An examination of the administration of intravenous fluids to women during labour

Abstract

Background: In Australia, midwives are integral to providing safe and supportive childbirth care. One clinical intervention managed by midwives is the administration of intravenous(IV) fluids during labour. However, practices lack comprehensive description, and there is limited robust evidence to guide midwives.

Methods: This mixed methods research examined IV fluids administration during labour. It comprised: (1) a retrospective clinical chart review and audit of fluid balance documentation;(2) qualitative interviews with midwives across Australia using reflexive thematic analysis to explore midwives’ perspectives on IV fluids administration; and (3) a retrospective cohort study examining maternal and neonatal outcomes.

Results: The study’s results included widespread clinical practice variation; insufficient evidence to support clinical practice; inadequate documentation of IV fluids practices; and the risk of adverse maternal and neonatal outcomes. The qualitative findings suggest that the current lack of evidence, education, and formal clinical guidance contribute to clinical uncertainty around the use of IV fluids in labour, hindering midwives’ ability to achieve optimal practice.

Conclusion: This thesis emphasises the importance of accurately documenting IV fluids administration during labour to enable better understanding of the broader implications on maternal and neonatal outcomes. The key findings highlight the Catch-22 situation hindering the progression of knowledge. Improved documentation to support research and clinical management are paramount. To achieve this, midwives require support to learn and recognise the importance of monitoring IV fluid practices during labour and integrating it fully into their role. It is imperative to proactively teach and implement the fundamentals of IV fluids administration.