Clinical decision-making regarding intravenous hydration in normal labor in a birth center setting

Intravenous hydration (IVH) in normal labor is used routinely in most hospital settings despite the lack of support from recent research. However, it is not used routinely at one in-hospital, Alternative Birthing Center (ABC), in the Midwest. The purpose of this study was to explore and describe the criteria and perspectives of the certified nurse-midwives (CNMs) and nurses (RNs) in their decision-making process toward nonroutine use of IVH. In-depth interviews with five CNMs and four RNs that work in the ABC provided insight into how they balanced patient preference, research-based knowledge, and clinical judgments, in making decisions about IVH. The RNs were slightly more in favor of IVH than the CNMs, but not because of philosophic differences. Rather, the different roles and responsibilities of CNMs and RNs seemed to be most important. CNMs had a stronger commitment to client preferences, whereas RNs were more concerned about their responsibility for efficiently starting IVs prior to an emergency situation. Understanding professional differences in the decision-making process for IVH can enhance clinical functioning of the caregiving team by helping CNMs anticipate and address potential conflicts.