Midwives may independently prescribe, order and administer this drug.
Intravenous access is indicated for the administration of medication and fluids (volume expansion, hydration and blood products). Prophylactic intravenous access with a saline lock can also be recommended in certain situations.
Normal Saline & Ringers Lactate
These isotonic crystalloid solutions can be used to provide volume and deliver medication and are the most likely solutions indicated for use during pregnancy, birth and postpartum.
- If an IV is established in third stage or the immediate postpartum during an out-of-hospital birth, the midwife must ensure that vital signs are normal and stable for one hour prior to removing the IV canula.
- In an out of hospital setting, initiating emergency transport to hospital should be considered early in the treatment of a postpartum hemorrhage. Emergency transport to hospital and consultation with a physician is required if bleeding is unresponsive to therapy.
- Water intoxication is a potential side effect of oxytocin administration. Use electrolyte-containing solutions (i.e. normal saline or Ringer’s lactate) with oxytocin reduces the risk of water intoxication.
- Intake and output records should be initiated when delivering IV fluids. Fluid overload and hyponatremia may be prevented by recording and use of balanced salt solutions.
In neonatal resuscitation Ringer’s Lactate or 0.9% NaCl may be administered intravenously as a volume expander (10 mL/kg over 5 to 10 minutes) if there is evidence of acute bleeding with signs of hypovolemia as per NRP guidelines.
5% Dextrose in Water is packaged as an isotonic solution and can be indicate for hydration and provide calories, however, the glucose in the solution is quickly consumed leaving the solution hypotonic. Administration of hypotonic solutions via IV will leave the intravascular space quickly and reappear in the cells. The need for calories is not usually warranted as mild to moderate ketosis is a normal intrapartum state and hydration with 5% dextrose is associated with poorer outcomes. Use of dextrose containing solutions in the absence of saline is associated with maternal hyponatremia and hypoglycaemia in the newborn.