Up until recently, whenever I was attending a birth as a doula, and the baby had some decelerations in their heart rate that were concerning to clinicians, several steps were usually taken.  There would be changes to maternal position, the start/increase IV fluids, turn off pitocin if it was being administered, and give the birthing person supplemental oxygen, often accompanied by the statement - “take some nice deep breaths, breathe for your baby.”

In my role as the doula, I would provide support in changing positions and help the parents to find balance and calm, especially when things were happening quickly with many people rushing in to assist if the decel was long and significant.  But silently, I always wondered, why the oxygen mask? Pulse oximeters would show 100% readings on the parent, and I could not understand how giving oxygen would *increase* the amount of oxygen their blood was carrying beyond full saturation.

In 2021, a new systematic review and meta-analysis was published: Maternal Oxygen Supplementation Compared With Room Air for Intrauterine Resuscitation: A Systematic Review and Meta-analysis that examined if oxygen administration impacted the fetus/newborn.  For decades, it had been assumed that this procedure prevented fetal hypoxia (oxygen deprivation) and improved outcomes for the newborn.  It is estimated that approximately 66% of people laboring in the United States labor receive oxygen at some point during the process. (Hamel, et al, 2014)  Cochrane reviews done in 2012 and 2016 had indicated that the evidence was not sufficient to be able to evaluate the effectiveness of oxygen during the intrapartum period. (Fawole, B., et al, 2012 and Catmongkolchart, S., et al, 2016)  Previous studies had shown a variety of results and some indicated that the fetus was more compromised at birth when oxygen is given during labor.  

What was being examined

The researchers wanted to compare outcomes on babies who received oxygen during labor or a planned cesarean birth versus those who where the birthing person just continued to breathe room air.

How was the research conducted

The researchers did a meta-analysis and systematic review (considered to be the gold standard of research) that was published in the JAMA Pediatrics journal.  The studies included in the analysis were all randomized clinical trials comparing maternal oxygen supplementation with just room air in pregnant people with single babies, regardless of oxygen dosing or system of administration (mask, cannula, etc).  The included studies looked at umbilical artery (UA) pH in the newborn along with APGAR scores and NICU admission. Statistical analysis was performed on data from the qualified studies.  16 articles met the standards for the review and were used for the analysis.  Ten trials included were on people having a planned cesarean, four were on people who were laboring and two included people having a planned or unplanned cesarean.  A total of 2052 people were included in the 16 studies, 1078 who received supplemental oxygen and 974 who did not.

What did the analysis find

Overall, there was no significant difference in UA pH in between the two groups.  There was also no significant differences in the one minute and five minute APGAR scores between the two groups.  NICU admissions did not note a significant difference between the two groups.

Discussion and Conclusion

After performing analysis of the 16 included studies, the researchers stated that their review suggested that  “peripartum maternal oxygen supplementation is not associated with a clinically relevant improvement in the UA pH or other neonatal outcomes.”

The researchers also state that additional research is necessary as published studies did not assess for administration of oxygen when abnormal fetal heart rate tracings were observed.  They acknowledge there is a need for an adequately powered study looking specifically at oxygen used for abnormal fetal heart rates during labor to be conducted.  Given the current lack of proven benefit, and a potential for harm to the fetus, they state that intrapartum oxygen use for fetal resuscitation should be limited until further research is conducted.

ACOG's practice advisory on this topic can be found here.

Relevance for educators

What is current common practice in the facilities in your community?  Has the administration of supplemental oxygen to the parent during labor been stopped?  Do you cover this topic during your classes?  Have you changed what you share?  Let us know in the comments below.

References

Chatmongkolchart S, Prathep S. Supplemental oxygen for caesarean section during regional anaesthesia. Cochrane Database Syst Rev. 2016;3:CD006161. doi: 10.1002/14651858.CD006161

Fawole B, Hofmeyr GJ. Maternal oxygen administration for fetal distress. Cochrane Database Syst Rev. 2012;12:CD000136. doi: 10.1002/14651858.CD000136.pub2

Hamel MS, Anderson BL, Rouse DJ. Oxygen for intrauterine resuscitation: of unproved benefit and potentially harmful. Am J Obstet Gynecol. 2014;211(2):124-127. doi: 10.1016/j.ajog.2014.01.004

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