Psychologic, physical, nutritional, and technologic aspects of intravenous infusion during labor

Group B Streptococcal Bacteriuria in Pregnancy: An Evidence-Based, Patient-Centered Approach to Care

Screening and management of group B streptococcus (GBS) bacteriuria in pregnancy aims to reduce the incidence of pyelonephritis and GBS-related neonatal morbidity and mortality. Universal screening and management of GBS bacteriuria in pregnancy are standards of care in the United States; however, some women may decline guideline-based recommendations for screening, treatment, or intrapartum antibiotic prophylaxis. This article uses a case study approach to discuss evidence-based, patient-centered care for GBS bacteriuria in pregnancy as well as ethical incorporation of individual patient preferences and values.

Eat, drink, and be labouring?

The practice of restricting oral intake during labour has been and remains controversial. Overall, the nutritional needs of labouring women are poorly understood. This literature review reveals that little evidence exists to support the general restriction of oral intake for all labouring women. Education of health professionals and pregnant women regarding intake in labour is required to encourage collaboration in the development and institution of appropriate policies in keeping with the available evidence for best practice.

Clinical decision-making regarding intravenous hydration in normal labor in a birth center setting

Intravenous hydration (IVH) in normal labor is used routinely in most hospital settings despite the lack of support from recent research. However, it is not used routinely at one in-hospital, Alternative Birthing Center (ABC), in the Midwest. The purpose of this study was to explore and describe the criteria and perspectives of the certified nurse-midwives (CNMs) and nurses (RNs) in their decision-making process toward nonroutine use of IVH. In-depth interviews with five CNMs and four RNs that work in the ABC provided insight into how they balanced patient preference, research-based knowledge, and clinical judgments, in making decisions about IVH. The RNs were slightly more in favor of IVH than the CNMs, but not because of philosophic differences. Rather, the different roles and responsibilities of CNMs and RNs seemed to be most important. CNMs had a stronger commitment to client preferences, whereas RNs were more concerned about their responsibility for efficiently starting IVs prior to an emergency situation. Understanding professional differences in the decision-making process for IVH can enhance clinical functioning of the caregiving team by helping CNMs anticipate and address potential conflicts.

Fasting in labor: relic or requirement

OBJECTIVE

To evaluate the scientific literature on restrictions of eating and drinking during labor.

DATA SOURCES

Computerized searches in MEDLINE and CINAHL, as well as historical articles, texts, and references cited in published works. Key words used in the searches included anesthesia in labor, childbirth, eating and drinking, epidural, fasting, fasting in labor, fasting and pregnancy, gastric aspiration, gastric emptying, intrapartum, intravenous fluids, i.v.s in labor, ketonuria, ketonuria in labor, parturition, pregnancy, and stomach contents in labor.

STUDY SELECTION

Articles from indexed journals, excluding single-person case studies.

DATA EXTRACTION

Data were extracted and organized under the following headings: historical review, effects of fasting on labor, research on maternal mortality/morbidity from aspiration, research on gastric emptying in labor, intravenous hydration in labor, and implications for nursing research.

DATA SYNTHESIS

Research does not support restricting food and fluids in labor to prevent gastric aspiration. Restricting oral intake during labor has unexpected negative outcomes.

CONCLUSIONS

Little is known about the differences in labor progress, birth outcomes, and neonatal status between mothers who consume food and/or fluids during labor and women who fast during labor. Research also is needed on the effects of epidural opioids on gastric emptying, nutritional requirements during labor, and the physiologic implications of fasting during labor. Fasting during labor is a tradition that continues with no evidence of improved outcomes for mother or newborn. Many facilities (especially birth centers) do not restrict eating and drinking. Across the United States, most hospitals restrict intake, usually to ice chips and sips of clear liquids. Anesthesia studies have focused on gastric emptying, measured by various techniques, presuming that delayed gastric emptying predisposes women to aspiration. Narcotic analgesia delays gastric emptying, but results are conflicting on the effect of normal labor and of epidural anesthesia on gastric emptying. The effect of fasting in labor on the fetus and newborn and on the course of labor has not been studied adequately. Only one study evaluated the probable risk of maternal aspiration mortality, which is approximately 7 in 10 million births.

Parturition and fetal adaptation

The fetus as "patient" during labor and birth has become an increasingly important concept during the past 20 years. However, what is understood about fetal status during labor and how the fetus prepares for its approaching separation from its mother? Current information indicates that not only is the term fetus well prepared for the adaptation to extrauterine life, but this transition is facilitated by normal labor.

Recommendations for the management of low risk obstetric patients

Specific interventional procedures have enjoyed widespread popularity in the United States in the routine management of low risk obstetric patients without the benefit of clinical studies attesting to their utility. A review of the literature was conducted to survey obstetric practice with regard to amniotomy, intravenous fluids, third stage administration of oxytocics, episiotomy and continuous fetal monitoring.