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Nutritional advice in labouring women with epidurals
Abstract Number: F 17
Abstract Type: Original Research
Introduction: Previously there have been strict policies with regard to nil by mouth during labour on the delivery suite. Changes in anaesthetic practices and research into the affects of nutrition during labour have led to the production of national guidelines on this subject. NICE guidance states that isotonic drinks maybe more beneficial during established labour than water. Our trust has adopted this and also states that post epidural insertion women should no longer eat food. We looked at women in labour with epidurals and noted poor uptake of this advice. We increased awareness of guidelines by giving nutritional advice when consenting the parturient for an epidural. We also increased availability of isotonic drinks in the hospital and used educational posters in areas where they were being sold. Adherence to guidelines was audited pre and post intervention.
Methods: Over a 5week period all women who had a labour epidural were followed up regarding nutritional intake. We ascertained duration of labour and information on types of food and drink consumed pre and post epidural insertion. After increasing the availability of isotonic drinks and the awareness of NICE guidelines on intrapartum nutrition we then re-audited.
Results: In the first audit cycle13/64 women ate after their epidural insertion. No woman drank isotonic drinks during their labour. Some women were drinking nothing at all pre (2/64) or post (2/64) epidural insertion. In the second audit cycle 4/31 women ate after their epidural was sited. One woman drank nothing pre epidural and 4/31 drank nothing post epidural. 11/31 women drank isotonic drinks after there epidural was sited and 19/31 stated they were aware that isotonic drinks were available in the hospital.
Discussion: We have shown an improvement with compliance of our trusts (and national) guidelines regarding intrapartum nutrition. This may have benefits to the high risk parturient by providing a calorific source, which is rapidly absorbed by the stomach, thereby reducing ketosis and aspiration risk.
1.NICE. Intrapartum care of healthy women and their babies during childbirth. 2007 Guideline 55
2. Kubli M, Scrutton M, Seed P, O’Sullivan G. An evaluation of isotonic sports drinks during labour. Anaesthsia and Analgesia. 2002. 94:404-408