Evidence-based guidelines for intrapartum maternal hydration assessment and management: A scoping review

Abstract

Problem: Inconsistent practice relating to intrapartum hydration assessment and management is reported, and potential harm exists for laboring women and birthing persons.

Background: Labor and birth are physically demanding, and adequate nutrition and hydration are essential for labor progress. A lack of clear consensus on intrapartum hydration assessment and management during labor and birth currently exists. In addition, there is an inconsistent approach to managing hydration, often including a mixture of intravenous and oral fluids that are poorly monitored.

Aim: The aim of this scoping review was to identify and collate evidence-based guidelines for intrapartum hydration assessment and management of maternal hydration during labor and birth.

Methods: PubMed, Embase, and CINAHL databases were searched, in addition to professional college association websites. Inclusion criteria were intrapartum clinical guidelines in English, published in the last 10 years.

Findings: Despite searching all appropriate databases in maternity care, we were unable to identify evidence-based guidelines specific to hydration assessment and management, therefore resulting in an "empty review." A subsequent review of general intrapartum care guidelines was undertaken. Our adapted review identified 12 guidelines, seven of which referenced the assessment and management of maternal hydration during labor and birth. Three guidelines recommend that "low-risk" women in spontaneous labor at term should hold determination over what they ingest in labor. No recommendations with respect to assessment and management of hydration for women undergoing induction of labor were found.

Discussion: Despite the increasing use of intravenous fluid as an adjunct to oral intake to maintain maternal intrapartum hydration, there is limited evidence and, subsequently, guidelines to determine best practice in this area. How hydration is assessed was also largely absent from general intrapartum care guidelines, further perpetuating potential clinical variation in this area.

Conclusion: There is an absence of guidelines specific to the assessment and management of maternal hydration during labor and birth, despite its importance in ensuring labor progress and safe care.

Keywords: birth; clinical variation; fasting in labor; hydration; hyponatremia; intrapartum care; intravenous therapy; labor; labor and birth management or care.