An Investigation into the Safety of Oral

Intake During Labor (2018)

JOURNAL

Submitted by:
Tamayo, Teanu Jose G. BSN-III D4

In partial Fulfillment of requirement

In CN 109: Duty

Submitted to:
Marian T. Barrientos RN. MN

June 7, 2018

Supporting articles:

Restriction of oral intake during labor: Whither are we bound?

The aspiration of stomach contents into the lungs during obstetric anesthesia
B. SUMMARY

i. Introduction

In summary from what I’ve read, observances and practices concerning the permission of solid and
liquid nutrition vary from country to country. In the Philippines, much like in the U.S.A, practice the
restriction of both respectively (providing only small sips of water and ice chips to hydrate the mouth and
ease the mother).

And since labor involves rigorous physical exertion and often lasts many hours, restricting a laboring
woman to ice chips as mentioned before may lead to ketosis and hyponatremia in both mother and newborn.
Enforced fasting during labor may also have psychological ramifications. It stands to reason that alleviating
a patient’s hunger and thirst during labor by allowing oral intake would ease any associated psychological
discomfort as well (Parson, 2004).

This practice of oral restriction stems from the findings of Mendelson (1946) which emphasizes the
risk of aspiration in instances where obstetric anesthesia was required.

ii. Gap of the Study and Research Objective

Since then, significant improvements in obstetric analgesia/anesthesia have made general anesthesia
during labor an uncommon occurrence. Hence in recent years, many HCP have advocated revisiting
restrictions on oral intake in lieu to these advances, pressing professional organizations to provide evidences
to warrant such practice through research studies and articles such as this.

The primary objective of this study was to compare maternal and neonatal outcomes among two groups
of laboring women: those who were permitted ad lib solid and liquid intake (the ad lib group) and those
permitted nothing by mouth (NPO)—except for ice chips (the NPO group). The secondary objective was
to increase the robustness of the findings by using propensity score estimates to compare matched subjects
on maternal and neonatal outcomes of interest.

iii. Methods

Quantitative retrospective observational cross-sectional design was used, utilizing a final data set of
closed medical records of 2,797 women (for comparison across covariates) and 2,784 women (for
comparison across outcomes) which were extracted and reviewed in the study setting of a suburban
community hospital in the northeastern United States from the years 2008 to 2012. Outcome comparisons
were obtained with traditional between-groups analysis and propensity score matching.

iv. Results

Analyzed from the results and discussions in the study, allowing laboring women ad lib oral intake did
not increase the incidence of adverse outcomes among either mothers or infants. The findings support
permitting women who are at low risk for an operative birth to self-regulate their intake of both solid food
and liquids during labor.

C. REACTION:
1. Insights/Relevance to patients’ care/care

Summarizing competing concerns from the journal relevant to patient’s care I formulated a list:

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• risk of gastric aspiration if women require general anesthesia
• energy needs of the laboring woman
• the effect of ketosis on the laboring woman and fetus
• hyponatremia due to excess intake of hypotonic fluids
• maternal stress associated with NPO status

Each point needed be considered, when deciding which precautions to follow. As suggested in the
study, permitting women who are at low risk for operative birth would be allowed to regulate their intake
of both solid and liquid during labor. The decision will be dependent on the assessment, obstetric history
of the mother and prenatal
visits.

A very comprehensive
table of recommendations
on restriction of oral
intake exists to guide
nurses, physicians and
midwives alike taken
from the respective article
of Sharts-Hopko, (2010).

2. Relevance to area of rotation/local setting/Phil.

Mentioned before, in the Philippines we practice the restriction of both solid and liquid oral intake
respectively; providing only small sips of water and/or ice chips to hydrate the mouth and ease the mother.
This leaves potential for ketosis and hyponatremia in both mother and newborn to occur. And as well, imply
psychological ramifications with an already distressing situation (labor).

With evidences provided and recommendations given by the professional organizations, we can avoid
situations of unnecessary oral restriction, preventing complications and promoting comfort. While, still
upholding safety for those potentially scheduled for an operative delivery.

3. Relevance to Nursing Education, Practice and Research

That being said, nursing education and practice aim to find the most effective and efficient way to
deliver holistic care through evidenced based research and practice. Updates such these are massive leaps
towards nursing research, disposing the norm of a mandatory NPO status.

This affects then the education delivered to student nurses, now aware of the indications and
ramifications that oral restriction entails (e.g ketosis, hyponatremia). This impacts practice in the area,
encouraging collaborating with the health care team to decide if oral restriction precautions are actually
necessary.

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4. Learning Insights on the Journal

Reiterating some points stated, leniency of restriction of oral intake will be heavily dependent on
the at-area-assessment, obstetric history of the mother and prenatal visits done. Collaboration is then vital
in the decision-making of allowance of intake oral nutrition.

That being said, if proved low-risk and allowed by the healthcare team in-charge, there must
be no hesitation to provide permission for mother’s to self-regulate their intake of both solid food and
liquids during labor.

References:

Mendelson, C. L. (1946). The aspiration of stomach contents into the lungs during obstetric anesthesia.
American Journal of Obstetrics & Gynecology, 52, 191-206.

Parsons M. (2004) Midwifery dilemma: to fast or feed the labouring woman. Part 2: The case supporting
oral intake in labour. Aust J Midwifery (1):5-9.

Providing Oral Nutrition to Women in Labor. (2016). Journal of Midwifery & Womens Health,61(4),
528-534. doi:10.1111/jmwh.12515

Sharts-Hopko N. (2010). Oral Intake During Labor. MCN, The American Journal of Maternal/Child
Nursing,35(4), 203-205. doi:10.1097/nmc.0b013e3181e3e22b

Shea-Lewis, A., Eckardt, P., & Stapleton, D. (2018). CE: Original Research An Investigation into the Safety of Oral
Intake During Labor. AJN The American Journal of Nursing, 118(3), 24-31.

Sperling, J. D., Dahlke, J. D., & Sibai, B. M. (2016). Restriction of Oral Intake During Labor. Obstetric
Anesthesia Digest, 37(1), 2-3 doi: 10.1016/j.ajog.2016.01.166.

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 Restriction of oral intake during labor: Whither are we bound?

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