Risky Water?

I recently read this article: Drinking Water During Labor Carries Risks. It talked about how that women who consume too much water during labor may set themselves up for too little sodium in their blood, which can cause complications in labor. Specifically, it said that women who had hyponatremia [hyponatraemia in non-American English] were at increased risk for prolonged pushing, instrumental delivery (forceps or vacuum), or Cesarean section for “failure to progress.” Here are the other things I read, at the BJOG and Wiley Interscience (sometimes the links to the latter website fail — will give a “cookie error”; but you can just click at the link on the bottom of the BJOG if this link doesn’t work). Unfortunately, they’re just abstracts, not the full text which you have to pay for.

Immediately, I had several questions and concerns that came to my mind — which may be answered in the full text, although I don’t have it. All of the information I have came from these articles, so if you haven’t read them yet, you’ll probably want to click over and read them then come back. If anyone has information to offer, I’m always glad to learn — some of these questions below may be based on an incorrect assumption, so I’d be especially glad to be set straight in my own mind on those points. Still, here they are, in no particular order:

  • There were 287 women in the study, 61 of whom consumed 2.5 liters or more of water; 16 of those were found to have hyponatremia when their blood samples were taken after birth.
  • Although these 16 women were found to have hyponatremia, which is a “potentially dangerous condition,” it does not say whether any of these women actually had any problems directly associated with hyponatremia that the article mentioned in the direst tones as being possible complications: nausea, vomiting, headaches, even brain swelling and coma if left unchecked. So, while women may want to avoid a water overload in labor to reduce their risk of C-section or instrumental delivery, I wonder if these other “dire warnings” are really necessary against drinking too much water during labor.
  • Did these women who were “allowed” fluids drink whenever they wanted, or were they encouraged to drink more than they wanted?
  • how long were their labors, and did it make a difference in how thirsty they were and/or how much water they drank? (Two liters of water in 24 hours is not a large amount, but that much water in 4 hours is.)
  • It said in the abstract that 2/3 of the water was orally ingested — was that even over all the women, or only those women who took in a total of 2.5 liters or more?
  • Did these women drink only water, or were other beverages allowed and included in the “water” category — tea, juice, soda, milk, broth, etc.?
  • Although this study seems to be concluding that it is oral intake that is or can be the problem, if women drink enough during labor, is it not then double-loading the body to also have an IV solution of glucose-water steadily dripping into the body that the woman cannot control?
  • Sugar makes me thirsty — is it possible that these women who drank too much water were unconsciously trying to counterbalance the effect of too much glucose in their systems (courtesy of the IV)? — perhaps they were diabetic or had subclinical or prediabetic symptoms, and an excess of sugar caused too much thirst?
  • In her discussion on the “pros and cons” of routine IV, Henci Goer in The Thinking Woman’s Guide to a Better Birth (p. 79-81) says, “Glucose-containing IV fluids, also called ‘dextrose’ IVs can raise maternal and fetal blood glucose levels to diabetic levels.” Then she branches off on a discussion of other primarily fetal/neonatal problems or concerns with this; then says, “Although this can happen with any type of IV, glucose infusions, because they typically lack salts (electrolytes), greatly increase the probabilty and danger of fluid overload.”
  • If 1/3 of 2.5 liters of water was ingested non-orally, that is, by IV solution, that means that in addition to drinking copious amounts of water, they received almost a full liter in an IV bag.
  • The current “suggested recommended daily amount” of water is about 2 liters total per day (atlhough I usually drink more than that), so they received almost half their “daily quota” without a drop passing their lips.
  • The article noted that “hyponatremia” (too little salt in the blood — due ostensibly to drinking too much water, but not to receiving too much glucose-water solution in an IV) was associated with longer second stage, instrumental delivery, and C-section for FTP.
  • When a woman receives an epidural, she is likely to receive at least one bag (1 liter) of fluids prior to the administration of the epidural to try to keep her blood pressure from dropping, in addition to whatever other fluids she may or may not have ingested prior to that point — maybe it is this excess amount of water that leads many women into “necessary” C-sections after an epidural, rather than just the effects or side-effects of the epidural itself — and perhaps that may be one confounding factor not isolated and accounted for in studying the question “does an epidural make you more likely to have a C-section?” If women receive different amounts of fluid during labor, and some become hyponatremic and others do not, that may make some women more likely to end up having an otherwise unnecessary C-section while other women breeze through labor without a hitch.

Regardless of these questions — which the full study may or may not answer — I think we can expect more efforts by the medical community to continue to limit the amount of liquids a woman can ingest, while keeping their precious IV lines open at all times. This study may be absolutely correct that too much fluid intake during labor can cause a difficult second stage. If so, we need to know this, and let others know that this may be a reason for them to avoid an early IV, or yet one more reason to stay out of the hospital. We can also suggest to them that they need to keep a balanced intake in labor as in other times — don’t overload on plain water, and certainly not on sugary beverages, and make sure to get plenty of salt (whether in the form of broth or other foods) if they drink a lot of non-salty fluid; as well as making sure that they know that a glucose IV solution might possibly be problematic. They should also know that if they’re not thirsty, they shouldn’t drink, or only in sips rather than in gulps. It’s not rocket science to me — leave the women alone and let them do as their bodies dictate, and they will likely do the right thing; but when you throw in the power imbalance of the people in the white coats telling them what they can and cannot or should and should not do, and then flood their bodies with IV solutions that the women cannot control, then “listening to their bodies” may not be enough at that point.

3 Responses

  1. Kathy,

    I’m trying to find women who are pregnant or had a baby and were considered high risk because of rh sensitivity (failed rhogam shot from first birth) I am 29 weeks pregnant and my midwives had to hand me over to high risk only obstetric dept at another hospital early in my pregnancy because they aren’t equipped to handle this situation. My first birth was vaginal and without intervention. The doctors have told me that they may induce as early as 37 weeks.
    I am desperate to hear from other women who have had pregnancies like mine and can’t find them..
    Thank you.

  2. Dear Julie,
    I had an inexplicable sensitization in my 2nd trimester of my first pregnancy. My son was born at 35 wks after spontaneous rupture with a bili of 11 (his only complication) and in the NICU under the lights for 2 weeks. It was quite a roller coaster watching the bili numbers climb, then drop with treatment (lights & IVIG in his case) and climb again.

    In my second pregnancy we had RH+ identical twins (very rare to do this plus be sensitized). They were born just shy of 30 wks, and also struggled with antibody-related anemia in addition to prematurity issues. They had courses of IVIG and each had 3-4 transfusions (not an exchange transfusion, which is a choice you may have at some point) in addition to the lights.

    I think that after 36 weeks or so, they have a hard time guaging the anemic affect on the doppler, which is why they don’t let the babies gestate much longer than that. I think there is a point where they are safer outside than in. I would willingly go with your perinatologist’s advice to induce for your baby’s well-being based on my experience.

    Best wishes to you and your little one.
    – Nikki

  3. Hi Julie,

    I’ve been thinking more about you and your concerns about induction. I can see that you really wanted as natural a birth experience as possible. I’m not a medical professional or midwife or anything related; just a mom who has been there. But I think you still have birth choices you can make.

    It sounds like your perinatal team is who you’re going to for all your prenatal care right now. This doesn’t have to be an all-or-nothing deal, I don’t think. You could use an OB/GYN practice (even one with midwives) as your primary and the perinatal group as the “expert consultant.” You’ll have more appointments that way, but have people on your side that don’t just look at you as a high risk patient, and can help you make choices during your induction to get the best possible experience for you.

    Also, if you don’t go that way and have the perinatologists as your birth practitioners, you could still consider having a doula. If that’s the way you want to go, start talking to your doctors about that..

    As far as the birth process itself with RH sensitization, there’s not a particular rush or high risk to you or the baby during labor (a day or two would not be such a big deal). But the longer you and your baby are joined, the more your immune system can be stimulated to produce increasing amounts of antibodies, which really wreak havoc in your baby.

    These antibodies do not just die off quickly after birth. It takes 2-3 weeks for them to decrease their potency, and all that time they are breaking down your baby’s blood, making it harder for your child’s system to get itself up and running after birth (i.e. reticulocyte production).

    If you haven’t already, I recommend getting familiar with the issues of rhesus disease, hyperbilirubinemia, the AAP chart for treatment over the first week or two of life, etc. Also start preparing yourself for a NICU stay. If you’re working with the perinatal group at the hospital, ask to meet the neonatal doctor(s) too.

    I hope this helps. You’re one of the lucky (!) few who get the rug pulled out of your plans. It will be ok. We are fortunate to live at this point in history when there is medical knowlege to save our children.

    I gave Kathy my email address to you can email me directly if you want. Please don’t hesitate.

    -Nikki

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