Giving supplementary oxygen to women in labour to increase oxygen supply to the baby might not be necessary, a recent study has revealed.
The research noted that forgoing oxygen supplementation would help reduce “an unnecessary intervention and likely reduce health-care costs.”
Based on the study, which analysed conflicting evidence on whether the “long-recommended practice” improves infant health, babies born to women who received supplemental oxygen fared no better or no worse than those born to women who had similar labour experiences but breathed normal air.
Findings from the study, which was carried out by researchers in Washington University School of Medicine, St. Louis, US, was published in JAMA Pediatrics, a monthly peer-reviewed medical journal published by the American Medical Association.
Reacting to the study, the Executive Secretary, Nigerian Academy of Science, Dr. Doyin Odubanjo, agreed with the findings noting that giving oxygen to a mother in labour is “absolutely unnecessary on a good day.”
The Public Health Practitioner noted that labour and childbirth is a natural process, which on a good day, happens without assistance.
“That is why you hear of women delivering at home, in cars, taxis, and other places without medical intervention or assistance.
“Generally on a good day, the mother and child will always be in good health.
“However, those that might need assistance might not know, which is why a pregnant woman needs to deliver in a certified health facility, as no mother should die giving birth.
“So, we want to be sure they are in a place where they can be medically assisted if need be,” Odubanjo said.
The physician, however, said except where it is indicated that there is severe anaemia and the woman is probably bleeding, what a doctor should be thinking of is a blood transfusion.
“Otherwise, there is no need for oxygen at all. The physician is there to stand guard and help where necessary.
“That is the traditional expectation. It is only when there is a health emergency with the woman that intervention is necessary, including that of administering oxygen,” Odubanjo said.
The medical practitioner said when there is talk about a newborn being in distress and in need of oxygen, there is need to be sure of what is causing the distress and the type of medical intervention needed, adding, “if not, mere giving of oxygen will be a waste.
“Oftentimes, it might be diversionary, which means it might be taking your attention away from the real thing the mother or newborn needs.
Based on reports, babies that suffer oxygen deficiencies during birth are at risk of brain damage that can lead to developmental delays that include cerebral palsy and even death.
However, to prevent such occurrence, most women in labour undergo continuous monitoring of the baby’s heart rate and receive supplemental oxygen if it is abnormal, with the mindset that the procedure would increase oxygen delivery to the baby.
The researchers noted that each year, 1.5 million women in the U.S. and two out of three pregnant women, receive supplemental oxygen at some point during childbirth.
The decades-long practise, they noted, is recommended by the American College of Obstetricians and Gynecologists to treat abnormal fetal heart rates, which may indicate the baby’s oxygen levels are low and pose health risks.
They, however, maintained that it is not in any way helpful and advised that the practice could be safely stopped.
According to the lead author, an Assistant Professor of Obstetrics and Gynaecology and specialist in the Division of Maternal-Fetal Medicine, “It is such a common practice because the thought is that by giving mom oxygen, we are increasing oxygen transfer to the baby;
“However, the results of this study suggest that oxygen is not helpful in these cases and that the practice could be safely discontinued for many women.”
Raghuraman further noted that supplemental oxygen is given mostly as a preventive measure, adding that it is a practice that began during the 1960s.
“Fetal monitoring can indicate a possible abnormal issue such as oxygen deprivation,” she said, adding “But about 80 per cent of the time, women giving birth fall into an intermediate category, in which cases are not completely benign but also not high-risk.
“And in cases such as these, supplementing oxygen offers no additional benefits.”
Explaining how the research was carried out, the team said they examined 16 studies published from 1982 through 2020 of randomized controlled trials in humans, including one carried out by researchers in School of Medicine that involved over 2,052 women in childbirth.
“Overall, the studies produced mixed results, with some indicating a benefit and others indicating no benefit. That was the reason for doing a meta-analysis.
“By pooling the numbers of patients across the studies, we could get a more definitive answer than looking at individual studies,” Raghuraman said.
The lead author further noted that they evaluated the pH levels of the babies’ blood from samples taken shortly after birth.
He explained that pH measures the body’s acidity and alkalinity in the blood and other fluids, with a neutral equaling pH value of seven for infants, noting that anything less than 7.1 is considered abnormal and indicates oxygen deprivation.
Raghuraman also said they compared neonatal intensive care admission rates and Apgar scores, a well-established test to evaluate newborn health at one and five minutes after birth.
“Apgar scores check a baby’s heart rate, breathing and other signs to determine if the baby needs additional medical care.
“Comparing the health of the babies whose mothers received oxygen and those whose mothers didn’t, we found that the differences were essentially zero,” he added.
The researcher concluded that forgoing oxygen supplementation would help reduce unnecessary intervention and likely reduce health-care costs.
“It’s been shown that moms, despite having health insurance, often incur steep out-of-pocket costs related to childbirth.
“Although oxygen is generally an inexpensive intervention compared with other labour and delivery services, minimizing any unnecessary procedure is important,” Raghuraman said.
He disclosed that at Barnes-Jewish Hospital, where he works, the findings have begun to influence clinical care, adding, “We are being more judicious about giving supplemental oxygen to women during labour.”
Speaking further, he said though past studies have indicated that supplementing oxygen may be beneficial to women delivering via caesarean section, there is, however, need for further research to be carried out on the new findings.
She said, “We also want to look at whether exposing mom and baby to prolonged oxygen during labour may be harmful.
“Outside of labour and delivery, a lot of research shows that over-oxygenation is associated with oxidative stress that can cause the kind of cellular damage that has been implicated in conditions such as cerebral palsy and Alzheimer’s disease.
“Our findings contradict a general myth that oxygen bars and other ways of increasing oxygen intake is healthy and helpful to a person’s overall well-being.”
According to Healthline, researchers have found oxygen therapy increases the risk of death when given liberally to patients.
It noted that the use of oxygen only became common in medical practice in 1917, with the publication of ‘The Therapeutic Administration of Oxygen’ by John Scott Haldane, a Scottish physiologist.
The online medical portal pointed out that in the past one hundred years, oxygen therapy has grown from a nascent, untested intervention to a ubiquitous practice in homes and hospitals across the world.
“But now, a landmark study published in the journal, Lancet, is causing doctors to take a second look and reconsider how safe it really is.
“The study concludes that oxygen therapy increases the risk of death when given liberally to patients with acute illness, such as heart attack, stroke, and trauma.
“It’s been the general thought of many clinicians that oxygen is not a harmless intervention, however the available evidence, until we published our study, was not definite.
“It seems that giving more oxygen than needed can actually increase death in the hospital,” Waleed Alhazzani, one of the authors and assistant professor in Critical Care at McMaster University, said.
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