(Updated 2023)

(I know, I know….. this isn’t a very empowering image - it is so difficult to find images that show moms pushing in an upright position that I can use freely given copyright laws - but this is the reality of hospital birth for most moms).

I wrote this blog almost 3 years ago and the evidence continues to mount against using oxygen in labor to help babies that seem to be having difficulties yet it’s probably used in YOUR hospital today. ACOG (US Obstetrician’s regulatory body) published guidance in January 2022 AGAINST using oxygen for fetal distress.

Khloe Kardashian High Risk Pregnancy Video with an Oxygen Mask

You may have seen clips of Khloe Kardashian in labor online in the YouTube clip, with an oxygen mask on while Face Timing her sister “What’s wrong with you?” Jenner asks. “I needed to get the baby’s oxygen back up,” Kardashian responds. But does it help your baby at all or are there potential issues scientists are alerting us to but hospitals continue to ignore. Read on.

New 2020 Research Against Oxygen Administration During Labor

If you’ve recently given birth and were given oxygen during labor you probably thought nothing of it. Maybe you were given oxygen while pushing (to ‘help’ your baby)? Maybe there was a concern with your baby’s heart rate and your nurse or midwife asked you to turn over on to your left side as she handed you the oxygen mask, told you to breathe deeply and started an IV. (Keep in mind that sometimes these drops are totally normal especially if you’re getting close to pushing as your baby’s head is squeezed). So it might surprise you to learn that oxygen therapy in labor for babies may not be as safe as we previously believed and current thinking is that there is an urgent need for research to confirm if any potential benefits outweigh the risks. However new research published in June 2020 reconfirms that this is not evidence based practice and can be harmful for your baby.

Does giving you oxygen during labor really help your baby?

No. In fact it may be harmful.

Maureen Hamel, M.D., OB-GYN author of a paper published in the American Journal of Obstetrics and Gynecology notes that only two randomized trials have investigated the use of maternal oxygen administration during labor, and researchers haven't found it likely to benefit your baby.

"We know that oxygen can cause free radicals to develop, and free radicals have been proven to be harmful in other settings (like if Baby is born prematurely or suffers certain injuries later in life)," says Dr. Hamel. At the moment until we have good research that specific risk is theoretical.

There is a gas exchange happening throughout pregnancy and sometimes gas exchange between mother and baby can be interrupted. Giving mom pure oxygen instead of room air can change the values of your baby’s blood pH and how much oxygen actually gets to your baby. The vessels of placenta and umbilical cord are highly sensitive to pure oxygen and can cause them to constrict – reducing oxygenated blood to the uterus and baby even more. In other areas of medicine we’re learning that too much oxygen can cause cell damage in adults.

Interestingly there is no consensus around the world by Obstetricians and Pediatricians. UK guidelines explicitly advises NOT giving oxygen during labor for a baby suspected to be having difficulties. US guidelines still include oxygen therapy for suspected fetal distress but recent discussions in the American Journal of Obstetrics and Gynecology emphasized the current lack of evidence. Giving moms supplementary oxygen in labor in the belief that it helps - doesn’t prevent oxygen deprived babies. It does not prevent oxygen deprivation for babies at birth.

“An increasing body of evidence now demonstrates no benefit of intrapartum oxygen supplementation.”

— ACOG Practice Bulletin - January 2022

So Why Giving Oxygen During Labor is Still so Common?

Old habits die hard. There are several care options in labor that have limited benefit but changing the culture of a hospital isn’t easy. Talk to your careprovider about oxygen therapy in labor and other ways you can have the healthiest birth possible.

Here’s some suggestions of what you might like to explore for your birth.

Stay Off Your Back in Labor

It’s probably not news to you that lying on your back at full term isn’t advised as it reduces blood flow to your baby so it makes sense that laboring in bed and then pushing on your back isn’t the healthiest position for you or your baby. Moms who labor in upright positions have babies with less fetal heart pattern concerns. Choose a position that supports the mechanics of birth whether you have an epidural or not. Side lying or upright with the help of gravity.

Holding Your Breath when Pushing

Don’t hold your breath for long periods when pushing. It’s still common practice in many hospitals to advise mom to hold her breath for long periods when pushing. But this advice can impact your blood pressure, cardiac output and simply turns off oxygen to your body and your baby. Long slow deep breaths bring lots of oxygenated blood to your baby and will help reduce exhaustion. Only push when you have an overwhelming urge – if you have an epidural that urge may not feel as strong so ask your careprovider to give you more time for ‘passive descent’ which basically means you rest while your body keeps nudging your baby down.

Choose Intermittent Monitoring instead of EFM (CTG).

Choose intermittent monitoring of your baby’s heartrate instead of EFM especially if you and baby are healthy and well. The fancy machines have a high error rate of suspected fetal distress of over 99%. It’s not evidence based at all… let that sink in….

Learn Relaxation Techniques

When we are stressed important blood vessels constrict the movement of oxygen to non essential organs such as the digestive system…and yes the reproductive system. So the more stressed you are the less oxygenated blood is getting to the fabulous muscles of the uterus – and your baby. Meditation, hypnobirthing and slow breathing techniques are proven stress reducers in labor. Mindfulness practices are associated with less intervention overall.

Avoid Pitocin without a Really Good Reason

Pitocin drives your surges chemically and the goal is for you to have 4-5 long strong contractions in 10 minutes. With each contraction oxygenated blood to your baby is reduced - after the contraction oxygenated blood flow returns.

When Pitocin is used your uterus may not get enough resting time between these intense surges. I’m not anti-Pitocin there’s a time and a place for it but it is one of the most commonly used medications in the US today.

Hire a Doula

Consider hiring a doula who can help you with all of the above including position changes with an epidural. Having a birth doula with you in labor means you’re less likely to need an epidural, or Pitocin, you’re less likely to have an unexpected cesarean and you’re more likely to have a shorter more satisfying birth experience and meet your breastfeeding goals.

A note to nurses/midwives and OBs from specialist obstetrician and gynaecologist Dr. Kirsten Small on this important topic.

If your practice continues to involve applying oxygen when the CTG (EFM) is abnormal but the woman is well oxygenated, please desist forthwith. It doesn’t modify the heart rate pattern (and these researchers are far from the first to report this). Fussing about with oxygen masks draws clinician’s attention away from doing something that might be more appropriate, like identifying whether this is an appropriate physiological response to the eustress of labour, or whether something pathological is happening, for instance.
For more on this important topic and others relevant to evidence based maternity services visit Kristen’s blog

References:

Maternal Oxygen Administration during Labor: A Controversial Practice (2023)

ACOG Practice Bulletin: Jan uary 2022

Chandraharan, E. (2020). Maternal “Oxygen and Fluids Therapy” to Correct Abnormalities in the Cardiotocograph (CTG): Scientific Principles vs Historical (Mal) Practices. Journal of Advances in Medicine and Medical Research, 10-16. https://doi.org/10.9734/jammr/2020/v32i830460

Maureen S. Hamel, Brenna L. Anderson, Dwight J. Rouse. Oxygen for intrauterine resuscitation: of unproved benefit and potentially harmful. American Journal of Obstetrics and Gynecology, 2014; DOI: 10.1016/j.ajog.2014.01.004

Fawole B, Hofmeyr GJ. Maternal oxygen administration for fetal distress. Cochrane Database Syst Rev. 2012;12:CD000136.

Why Giving Oxygen During Labor is Not Recommended - But Still Common