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An Investigation into the Safety of Oral Intake During Labor
To present the details of a study done to compare maternal and neonatal outcomes among laboring women permitted ad lib oral intake with those permitted nothing by mouth except for ice chips.
After completing this educational activity, you should be able to
- identify findings from the review of the literature.
- outline the design and methods of this study.
- summarize the study findings and their implications for practice.
- In 1946, a paper by Mendelson highlighted a risk for laboring women associated with oral intake prior to obstetric anesthesia. That risk was
- vomiting and aspiration.
- fluid overload.
- prolonged labor.
- Later researchers reported mortality rates associated with obstetric anesthesia after oral intake as high as
- Studies have reported that, compared with outcomes seen with restricted oral intake during labor, outcomes seen with a more relaxed oral intake approach are
- According to Maharaj, restricting a laboring woman to ice chips can lead to which of the following in both mother and newborn?
- In 2007, the American Society of Anesthesiologists (ASA) Task Force on Obstetric Anesthesia stated that oral intake of clear liquids during labor improves
- newborn Apgar scores.
- maternal satisfaction.
- labor progression.
- A working group of the World Health Organization concluded that, absent a valid medical reason, food or drink during labor should
- be prohibited.
- be limited.
- not be discouraged.
- In a 1998 Dutch study, what percentage of obstetricians left decisions about oral intake to the laboring woman?
- A study conducted in the United Kingdom found that 96% of hospitals allowed some type of oral intake. Of these, what proportion allowed both liquid and solid intake?
- In the authors’ study, women were excluded as participants if they
- were older than 35 years and nulliparous.
- had comorbidities identified during the prenatal period.
- had conditions that would result in birth by scheduled cesarean section.
- In this study, the majority of participants in both the nothing by mouth— nil per os (NPO)—and ad lib groups had
- no preexisting medical conditions that complicated pregnancy.
- only 1 preexisting medical condition that could complicate pregnancy.
- more than 1 preexisting medical condition that could complicate pregnancy.
- What percentage of participants in the ad lib group had a medical condition complicating pregnancy that was identified prenatally?
- Compared with the incidence of intrapartum complications in the ad lib group, the incidence in the NPO group was
- significantly lower.
- about the same.
- significantly higher.
- Compared with participants in the ad lib group, how likely were those in the NPO group to require a higher level of postpartum care?
- significantly more likely
- about equally as likely
- significantly less likely
- How did neonatal outcomes, as measured by Apgar score, compare for the newborns of women in the NPO and ad lib groups?
- The ad lib group newborns had better outcomes.
- There was no significant difference in outcomes.
- The ad lib group newborns had worse outcomes.
- Which statement about propensity scoring is correct?
- The method involves taking multiple covariates and creating a single covariate.
- The purpose of propensity score matching is to balance covariates.
- Propensity score matching assumes that treatment assignment is important.
- In the authors’ study, how did allowing laboring women ad lib oral intake affect the incidence of adverse outcomes for mothers and newborns?
- There was no effect on the incidence of adverse outcomes.
- Such incidence was lower for newborns but unchanged for mothers.
- Such incidence was lower for mothers but unchanged for newborns.
- In its most recent guideline, the ASA recommends that women in labor
- consume nothing by mouth.
- avoid solid food.
- consume liquids and solid food.
- Which of the following statements about the authors’ study is inaccurate?
- It was designed as a randomized controlled trial.
- The authors’ conclusion that low-risk laboring women should be permitted to self-regulate oral intake was consistent with those of earlier reports.
- For the 2 study groups, there were no significant differences in unplanned maternal ICU admissions postpartum.