Needle Pokes During Pregnancy

02.04.11: Why they're unavoidable


Women count lab tests, IVs, shots, stitches and “huge honking needles” among their biggest pregnancy fears. Can you have a baby without getting poked? You can, but you shouldn’t. Here’s why:

During early pregnancy your physician orders blood tests to check for anemia, diabetes, HIV and other sexually transmitted diseases, immunity to certain diseases like rubella, blood type and Rh titer, and more. These are important for all pregnant women and will guide your physician on how to keep you and your baby healthy. Let’s call these the mandatory tests.

Then, there are screening and diagnostic blood tests for genetic disorders, like Downs’ syndrome and cystic fibrosis (among many others). These are optional though they’re routinely offered to all mothers. Some can be done on the same needle poke as the mandatory tests. Others require a separate trip to the lab and another poke.

Later, your blood is tested again for gestational diabetes, which can create big problems for moms and babies. Add this to the mandatory list.

When you’re in the hospital in labor, you’ll most likely have another blood test to make sure you’re not anemic, infected or have a low platelet count (platelets help your blood clot).

Do you have to have an IV when you’re in labor? No, but you might want one anyway. Plenty of women get through labor without IV hydration, medication or an epidural. Most American women, however, opt for epidurals, which you can’t have without an IV.

It usually goes like this: once you’re admitted to the hospital, you’ll get an IV started and lab work drawn – sometimes with one needle poke; sometimes, it’s a two-poke (or more) deal. The nurse who starts your IV won’t necessarily hook it up to tubing and IV fluid immediately. She might just “cap it and tape it,” in case she needs it later.

You have the option of refusing an IV, but that’s not always the best plan. Besides pain management, here are four good “just in case” reasons why an IV is a good idea:

1) You develop complications in labor like infection, low or high blood pressure. These can often be easily treated with IV fluid and/or IV antibiotics or other medications.

2) You start bleeding suddenly during labor or immediately after delivery. When a patient bleeds heavily, her veins naturally clamp down to decrease circulation to non-essential body parts. The heart, lungs and brain are essential; arms and legs, not so much. Experienced IV nurses can start a line on virtually anyone, but it’s tricky when veins aren’t cooperating.

3) You’re vomiting during labor. Your nurse can add some anti-nausea/anti-vomiting medication and IV fluid, and voila – you feel a whole lot better.

4) You need an emergency c-section. If we need to get that baby delivered fast, we don’t want to slow down to get the IV started. If it’s already in place, we’re ahead of the game.

Here’s why you might not want an early IV:

You don’t want to make it too easy to start using non-essential interventions like Pitocin or pain medication. If you’re determined to have a low-intervention birth, you’re completely healthy and low-risk and you’re willing to hand over your veins if you develop one of the “just in case” situations above, then opt. Once the IV is already in place, it’s easy to hook up a line and fluid and start adding medications. If you don’t have one yet, the time it takes to get one might be an incentive to try something else, like a walk, a position change or warm bath.

What if you’re a tough poke? Most pregnant women have easy-access veins the size of drinking straws. Some don’t. If it’s taken s several tries in the past to get an IV started, ask for an IV specialist. If you don’t have any previous problems, let the nurse assigned to care for you try twice. Don’t go for round three with the same nurse. If she/he doesn’t get in the vein after two pokes, ask for a specialist. She might be having an off day or you might have veins that need someone else’s technique. The same rule applies to epidurals. If the anesthetist or anesthesiologist can’t get the epidural needle into the right space after two tries, ask for someone else.

How about stitches? If you need them because of a tear or episiotomy, there’s no way around it. Your doctor will use a local anesthetic (yep, that’s a needle poke) and as many stitches as necessary to put your girl parts back in order. Patients always ask, “how many stitches did I get?” We don’t usually count. It’s usually one or two pieces of suture material (thread) and as many pokes as it takes to get the job done.

Needle pokes are an art and a science. We don’t want to poke you any more than necessary. What can you do to make it easy on us?

• Drink plenty of fluid before lab visits and IV starts.

• If your veins aren’t visible on your arm, try putting a warm pack on your skin to pump them up a little.

• Most important, try to relax, but if you can’t, we’ll totally understand.

Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to and it may be answered in a future blog post.

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.