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A multicenter interdisciplinary survey of practices and opinions regarding oral intake during labor

Published:September 05, 2022DOI:https://doi.org/10.1016/j.ijoa.2022.103598

      Highlights

      • Survey regarding oral intake in labor in units in Israel.
      • Practices varied between disciplines, midwives were significantly more permissive.
      • Women received conflicting recommendations.
      • There is a lack of awareness of the risks associated with oral intake in labor.
      • There is a need for standardized guidelines and patient risk stratification.

      Abstract

      Introduction

      Different society guidelines diverge regarding oral intake in labor. Our goal was to assess practices and opinions in Israeli labor and delivery units, comparing different disciplines.

      Methods

      An anonymous Google Forms survey was sent to anesthesiologists, obstetricians and midwives in all Israeli labor and delivery units.

      Results

      Responses were collected from all 27 labor and delivery units contacted, with a total of 501 respondents comprising 161 anesthesiologists, 102 obstetricians and 238 midwives. Forty-eight per cent stated there were no institutional guidelines for oral intake. The most common oral intake permitted was light food (60%). Midwives were significantly more likely than anesthesiologists and obstetricians to consider that women who are both low risk for cesarean delivery (P <0.00001) and high risk for cesarean delivery (P=0.001) should eat. Epidural analgesia did not impact recommendations regarding oral intake. The most common reasons for restricting oral intake were obstetric. Sixty-two per cent identified aspiration as the main risk associated with eating during labor, but 19% of midwives compared with 4% of anesthesiologists and obstetricians stated there were no risks (P <0.00001). The annual delivery volume of the unit did not impact staff practices.

      Conclusions

      There was a discrepancy between opinions and practices across all disciplines. Permissive practices identified in this survey should be addressed to find the safe middle ground between restrictive and permissive policies for low- and high-risk women.

      Keywords

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      References

        • Mendelson C.L.
        The aspiration of stomach contents into the lungs during obstetric anesthesia.
        Am J Obstet Gynecol. 1946; 52: 191-206https://doi.org/10.1016/s0002-9378(16)39829-5
        • Sandhar B.K.
        • Elliot R.H.
        • Windram I.
        • Rowbotham D.J.
        Peripartum changes in gastric emptying.
        Anaesthesia. 1992; 47: 196-198https://doi.org/10.1111/j.1365-2044.1992.tb02116.x
        • Hawkins J.L.
        • Gibbs C.P.
        • Martin-Salvaj G.
        • Orleans M.
        • Beaty B.
        Oral intake policies on labor and delivery: a national survey.
        J Clin Anesth. 1998; 10: 449-451https://doi.org/10.1016/s0952-8180(98)00054-3
        • Chackowicz A.
        • Spence A.R.
        • Abenhaim H.A.
        Restrictions on oral and parenteral intake for low risk labouring women in hospitals across Canada: a cross-sectional study.
        J Obstet Gynaecol Can. 2016; 38: 1009-1014https://doi.org/10.1016/j.jogc.2016.08.003
      1. The Royal Society of Medicine Journals. Confidential enquiry into maternal and child health (CEMACH). Saving mothers’ lives: reviewing maternal deaths to make motherhood safer 2003–2005. The seventh report of the confidential enquiries into maternal deaths in the UK. Obstet Med. 2008;1:54.

        • Bouvet L.
        • Garrigue J.
        • Desgranges F.P.
        • Piana F.
        • Lamblin G.
        • Chassard D.
        Women's view on fasting during labor in a tertiary care obstetric unit. A prospective cohort study.
        Eur J Obstet Gynecol Reprod Biol. 2020; 253: 25-30https://doi.org/10.1016/j.ejogrb.2020.07.041
        • Broach J.
        • Newton N.
        Food and beverages in labor. Part i: cross-cultural and historical practices.
        Birth. 1988; 15: 81-85https://doi.org/10.1111/j.1523-536x.1988.tb00811.x
      2. ACOG Committee Opinion No. 441: Oral intake during labor. Obstet Gynecol. 2009;114:714. https://doi.org/10.1097/AOG.0b013e3181ba0649.

      3. Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology. 2016;124:270-300. https://doi.org/10.1097/ALN.0000000000000935.

      4. Care in normal birth: a practical guide. Technical Working Group, World Health Organization. Birth. 1997;24:121-123.

      5. Society of Obstetricians and Gynaecologists of Canada. Healthy beginnings: guidelines for care during pregnancy and childbirth. SOGC Clinical Practice Guidelines. 1998;72.

      6. Israel Society of Anesthesiologists, Clinical Guidelines, 2019.

      7. Singata M, Tranmer J, Gyte GM. Restricting oral fluid and food intake during labour. Cochrane Database Syst Rev 2013;8:CD003930. https://doi.org/10.1002/14651858.CD003930.pub3.

        • Michael S.
        • Reilly C.S.
        • Caunt J.A.
        Policies for oral intake in labour.
        Anaesthesia. 1991; 46: 1071-1073https://doi.org/10.1111/j.1365-2044.1991.tb09928.x
        • Scheepers H.C.
        • Essed G.G.
        • Brouns F.
        Aspects of food and fluid intake during labour: policies of midwives and obstetricians in the Netherlands.
        Eur J Obstet Gynecol Reprod Biol. 1998; 78: 37-40https://doi.org/10.1016/s0301-2115(98)00007-4
        • Shatalin D.
        • Weiniger C.F.
        • Buchman I.
        • Ginosar Y.
        • Orbach-Zinger S.
        • Ioscovich A.
        A 10-year update: national survey questionnaire of obstetric anesthesia units in Israel.
        Int J Obstet Anesth. 2019; 38: 83-92https://doi.org/10.1016/j.ijoa.2018.10.014
        • Parsons M.
        A midwifery practice dichotomy on oral intake in labour.
        Midwifery. 2014; 20: 72-81https://doi.org/10.1016/S0266-6138(03)00055-X
        • Vallejo M.C.
        • Cobb B.T.
        • Steen T.L.
        • Singh S.
        • Phelps A.L.
        Maternal outcomes in women supplemented with a high-protein drink in labour.
        Aust N Z J Obstet Gynaecol. 2013; 53: 369-374https://doi.org/10.1111/ajo.12079
        • Kubli M.
        • Scrutton M.J.
        • Seed P.T.
        • O'Sullivan G.
        An evaluation of isotonic “sport drinks” during labor.
        Anesth Analg. 2002; 94: 404-408https://doi.org/10.1097/00000539-200202000-00033
        • Kelly M.C.
        • Carabine U.A.
        • Hill D.A.
        • Mirakhur R.K.
        A comparison of the effect of intrathecal and extradural fentanyl on gastric emptying in laboring women.
        Anesth Analg. 1997; 85: 834-838https://doi.org/10.1097/00000539-199710000-00022
        • Hasuo H.
        • Kusunoki H.
        • Kanbara K.
        • et al.
        Tolerable pain reduces gastric fundal accommodation and gastric motility in healthy subjects: a crossover ultrasonographic study.
        Biopsychosoc Med. 2017; 1: 4https://doi.org/10.1186/s13030-017-0089-5
        • Parsons M.
        Policy or tradition: oral intake in labour.
        Aust J Midwifery. 2001; 3: 6-12https://doi.org/10.1016/s1445-4386(01)80017-3