Hospitals across the United States have been feeling the impact of a shortage of IV bags since Hurricane Maria hit Puerto Rico in September 2017. Puerto Rico, a territory of the United States, has been a major manufacturer and supplier of IV bags to US hospitals. Prior to Hurricane Maria, the supply chain had already been experiencing intermittent shortages and the natural disaster had a tremendous impact on the infrastructure of the island of Puerto Rico which of course impacted manufacturing there as well. While the 500 ml and 1000 ml bags are not directly affected, (the common size used on labor and delivery units) there has been juggling resources to deal with the small volume bag shortages.
Puerto Rico has long been a major supplier of pharmaceuticals, and the dollar value of these products produced there is more than the value of pharmaceuticals produced in any of the 50 states or foreign country. The manufacturing problems have had a major impact on the availability of small volume IV bags to the United States. CNN covered this topic late last week.
The Food and Drug Administration (FDA) has been working with hospitals to help them deal with the IV bag shortage by issuing recommendations for protocols during the shortage that provide safe and effective alternatives while being mindful of the resource concerns. Some considerations include looking at using existing products beyond their expiration date if safe, and source products from locations that are not currently approved by the FDA but could be fast-tracked if deemed acceptable.
One FDA recommendation during this shortage is to substitute IV hydration with an oral electrolyte product when appropriate. Pregnant people are provided with IVs routinely as part of the standard hospital protocol upon admittance for labor. Despite evidence that oral hydration and nourishment in fact can provide fuel for the laboring person, many facilities do not "permit" this common sense approach and instead encourage hydration through an IV, while allowing ice chips only.
According to Listening to Mothers III, 86% of laboring people were given IV fluids. For healthy, low-risk people, laboring with an IV pole and the IV fluids reinforces the mindset that labor is not a normal physiological event, limits mobility and interferes with changing positions frequently. Additionally, too much IV fluids impact the labor and put the newborn at risk of excessive weight loss due to the fluids administered to the parent intrapartum.
Lamaze International's Healthy Birth Practice 4 states "Avoid Interventions That Are Not Medically Necessary." Despite being a common procedure experience by most laboring people, it is not evidence-based and can lead to unnecessary complications for the parent and the newborn when not needed as a result of a medical situation.
Rebecca Dekker also has a very useful discussion on this topic that can be found on Evidence Based Birth: Evidence on IV Fluids During Labor.
Could this current shortage of IV bags cause a permanent change in protocols for low-risk labors, which evidence has long supported? Will labor and birth units observe the benefits of people laboring without an IV when not necessary? Will this shortage demonstrate a positive impact on the outcome and the experiences of the people giving birth in their facilities? Will hospital admins notice any cost savings?
Do you work in a hospital labor & delivery unit? Has your facility been affected by this shortage? Will this potentially short-term situation be an opportunity for systemic change? What are your thoughts?
Hat tip to Lamaze International's Lead Nurse Planner, Susan Givens, for sharing this news with me and allowing me to investigate further.
American College of Obstetricians and Gynecologists. (2009). ACOG Committee Opinion No. 441: Oral intake during labor. Obstetrics and Gynecology. 114 (3), 714.
Chantry, C., Nommsen-Rivers, L., Peerson, J., et al. (2011). Excess weight loss in first-born breastfed newborns relates to maternal intrapartum fluid balance. Pediatrics, 127 (1), 171-179.
Dawood, F., Dowswell, T., & Quenby, S. (2013). Intravenous fluids for reducing the duration of labour in low-risk nulliparous women. Cochrane Database of Systematic Reviews. DOI: 10.1002/14651858.CD007715.pub2.
Declercq, E., Sakala, C., Corry, M., Applebaum, S., & Herrlich, A. (2013). Listening to Mothers III: Pregnancy and Childbirth. New York: Childbirth Connection
Singata, M., Tranmer, J., & Gyte, G. (2013). Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews, 2013, Issue 1. [DOI: DOI: 10.1002/14651858.CD003930.pub3]