The Effect of Conservative versus Usual Intrapartum Fluid Management for Low Risk Women with Epidural Analgesia on Newborn Weight Loss in Breastfed Infants

There is uncertainty regarding how much intravenous fluid should be given to women in the intrapartum period. There are no published protocols or guidelines available to address fluid management in labour to optimize care for women and their infants. The absence of an evidence-based approach to intrapartum fluid management may result in fluid overload, with consequent maternal and newborn morbidity. The FILL Trial sought to answer the question, for low risk women receiving epidural analgesia in labour, ‘what is the effect of a conservative protocol for fluid management versus usual care on breastfed newborns’ weight loss prior to hospital discharge? The FILL Trial was a single site randomized controlled trial comparing a conservative protocol of fluid management with usual care for low risk women receiving epidural analgesia in labour. Women in the conservative care group received an IV volume prior to epidural analgesia initiation of 500 ml and an IV infusion rate of 200 ml per hour. The primary outcome of interest was the proportion of breastfed infants who lost > 7% of their birth weight prior to discharge. Two hundred women participated, 100 in the conservative care group and 100 in the usual care group. Forty-four infants in the conservative care group and 48 infants in the usual care group lost > 7% of their birth weight, p=0.57. There were no statistically significant differences between groups for breastfeeding outcomes or measures of newborn well being. More babies in the conservative care group required initial admission to the neonatal intensive care unit for septic work up for maternal fever. No septic work ups of the babies yielded positive results. More instrumental vaginal deliveries occurred in the conservative care group. No change in current practice is warranted for intrapartum intravenous fluid volumes < 2500 ml. Future research should focus on the creation of more evidence regarding safe volumes of intravenous fluid during labour.Ph