Oral Intake During

labour Review of the

Evidence

Major :Areej Faeq

Registered Midwife

Out line

IntroductionObjective of research study Methodology Historical Background of NPO policies Evidence's summery Summery TableConclusion and RecommendationReferences

Introduction

In various hospitals; patients are advised not to eat or drink during labour. The medical order for this is "NPO" which originates from the Latin ‘nil per os’; meaning nothing per mouth.

In a current study of a client who delivered in a Hospital in the United States; 60% of clients were ordered to not drink anything during labour, and 80% said that they didn't eat or drink (Declercq et al. 2014).

In Jordan;

No studies were found to investigate the mortality rate causes related aspiration during labour, all the kingdom’s hospitals and health centers have an active policy of making the clients fast during the process, some during the active phase, some order fasting the minute the induction of labour starts, and only a few provide sips of water or ice chips, otherwise it is a taboo to discuss such measures with the obstetrics or midwives.

Objective

This search was to find whether there is a significant relationship between fluid and food intake by a client during labour will cause aspiration.

Methodology

After performed an electronic search through JUST University’s database. Searches included, Pub Med, MEDLINE, Google Scholar, and EBSCO. Searching and looking for keywords (e.g. oral, intake, restriction fluid, labour and delivery). And using AND with other key words (e.g. carbohydrates, aspiration, death, suffocation)’. The search was restricted for experimental quantitative study that were written in English Languages only.

Historical Background of NPO Policies

Since 1946 Dr. Mendelson studied approximately 44’016 mothers who gave birth between 1932 and 1945, Dr. Mendelson found that only sixty six mothers developed aspiration complications (0.15%).

Mendelson concluded that aspirations are preventable complications and he recommended to be managed by replacing oral intake with intravenous fluids. He also advised to replace general anesthesia by using localized anesthesia if possible.

His recommendation “Nothing by Mouth” became the hospitals’ policies, not only across the U.S but all around the world.

In that time, when aspiration was mentioned as a major problem during delivery in the 1940’s; anesthesiologists were not using modern techniques, they were using very primitive tools to keep a client’s airway open under general anesthesia, and some of them did not use any airway tools at all. Up-to-date versions of equipment/ a laryngoscope; were developed in the 1940’s; it helped the anesthesiologists to view the client’s vocal cords so that they can place a tube in the trachea (intubation) and keep it open, thus protected the airway during general anesthesia (Robinson & Toledo, 2012).

Systematic review was comparing the positive

effects with the negative effects of eating and

drink during labour (Ciardulli et al. 2017).

The researchers investigated five studies from the systematic review and added another five studies, the total participants were 3’982 pregnant women.

The researchers found that women who delivered under the restrictive eating and drinking policies had longer labour times, about sixteen minutes, rather than those with less restrictive policies.

The author mentioned that there are no statistical differences in other variables like Apgar score, vomiting, incidence of caesarian section and other health outcomes.

The only study discussed maternal satisfaction and showed that the eating group of mothers were more satisfied with their nourishment during labour compared to the others who given sips of water only showed a result of (97% versus 55%).

The significant systematic review showed that most mothers prefer to limit their oral intake in progress of labour, the mothers prefer not to eat or drink when labour pain becomes more intensive.

The authors concluded that low-risk pregnant women must have the right to be free whether she would like to eat and drink during labour (Singata et al. 2013).

The Incidence of Aspiration

Complications

Researchers during the 2015 annual meeting of anesthesiologists in the U.S recommended that healthy low-risk clients would not be harmed from a light meal in labour, on the complete opposite; if clients were left with no food, gastric acid in their stomachs will increase and raise the risk of refluxes and aspiration. (Harty et al. 2015).

Summery Table

Study Experimental Group

versus Control Group

Results Note

Scrutton, Metcalfe et

al.1999

45 women, ate and

drank specific foods

and 43 were on water

only

There were no difference

between both groups regarding

the duration of labour or

incidence of C/S or the neonatal

Apgar score.

Increasing incidence of vomiting

in experimental group and

decrease the developing of

ketones body

Study Experimental Group versus

Control Group

Results Note

Scheepers, Thans

et al.2002

102 mothers drank a high

concentration carbohydrate

solution 12.6g/100ml as much

as they required, versus 99

women drank placebo water

flavored solutions

The experimental group

significantly increased the

incidences of C/S delivery and

showed longer duration of

labour stages.

O’Sullivan, Liu et

al.2009

Experimental group of 1219

mothers ate specific food and

control group only on water

No difference between groups

in labour duration, vomiting

or neonatal Apgar score.

Study Experimental Group versus Control

Group

Results Note

Kordi et al

.2010

45 women took honey date syrup versus

45 women took sips of water only

A significant shorter

duration of labour in

active phase and second

stage of labour in

experimental group

mothers.

Study Experimental Group

versus Control Group

Results Note

Rahmani et al.2012 The researcher made

three protocol for intake

on 87 mothers and 90

mothers were provided

only water

Significant result showed shorter

second stage of labour and

stronger pushing among

experimental group mothers

without any difference in duration

of labour incidence of C/S

,vomiting or neonatal Apgar score

between experimental and

control groups .

Intervention

were on three

medium dates

with 110ml of

water. Three

dates with

tea, no added

sugar. And

110ml of

orange juice

Study Experimental Group

versus Control Group

Results Note

Taranmer, Hondnett et

al.2015

Provided antenatal

advisors to eat and drink

during labour, 163

mother versus 165

mother took only sips of

water

There were no difference between two

groups in duration of labour, needed

augmentation or delivered by cesarean

section.

Conclusion and Recommendation

The policy of ‘Nothing per Mouth’ has been widely adopted by health care provider, depending on their assumptions and fears of aspiration consequences and complications that were provided by old studies and cases that occurred long time ago when there were no modernized methods nor facilities for anesthetic methods,

researches in this field are very few, most of which are systematic reviews for previous studies, that’s why we are in desperate need to newly experimental studies or to say the least; update the new evidence-based events to change up the situation in the hospitals and health centers nowadays.

As a final statement; I want to stress on the fact that the mother during labour has every right to decide whether she wants to eat or drink during the process. And as I advise my clients all the time, they need to listen to their bodies and respond to their vital needs whenever needed.

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