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

Background  Although supplemental oxygen (SO 2 ) is routinely administered to laboring gravidas, benefits and harms are not well studied. Objective  This article compares strategies of liberal versus indicated SO 2 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 SO 2 was administered at the discretion of the provider followed by an 8-week period where SO 2 was to be given only for protocol indications. Results  Our study included 844 women. There was no difference in number of women receiving SO 2 (53% liberal vs. 50% indicated; p  = 0.33). For those receiving SO 2 , there was no difference in SO 2 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  Conclusion  Approximately half of women receive SO 2 intrapartum regardless of a strategy of liberal or indicated oxygen use. There were no clinically significant differences in outcomes between strategies.