TRAVIS AIR FORCE BASE,
Calif. –
The labor and delivery unit at Travis Air Force Base, California, has searched since
October for healthy pregnant volunteers who are at a low risk of a cesarean delivery
to take part in a two-year research study to evaluate the impact of eating
certain foods during labor.
The
study’s results will benefit the Air Force and the medical community in general
“by supplying crucial data that will improve intrapartum care for all pregnant
women,” said Maj. Jeannette Brogan, 60th Medical Group Maternal Child Flight perinatal
clinical nurse specialist.
While women have long expressed the desire to eat
and drink while in labor, current guidelines from the American College of
Obstetricians and Gynecologists and American Society of Anesthesiologists
restrict oral intake to clear liquids.
“The
practice of restricting low-risk laboring women to clear fluids during labor
dates back to the 1940s, when Dr. Curtis Mendelson made the recommendation to
restrict oral intake to avoid aspiration (choking) during general anesthesia,” said
Brogan.
Mendelson,
who was both an obstetrician and a cardiologist, hypothesized that the cause of
pneumonia following general anesthesia was aspiration of the stomach contents
due to delayed gastric emptying in labor. He also noted that food could be
vomited up to 48 hours after eating which could cause problems if the mother
required a C-section.
“Since
that time, anesthesia medications and methods have evolved significantly and
general anesthesia – going to sleep – is no longer routinely used,” said
Brogan. “While the practice of
restricting oral and fluid intake is still common in many U.S. hospitals, women
are frequently allowed to eat and drink in birthing centers and home
deliveries.”
Several recent studies show that eating during
labor is not only safe, but may shorten labor, decrease the need for pain
medications and increase patient satisfaction.
A study presented at the
2015 ASA annual meeting also reported that women in labor need the same kind of
energy and calories as marathon runners. When they don't get it, their bodies
turn to fat for energy which can slow contractions and lead to longer labor and
lower health scores in newborns.
According
to the researchers, fasting during labor poses the risk of making stomach
juices more dangerously acidic if the patient choked. Additionally, the
researchers noted that between 2005 and 2013, there was only one case of aspiration
in the United States and that occurred in a woman who was obese and had
pre-eclampsia.
Several
aspects of oral intake during labor already have been studied, including gastric
emptying times, energy requirements and the use of carbohydrate or protein
drinks.
“These
studies have shown similar outcomes in nausea, vomiting, mode of delivery,
length of labor, aspiration, neonatal (appearance, pulse, grimace response,
activity and respiration) scores at five minutes of life as well as well as an
increase in patient satisfaction.,” said Brogan. “This study intends to add to
the knowledge base.”
Labor and delivery hopes to recruit 200 women for
its study at Travis AFB.
“One-hundred
women will be randomly assigned a clear liquid diet – this is our control group
and will give information about our current practice – and 100 women will be
randomly assigned a special diet – this is our experimental group,” said
Brogan.
At
mealtime, participants in active labor – those with a cervical dilation of 6 centimeters
or more – will receive either clear liquids such as broth, jello, juice and popsicles
or a low-fat, low-residue diet which includes a meat, starch, vegetable and
beverage.
Brogan
said that although L&D is interested in safe, patient-centered, evidence-based
and current practices, this study carries some risks the same as with normal
labor.
“It
is likely that (participants) will experience increased nausea, vomiting and or
a larger bowel movement due to eating,” said Brogan. “It is less likely they will experience a
longer labor or a likelihood rate of cesarean delivery.”
Additionally,
participants could be at risk of pulmonary aspiration, which may lead to
coughing, difficulty breathing and, in some instances, choking, said Brogan.
To
participate in the study, volunteers must be TRICARE beneficiaries ages 18 and
older who plan to deliver at the David Grant USAF Medical Center. Also, they must be at 37 weeks gestation or
greater with only one baby developing in the uterus.
Women
in the high-risk category will not be accepted. This includes those with a
pre-pregnant body mass index over 40, diabetes, hypertension, allergies to
foods offered in the study, women who previously had a C-section or a past
history or current diagnosis of hyperemesis gravidarum – severe nausea and
vomiting that causes weight loss and dehydration – or a difficult airway as
determined by the anesthesia provider.
Women
who deliver at DGMC still have the option not to participate in the study, said
Brogan.
For
more information or to volunteer for the study, call Toni McNeary-Garvin at
707-423-7733 or Delicia Echevarria Valentin at 707-423-7188.