Article
The intrapartum intravenous vein catheter in low-risk births from the perspective of the midwife – Is the intravenous vein catheter a part of a normal birth?
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Authors
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Luise Lengler
- Hannover Medical School, Hannover, Germany
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Mechthild M. Groß
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
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Stefanie Ernst
- Institute of Biometry, Hannover Medical School, Hannover, Germany
| Published: | February 18, 2014 |
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Outline
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Background: A key guiding principle of midwifery care of normal birth is non-intervention (DGHWi 2012). In Germany, childbearing women experience a high rate of interventions that affect maternal and child morbidity during care in clinical practice. These include the routine use of an intravenous vein catheter in low-risk births.
Research question: What experiences do midwives have regarding the use of intravenous vein catheters during childbirth in low-risk births?
Methods: In a prospective study on midwives’ attitudes regarding oxytocin augmentation, data were collected regarding the use of intravenous vein catheters during childbirth by means of a questionnaire. In a pilot study the self-constructed questionnaire was tested for comprehensibility and applicability. After revision of the questionnaire, a multicentre survey was conducted in Baden-Wuerttemberg, Germany. Descriptive statistics as well as bivariate and multiple logistic regressions were used to identify predictors of midwives’ attitudes regarding the use of oxytocin sub partu.
Results: 223 midwives employed in 27 hospitals participated in the study. A birth without the use of an intravenous vein catheter was rarely, or never, experienced by about 60% (n=128) of the participating midwives. A large proportion (77.8%, n=172) of the study participants advocated for the omission of the use of an intravenous vein catheter during the normal birth process. However, 58.3% (n=130) of the study participants reported that an intravenous vein catheter was placed upon admission of a woman in labour. If an intravenous vein catheter was placed during labour, it was inserted by a midwife in 57.8% (n=129) of the responses. Midwives working in a labour ward, where an intravenous vein catheter was placed at admission of a woman to the labour ward, are more prone to an affirmative attitude towards intrapartum oxytocin (and an intravenous vein catheter) in low-risk births compared to midwives who forgo the placement of an intravenous vein catheter when a woman is admitted for labour in their department (OR=2.051, CI: 1,2–3,6, n=221).
Discussion: The focus on medical safety and on a low perinatal mortality in obstetrics leads to a greater willingness to perform interventions. In contrast, a “normal birth” is characterized by non-intervention. There is not enough scientific evidence to justify the placement of an intravenous vein catheter on admission of a woman in labour.
Recommendations: The results suggest that the use of interventions, such as the placement of an intravenous vein catheter and the use of intrapartum oxytocin, are an invariable part of routine procedures during childbirth. In care that is woman centred, however, these routine procedures should be reconsidered and an intravenous vein catheter should only be placed when explicitly indicated.
