How dehydration in labour can increase the likelihood of medical interventions

If you’ve read the About page, you’ll know I've had the amazing opportunity to support women in labour as a doula for 15 years.

At one of our last prenatal appointments, we’d always chat about the practicalities of ‘labour day’; including what to pack, what to prepare, and what to eat and drink during labour.

This would lead to conversations about the importance of staying hydrated in labour, and how to plan ahead for this. Hint, it's more than bringing a water bottle.

Why it is so important?

Being dehydrated in labour can affect a woman's physical and mental stamina, her labour's progress and her need for medical interventions.

If her labour begins to slow or even stall due to dehydration, this can lead to receiving fluids via an IV drip.

Her mobility is usually affected as she is ‘connected’ to IV leads, drips and poles. Blood pressure will be monitored more closely so this can also ‘connect’ her closer to the bed and built-in equipment.

If her labour has slowed, or contractions have become irregular or not as strong nor effective, then she’s likely to receive synthetic oxytocin (syntocinon) via IV drip. This stimulates contractions and brings her labour back on. This is called augmentation of labour. This intervention alone can be the beginning of the slippery slope into the cascade of interventions.

Contractions artificially stimulated by syntocinon are often more intense and painful than those stimulated by her body’s natural oxytocin.

With this labour intervention, other protocols follow. This includes continuous fetal monitoring (CFM) via a cardiotocograph (CTG) machine (pictured below, at the top right of photo). This is because the synthetic IV hormone often promotes very strong and very regular contractions that can be ‘too much’ for the baby. When the uterus contracts the blood flow to the baby is effected. The CTG records the baby’s heart rate to help identify any potential oxygen problems occuring during labour. Oxygen issues can lead to complications such as cerebral palsy, brain damage, newborn seizures or death.

However, the evidence for CFM via CTG shows it results in a higher risk of ‘emergency’ caesarean birth (>200% increase in false positive for fetal distress), a higher risk for instrumental birth (vacuum and/or forceps) and a higher need for pain medication (e.g epidural). This is because the contractions are very different to ‘natural’ contractions, plus most women find being restricted to the bed is always more distressing and painful in labour.

With the loss of mobility to use the gift of gravity, women tend to stay on the syntocinon for the rest of their labour, especially after they have an epidural. This is because the epidural effects the nerve and muscle connections involved in efficient labour contractions. So, they typically require continuous stimulation for their labour to progress.

SUPPORTING ADEQUATE HYDRATION IN LABOUR

What do electrolytes have to do with hydration?

Electrolytes are tiny particles that carry electrical charges. They serve many roles throughout the body and are required for our optimal functioning. They play key roles in keeping water balanced both inside and outside of cells. This balance helps your muscles (e.g. your contracting uterus) function optimally.

Electrolytes help make the most of your water - this is the key to proper hydration. You can't be adequately hydrated, without balanced electrolytes.

Here's a quick run-down on the electrolytes. As you read through them, keep in mind how these actions relate to a woman in labour!

• Sodium - helps maintain fluid balance

  It's easily lost through sweat and excessive loss can lead to muscle cramps. It's required for maintaining fluid balance, nerve function, muscle contractions and acid-base balance.
  

• Potassium - helps prevent cramping

  Potassium works with sodium to help alleviate and prevent muscle cramps. Some is lost through sweating, but not as much as sodium.
  

• Calcium - helps regulate muscle contractions

  The most abundant mineral in the body, it serves many roles both in normal bodily functions, and athletic performance. It's involved in all types of muscle functions and contractions. It's also involved in the synthesis and breakdown of muscle and liver glycogen to be used as fuel stores.
  

• Magnesium - helps relax muscles

  Similar to how sodium and potassium function together, magnesium and calcium do the same. Calcium is essential for muscle contractions; magnesium aids in helping muscles relax. So the balance between the two is very important. 

When you sweat or vomit - two very likely events during labour - you lose both water and electrolytes. Knowing this, you can understand how electrolyte drinks that are high in sodium, potassium, magnesium and calcium, can help you stay hydrated. Remember with optimal fluid balance, you get optimal performance.

SOME TIPS

• Consider replacing or alternating plain water with coconut water, electrolyte drinks (but try to avoid the sickly sweet, artificial coloured ones), diluted fruit juice or chilled herbal teas (peppermint is refreshing, or consider Raspberry Leaf or the Birth Ready blend)

• Cold drinks, or those with ice are great once you're at the hot and sweaty point of labour ie. transition!

• Aim to drink 250-300ml per hour, also remembering to empty your bladder every ~2 hours to make room for your baby coming down. Setting an alarm on your partner's phone can be helpful here as you're likely to lose track of time!

• A bendy straw helps as labour progresses, so you don’t have to lift your head, move too much or hold anything.

• I created the Labourade powder to take with me to births as a doula. Prior to this, I would take cartons of coconut water with me - both heavy and bulky!

Labourade is a powder concentrate of electrolytes, magnesium, calcium, pineapple and honey.

It contains coconut water, also known as "nature's Gatorade" as it contains the 5 key electrolytes (above) plus phosphorus. It's designed to be mixed with water and sipped on during labour and/or made into frozen icy poles/ice blocks. These are great to suck or bite on during labour!

There are 12 servings in a Labourade pack; that is 15gm scoop into 500ml water. The generous 180gm pack makes 6 litres of Labourade drink. This is enough to last for a full 24 hours labour, if need be!

Otherwise, any leftovers are great to quench that breastfeeding thirst!