Nutritional Intake Guidelines for Obstetrical Patients

The purpose of this scholarly doctoral nurse practitioner (DNP) project was to create nutritional intake guidelines for obstetrical patients who were laboring at a local hospital. Currently in the United States, women who are laboring are routinely deprived of food and are often restricted to minimal or no oral hydration due to the concern for risk of aspiration and Mendelson syndrome. Despite this practice, the actual risk of aspiration is extremely low, and women often desire to eat and drink in labor. Restriction of oral nutritional intake during labor is not a benign practice, and has implications for the physical and psychological well-being of the laboring woman and her baby. The majority of obstetrical patients are low-risk laboring women who lack choice in their nutritional intake during labor, and have a global restriction of nutritional intake enforced upon them. In an extreme minority of laboring patients, the risk of aspiration is associated with identifiable high-risk factors. To allow low-risk laboring women the right to oral nutrition during labor, the risk for aspiration needs to be defined. A guideline that clearly identifies the risk of aspiration for laboring woman is needed. The objectives of this DNP project were to (1) identify the risks and benefits of oral intake in laboring patients; (2) determine risk criteria for intubation and aspiration in laboring women; (3) write a guideline for oral intake in low-risk laboring women; (4) and disseminate the guideline to the obstetrical anesthesia department in the project hospital. The project was implemented by analyzing the current evidence regarding the risks and benefits of oral intake in laboring patients and determining a risk criteria for intubation and aspiration. This was evaluated further by content experts who informed additions to the literature search and agreed with the literature review. A risk stratification for aspiration and intubation for laboring patients was determined and reviewed by content experts for agreement and then incorporated during the creation of the guideline. The guideline was finalized and presented to the anesthesiology physicians at the project hospital. They evaluated the assessment tool and guideline and approved it for implementation. Women desire to eat and drink during labor, and their wishes should be addressed, evaluated, and honored in a safe manner based on current evidence. The evidence supports a very low risk of aspiration in labor. A tool that assesses risk of aspiration while laboring can serve as a guideline to support oral nutrition for low-risk women during labor.