To refuse an IV?

[Teaandflapjacks]

Is it possible to refuse this do you think - and if so would that be daft of me? I have recently come out of hospital after going into early stage labour too soon with a short cervix - which has now calmed down and nearly at 36 weeks so not an issue now - and they put the thing in my hand 'just in case' and took some blood from it, but no fluids or meds went in it as i was able to swallow tablets. When they put it in I didn't think to question it. It was agony, could not sleep the whole night from it there and begged them the next day to take it out, which they did after the consultant said it was OK after me begging him. Then my whole wrist and half my hand slowly turned blue and black, plus the vein in my elbow fold went dark black - so I am sure it wasn't put in right. Now I am terrified of the ruddy things (and I have a high pain thresh hold normally...!).

I've replied (at length, sorry about that!) on your other thread, hope it settles your fears a little.

I've had a few in over the years and it sounds like you we're unlucky. It's not nice when they put it in, but usually it's fine once it's there.

Hopefully, next time will be better for you!

If you think your hand hurt, wait until you try childbirth!

Seriously, stop whining about it - of all the things you want to complain about - medical aid is top of your list? If there's an emergency you'll be fucking glad it's there and ready to go.

Why don't you also add to your list "no vaginal pain pls lol!".

that's helpful, Cheesecake

Thanks ladies for feedback (and izchaz again).

'DayOld* the lower half of my right hand was dark black and blue, my wrist too - I could hardly move it for a week - how is that practical with a newborn was my first thought - with feeding her, changing her etc - I couldn't lift anything with it properly for over a week and dropped loads of stuff when I did. I am quite right to be concerned about that and to question if that is normal, what is it really used for and what should I do for the next time - hence me asking am I daft to say no, and what is it required for - which other posters have kindly helped me understand. Vis a vis childbirth - I really couldn't care less about the pain, I just want her safely into the world - after numerous scares during the pregnancy, and a MC last year - end of. Hence my worries about the canula and my hand afterwards.

To the other ladies - thanks again!!

If there is no clinical indication for you to have an IV then I wouldn't say it's unreasonable to refuse one.

If you need one then you need one.

I had a massive unexpected post partum haemorrhage after my baby was born. luckily I had a cannula in so immediately got blood and fluids don't know what would have happened if I'd not already had it as I was losing blood faster than they were replacing. I'd rather have the inconvenience of the iv than risk stressed doctors trying to find a shutting down vein and getting fluids up in an emergency.

For most births (in my health care trust, could differ elsewhere) you won't be offered one anyway Teaandflapjacks, so that is good news :-)

If you are then no harm in asking what it is for and if you need it now.

And no, they really shouldn't have the effect that yours did! (You can also ask for someone with a LOT of experience/at the start of their shift so they are really awake do put yours in if you do decide to have one - explain what happened last time if they want to know why!)

Remember the BRAIN acronym to help you decide at the tie with your health care professional...
Benefits - What are the benefits of this procedure? How will this help me/my baby/my labour?
Risks - What are the risks of this procedure? How might this negatively affect me/baby/labour?
Alternatives - Are there alternatives to this procedure? Are there other options?
Intuition - What is my gut feeling about this?
Need Time, or Nothing - Can I delay this procedure and take some time to think about it/Discuss it with my partner? What will happen if I choose to do nothing for now?

You have my sympathy on this as despite being ok with injections and self injecting I too have a problem with these to the extent that I find it difficult even when they are in other people. As I've done four rounds of ivf I've had to control my feelings. I've tried (d

I've tried (don't laugh) visualising my body as flexible and capable. I also had a good chat with a sympathetic anaesthetist who offered a choice of locations and reassurance. I also covered my arm with a sheet. I also think that when you are in the thick of it as it were you will be distracted too. To be fair I think you've had a bad experience and next time will be better. I am in for induction next Wednesday and am practising vidualing my baby as well as being stoic!

Both my hands were battered and bruised by an incompetent midwife screwing up the drip so I understand your concerns. In the end though it made no difference cuddling and caring for my baby (but a good reason to not do other tasks!)
Rather than refuse the IV can you discuss before the throes of labour that you have difficulty giving blood and can they get their most experienced member of staff on shift to put in your IV. In the end the supervisor took over and you could barely see where she did the entry point.
If I need to give a blood sample I know I have difficult to find veins so I prewarn the nurse and always refuse a student. The only reason this didn't happen was that I'd been having contractions for over 2 days and wad not quite with it when the decision was made to put the drip in - so thinking ahead as you are is not a bad thing...

Thanks ladies - and lozster thats a great tip! TBH I was more thinking (please do excuse my total ignorance) that they could quickly put it in if it was suddenly required, since all they did was take blood from it, which would have been better done in the usual elbow fold for me - but actually now rationally thinking it through that is an extra step in an emergency that would be better to do without. I guess I was just really anxious about it, thinking is the awful after bruising normal, and also is such pain coming from it right when it is in- how will that affect me in labour? will that create more stress in my body - hence more stress for the baby - hence more intervention/risk IYSWIM, and after a lot of issues throughout with bleeding, then short cervix and so on, I got a bit stressed about it - I just thought 'tackle this head on - mners will have the right advice!'. Because I think - the more relaxed (as poss!) you are about the birth, the better all round.

Hi Teaandflapjacks, it's not just an extra step in an emergency. A sudden haemorrhage during labour can cause you to go into rapid hypovolaemic shock. This causes the blood vessels in your arms and legs to shut down, so that the blood is routed to the heart, lungs and brain.

Once a person is losing a lot of blood, which can happen easily in labour because the placenta is basically a bag of blood vessels which plugs into the uterine wall and can detach accidentally, the amount of time to get a cannula sited is minimal.

If the medical team can't site a cannula through your skin as normal, they will have to use a cut-down set to reveal the vein and then cannulate.

The questions you may like to ask are:

Why do they want you to have a cannula?
What monitoring would they be doing?
What do they consider your risk of haemorrhage to be?

Hmmmm, I think they like to have them in where there is a clinical indication it might be needed to save time in an emergency. I had one put in as they were worried about DD and weren't sure where they were heading with that. The midwives and obstetrician couldn't get it in (they struggle to take blood from me too) and called an anaesthetist to put it it in the end. There wouldn't have been time for that in an emergency.

That said your hand shouldn't have reacted like that. Perhaps you could make a note on your birth plan about the extent of the bruising and ask that someone very experienced put the cannula in were it required?

The anaesthetist was amazing at it. Didn't even feel it go in although I was in a lot of pain with my contractions by that point so perhaps it was just relative

I didn't know that lougle everyday is a school day and all that.

That said they did take a very long time to get mine in and had similar struggles with DD when she was in hospital so it would appear to me that it isn't always an easy procedure / you need a lot of practice to be good at it?

It isn't always easy, no. Veins aren't as nice and straight as the body diagrams you see. They wiggle and have kinks. If there is insufficient blood in the vein then the vein collapses, which makes it hard to get a tube (cannula) into it. Similarly, if the person is cold, the vessels shrink down further below the skin.

Unfortunately, that means that cannulas sometimes do cause damage. Sometimes a bit of blood leaks out of the vein once the needle is inserted, before the tube fills the space, causing bruising. Sometimes, the needle can go too far and pierce the back wall of the vein.

However, a working cannula can be the difference between life and death.

Thanks lougle everything you have posted is really interesting, helpful and makes a lot of sense - THANKS!!. Pasta - good idea - will just let the midwife know when I go to sign my hospital forms and DH will be on hand to supervise - he was a bit 'don't be ridiculous - it could save your life' when I worried about it, but then he is a man and my hormones are all over the shop - poor man!.

Of course, I will be having the cannula, I was just honestly rather ignorant about it - so it's been good to get some tips on the best way to get it in up front, and actually the last post on why they may not work well has also really helped. I guess with all of this the logical answer is there, but you just can't see it for yourself. TBH I have done exactly as told throughput the pg by the docs and medical staff here in Germany, but it's not my homeland, and I guess I just got a worried by the bruising factor and what it was all about - why would I need it, what for etc - which I get now - and it was a bit tricky to fully get this explained to me in german, partic when I was discharged I was just happy baby was safe and I was going home to DH. I have googled before coming on here to check - but there is so much conflicting info I stepped well back!

I'm glad it's helpful. Also, something to bear in mind is that a cannula placed routinely in a calm environment is much less likely to cause bruising than a cannula placed in an emergency, where the priority is to get it in and get fluids in before the vein collapses completely.

they tend to use larger cannulas when you're in labour than they do on the wards as you're at greater risk of a sudden massive haemorrhage which means they do irritate your veins a bit more. but obviously if you do have a massive blood loss bigger cannula mean they can get more blood in faster.
if you are really worried ask for an anaethetist to site the cannula and ask them to inject local anaesthetic into your arm first so it's numb while they're doing it....I know you mentioned you'd rather have it near your inner elbow part of the arm but from experience you really can't move your arm much if you do have one there ...as soon as your baby is born and you know your blood loss is ok get then to take it out

I think the key is to know why this is thought necessary and then you can decide if you agree with that. Personally I'm very anti additional medical stuff but if I was having another dc (which I'm not) I believe the local hospital would want to site a cannula. This is part of their policy for overweight mums as they seem obsessed in said policy with taking every overweight mum to theatre for a section. In my case I would be refusing the epidural which is also part of the same policy but I would take the cannula because I had a pph with dd3. I didn't need a transfusion but if I was labouring again I would want things in place to deal with that if it happened and was worse. That's a long winded way of saying 'get more information'

Also, to be fair, it can be much harder to site a cannula in an obese patient because the veins are less accessible. The harder it it's likely to be in an emergency, the more likely they are to want to insert one as a precaution.