an indwelling IV as it puts less pressure on us during an emergency.

For most of us IV’s aren’t that hard when we place it during your calm admission, but I can’t tell you how scary it is to put in an IV as blood is pouring out of someone and their veins are collapsing. This is why nurses just much prefer to have the IV in.

I also appreciate how having a saline lock can mitigate some provider’s issues with giving too much fluid (often without really meaning to) — which can make you and the baby a bit swollen after birth.

While you can predict postpartum hemorrhages frequently (things like having multiple children, or being in labor for a long time or inductions), sometimes they happen out of the blue and everyone in the room feels safer knowing we have IV access.

This all being said — I also want to support you in the birth experience you want.

If you liked this post and would like to know more about the entire labor process I’d encourage you to join me in my Online Prenatal Class for Couples. We go from bump to bassinette to help you have a confident collaborative hospital birth. It fits your budget, and can be done in just a few hours check it out!

And, if you’re not quite sure you’re ready for that whole thing, check out my free prenatal class. It’s your first step toward getting in the driver’s seat of your birth.