Liberal versus Indicated Maternal Oxygen Supplementation in Labor: A Before-and-After Trial

Background: Although supplemental oxygen (SO₂) is routinely administered to laboring gravidas, benefits and harms are not well studied.

Objective: This article compares strategies of liberal versus indicated SO₂ therapy during labor on cesarean delivery (CD) rate and neonatal outcomes.

Study design: A controlled, before-and-after trial of laboring women with term, singleton pregnancies. During an initial 8-week period, maternal SO₂ was administered at the discretion of the provider followed by an 8-week period where SO₂ was to be given only for protocol indications.

Results: Our study included 844 women. There was no difference in number of women receiving SO₂ (53% liberal vs. 50% indicated; p = 0.33). For those receiving SO₂, there was no difference in SO₂ duration (median, 89 minutes [interquartile range, 42-172] vs. 87 minutes [36-152]; p = 0.42). There were no differences in overall CD rate (20% vs. 17%; p = 0.70), CD for nonreassuring fetal status, or use of intrauterine resuscitative measures. There were more 5-minute APGAR < 7 in the indicated group, but no difference in umbilical artery pH < 7.1 or neonatal intensive care unit (NICU) admission.

Conclusion: Approximately half of women receive SO₂ intrapartum regardless of a strategy of liberal or indicated oxygen use. There were no clinically significant differences in outcomes between strategies.