Intrapartum hydration assessment and management: A cross-sectional survey of Australian and New Zealand maternity units

Background: Hydration assessment and management during labour play an important role in maternal and newborn outcomes. Studies indicate that clinical practice is inconsistent, with limited consensus evident in clinical guidelines. Current practices in fluid management across public and private maternity units within Australia and New Zealand remain unknown. Respondents highlighted the importance of maternal hydration assessment and management to well-being. However, inconsistencies were noted in the documentation, medication use and adherence to clinical protocols. Aim: Our study aimed to investigate unit-level clinical practice regarding intrapartum hydration assessment and management across Australian and New Zealand private and public hospitals. The scope of this study focuses on fluid management during both spontaneous and induced labour. Method: We conducted a cross-sectional, descriptive survey to assess the fluid management practices of Australian and New Zealand maternity services. Results: Of the 307 eligible maternity units, 89 participated (responding key informants included midwives, obstetricians, managers, and educators). All acknowledged the importance of maternal intrapartum hydration assessment and management. However, variations existed in assessment methods, with urine colour (87.6 %, n = 78) and frequency (84.3 %, n = 75), as well as maternal and fetal vital sign assessments (83.1 %, n = 74) being most prevalent. Documentation format and tools varied, and midwives identified this as their role. Despite the significance attributed to hydration by clinicians, not all felt confident in their capabilities to assess or manage intrapartum hydration. Free-text responses emphasised the significance of this topic from an educational perspective. Conclusion: Respondents highlighted the significance of maternal intrapartum hydration assessment and maternal and newborn well-being management. However, inconsistent documentation, medication usage, including intravenous fluids, and clinical protocols were evident.