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Restricting oral fluid and food intake during labour

  1. Mandisa Singata1,*,
  2. Joan Tranmer2,
  3. Gillian ML Gyte3

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 22 AUG 2013

Assessed as up-to-date: 9 JUL 2013

DOI: 10.1002/14651858.CD003930.pub3


How to Cite

Singata M, Tranmer J, Gyte GML. Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD003930. DOI: 10.1002/14651858.CD003930.pub3.

Author Information

  1. 1

    University of the Witwatersrand/University of Fort Hare/East London Hospital complex, Effective Care Research Unit, East London, South Africa

  2. 2

    Queen's University, School of Nursing, Kingston, Ontario, Canada

  3. 3

    The University of Liverpool, Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, Liverpool, UK

*Mandisa Singata, Effective Care Research Unit, University of the Witwatersrand/University of Fort Hare/East London Hospital complex, East London, South Africa. mandisa.singata@gmail.com. mandisa.singata@gmail.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 22 AUG 2013

SEARCH

 
Characteristics of included studies [ordered by study ID]
Kubli 2002

MethodsRCT of individual women.


ParticipantsInclusion: women at low risk of complications in early labour (> 37 weeks; singleton; cephalic; < 5 cm dilatation).

N = 60.

Exclusion: obstetric or medical complication; increased likelihood OVB or CS; mothers requesting IM meperidine.


InterventionsIntervention: water only, as much as desired.

Comparison: isotonic sports drink (dextrose, maltolactose, glucose, 28 kcal/dL), women encouraged to drink 500 mL in 1st hour and further 500 mL every 3-4 hours. Small quantities of water were also available if desired.


OutcomesVomiting; duration of labour; oxytocin augmentation; mode of birth; Apgar scores; umbilical artery and venous blood gasses.  

Also: plasma ß-hydroxybutryate; NEFAs; glucose measured early and at end of 1st stage of labour; residual gastric volume (assessed using real-time ultrasound).


Notes
  • Review comparison 1 and 10.
  • The isotonic sport drinks were acceptable to most mothers in the sport drink group, with only 1 woman refusing to consume more than 200 mL for the study.
  • Data on metabolic gastric volume and vomiting data were analysed by parametric methods using linear regression analysis, adjusting for baseline as appropriate.
  • At the end of labour, plasma ß-hydroxybutryate (principal ketone produced in starvation) and nonesterified fatty acids were significantly raised and plasma glucose significantly decreased in the water-only group.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskComputer random number generation.

Allocation concealment (selection bias)Unclear risk"Sealed envelopes were opened after recruitment to the study” but no mention if numbered or if opaque.

Blinding (performance bias and detection bias)
All outcomes
Unclear riskNo information on blinding.

Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskNo information on blinding.

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskNo information on blinding of assessors.

Incomplete outcome data (attrition bias)
All outcomes
Low riskNo women withdrew from the study.

Selective reporting (reporting bias)Unclear riskNot apparent but we did not assess the protocol so cannot be sure.

Other biasLow riskNo evidence of other bias.

O'Sullivan 2009

MethodsRCT of individual women.


ParticipantsInclusion: women in labour at low risk of complications (no known obstetric or medical complication that would increase the likelihood of operative birth; nulliparous; singleton; cephalic; > 36 weeks; no diabetes; but included induction and augmentation); also women were < 6 cm.

N = 2443 women randomised, 2426 women analysed.

Exclusion: multiparous; women with a known obstetric or medical complication that could have increased the likelihood of an operative birth, were in severe pain, intended to use parenteral opioids for analgesia in labour; unable to understand English (and no interpreter available).


InterventionsIntervention: water and ice chips only.

Comparison: specific foods and fluids encouraged (women advised to consume low fat, low-residue diet at will during labour). Foods advised were: bread, biscuits, vegetables, fruits, low fat yoghurt, soup, isotonic drinks and fruit juice.


OutcomesPrimary: spontaneous vaginal birth.

Secondary: included: duration of labour; use of IV oxytocin for augmentation; CS; OVB; food intake in 6 hours before labour (snacks/light meal/large meal); food intake in labour (no intake/water only/calorific drinks/solids).


Notes
  • Review comparison 1 and 7.
  • 20% of women in the water-only group ate in labour and 29% of women in the food and fluid group choose not to eat during labour.
  • There were high intervention rates for women assessed as at low risk (women with a known obstetric or medical complication that could have increased the likelihood of an operative birth were excluded, though induction and augmentation were included) ( Table 1). It is unclear how these high rates in interventions arose in the low-risk population.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"...computer randomisation..."

Allocation concealment (selection bias)Low risk“Entry of a woman’s initials, hospital number, and date of birth on to a dedicated computer on the labour ward automatically generated the allocation group together with a study number, which was then recorded on the outcomes sheet. These data could, if necessary, be verified against the computer randomisation at a later date.”

Blinding (performance bias and detection bias)
All outcomes
High risk"The attending obstetricians and midwives made all the relevant decisions about the woman’s obstetric management but obviously could not be blinded to trial allocation. The people deciding on obstetric interventions were generally unaware of the trial intervention allocation and had no vested interest in the study."

Blinding of participants and personnel (performance bias)
All outcomes
High risk"The attending obstetricians and midwives made all the relevant decisions about the woman’s obstetric management but obviously could not be blinded to trial allocation."

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on this is not clear in the publication.

Incomplete outcome data (attrition bias)
All outcomes
Low risk
  • 2443 women were randomised but 17 were excluded from final analysis, leaving 2426. 9 were lost from the water-only group (1 withdrew, 4 were multiparous, 1 diabetic, 1 breech, 1 subarachnoid haemorrhage death and 1 had no data) and 8 from the eating group (2 withdrew, 4 multiparous, 1 diabetic and 1 had no data).


  • Although the authors report the study as ITT, it is not strictly so because of 17 exclusions, so ‘available data analysis’, but the loss of 17/2443 (0.6%) is unlikely to impact on outcomes.

Selective reporting (reporting bias)Unclear riskPaper specifies some of the outcomes to be assessed and we did not assess the protocol.

Other biasUnclear risk20% of women in the water-only group ate in labour. This may have caused some bias in the outcome estimations, but shows in part women's views of restricting food and fluids during labour.

29% of women chose not to eat any food during labour. This would be considered part of women's freedom of choice whether to eat or not during labour.

Scheepers 2002

MethodsRCT of individual women.


ParticipantsInclusion: nulliparous women in early labour (singleton; cephalic; 2-4 cm dilatation).

N = 203.

Exclusion: elective CS; multiple pregnancy; diabetes, and women who were considered by the attending clinician to have a direct risk for a CS.


InterventionsIntervention: flavoured water (artificial aroma, aspartame, acesulfame), as much as desired.

Comparison: carbohydrate drink (per 100 mL: 12.6 g carbohydrates: 9.8% polysach/Na: 50 mg, Osm: 280 mOsm/L), as much as desired.


OutcomesDuration of the active labour (i.e. from randomisation to birth), pain medication; augmentation; the mode of birth, fetal presentation; birthweight, fetal arterial cord pH and Apgar scores.


Notes
  • Review comparison 1 and 10.
  • 81.5% of women pregnancies considered at increased risk of complications (water group 83% and CHO group 80%), e.g. non-progressing labour, meconium, fetal distress, hypertension/pre-eclampsia, duration of pregnancy > 42 weeks, duration of pregnancy < 37 weeks, small-for-gestational age, maternal disease. These either arose during the study or were considered at recruitment not leading to an increased risk of requiring a CS.
  • In both groups, no additional food or drinks were offered, but on specific demand, women could take small standardised amounts of food or drinks. About 32% of women in each group had additional intake.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk'Computerised list.'

Allocation concealment (selection bias)Low risk'Drawing consecutive envelopes, which included numbers of a computerised list corresponding to numbered bottles in identical packages.'

Blinding (performance bias and detection bias)
All outcomes
Low risk'In identical packages’ ‘both solutions had an identical taste and colour and were prepared by the producer of the carbohydrates.'

Blinding of participants and personnel (performance bias)
All outcomes
Low risk'In identical packages’ ‘both solutions had an identical taste and colour and were prepared by the producer of the carbohydrates.'

Blinding of outcome assessment (detection bias)
All outcomes
Low risk'In identical packages’ ‘both solutions had an identical taste and colour and were prepared by the producer of the carbohydrates.'

Incomplete outcome data (attrition bias)
All outcomes
Low riskData were missing in 2 women and so less than 1% which should not affect outcomes.

Selective reporting (reporting bias)Unclear riskNot apparent, but we did not assess the protocol so cannot be sure.

Other biasLow riskNo evidence of other bias.

Scrutton 1999

MethodsRCT of individual women, stratified by parity and induction.


ParticipantsInclusion: women at low risk of complications in early labour (> 37 weeks; singleton; cephalic; < 5 cm dilatation).

N = 94.

Exclusion: obstetric or medical complication increasing the likelihood of instrumental delivery or CS; requesting IM pethidine for analgesia.


InterventionsIntervention: water only.

Comparison: low residue food (women were allowed to select from a low-residue diet throughout the course of labour).


OutcomesVomiting; duration of first and second stage of labour; oxytocin requirements; mode of birth; Apgar scores; umbilical artery and venous blood gases.

Also: plasma ß-hydroxybutyrate; nonesterified fatty acids; glucose; insulin and lactate; gastric volume.


Notes
  • Review comparison 1 and 7.
  • Groups were similar in relation to age, parity, induction, cervical dilatation at randomisation. Epidural rate was 40%.
  • Power calculation based on biochemical parameters.
  • Metabolic, gastric volume and vomiting data were analysed using linear regression analysis with dummy variables for treatment, adjusting baseline as appropriate.
  • ß-hydroxybutyrate (principle ketone produced in starvation) and nonesterified fatty acids were significantly increased in the water-only group.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskNo information provided.

Allocation concealment (selection bias)Unclear riskSealed, pre-randomised envelopes.

Blinding (performance bias and detection bias)
All outcomes
High riskBlinding of participants and clinician was not feasible.

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants and clinician was not feasible.

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding of outcome assessor was not provided

Incomplete outcome data (attrition bias)
All outcomes
Low risk2 women withdrew from the trial (1 from each group). 4 (2 from each group) were excluded because they reached the second stage of labour within 1 hour of entry to the study. Their data could not be re-included but were not considered large enough (6%) to impact differentially on outcomes.

Selective reporting (reporting bias)Unclear riskNot apparent, but we did not assess the protocol so cannot be sure.

Other biasLow risk2 groups were similar with respect to age, parity, induction and cervical dilatation at the time of randomisation.

Tranmer 2005

MethodsRCT of individual women at low risk of complications.


ParticipantsInclusion: women at low risk of complications (> 30 weeks; singleton; no recorded maternal or fetal complication).

N = 330.

Exclusion: planned CS; maternal illness such as oral intake would be restricted during labour and IV therapy required (e.g. diabetes); fetal compromise such that there was high risk of CS (e.g. severe FGR, fetal anomalies).


InterventionsIntervention: ice chips and sips water (women were permitted ice chips, popsicles, or sips of fluid during active labour. Women received no specific or written instructions on oral intake during labour and were permitted).

Comparison: unrestricted access to their choice of food and fluids during labour (women received a booklet containing easy-to-read guideline on suggested nutrient and fluid intake during labour based on nutritional guidelines for individuals who participate in prolonged, moderate, aerobic exercise. Women in the intervention group were encouraged to eat easily digestible foods or fluids in frequent and small amounts and to bring their own selection of desired food and drinks. Although the investigators suggested certain foods and fluids, women were free to consume what they desired).


OutcomesPrimary: incidence of dystocia (mean rate of dilatation of < 0.5 cm/hr during a period of at least 4 hours after 3 cm cervical dilatation).

Secondary: perception of thirst, hunger, nausea, and fatigue; labour length, the incidence of medical interventions during labour, fluid and nutrient balance, and the incidence of maternal and newborn complications.


Notes
  • Review comparison 1 and 2.
  • There is a typing error in the published paper. Where it reports (page 323) "Intravenous therapy was initiated in 85% (n = 278) of all labours, generally between 3 and 4 cm dilatation. Normal saline or Ringers lactate solutions were the most common solutions used in conjunction with epidural. When labours were augmented with oxytocin, the oxytocin was administered in a solution of 2/3 glucose and 1/3 saline". This should have read "Intravenous therapy, with isotonic solutions of either Ringer's lactate or normal saline, was used in 85% of labours (n = 278), most commonly for initiation of oxytocin therapy or fluid hydration for initiation of epidural analgesia. In 2 instances, one in the control and one in the intervention group, women received a solution of 2/3 glucose and 1/3 saline". (Tramner 2009, personal communication).
  • During early labour at home, most women in both groups tended to follow their normal dietary pattern with around 50% reporting carbohydrate intake. Oral intake was recorded both at home and in hospital.
  • Oral intake (but not inclusion in the study) was restricted when women developed intrapartum complications or had epidural analgesia.
  • Women rated their perceptions of thirst, hunger, nausea and fatigue on 7-point Linkert-type scales anchored at each end with descriptors, such as worst nausea to no nausea.
  • Intervention rates: IV oxytocin 41%; epidurals 77%; CS 22%; OVB 2%.
  • Of the 78% who returned the questionnaire, 56% (63/119) of women in the unrestricted access group reported they ate or drank some source of carbohydrates, in comparison to only 13% (15/120) in the ice-chips/sips of water-only group.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"...computer-generated group assignment designations."

Allocation concealment (selection bias)Low risk“..sequentially numbered opaque envelopes...”

Blinding (performance bias and detection bias)
All outcomes
High riskParticipants and clinicians cannot be blinded.

Blinding of participants and personnel (performance bias)
All outcomes
High riskParticipants and clinicians cannot be blinded

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskNo information provided.

Incomplete outcome data (attrition bias)
All outcomes
Low risk2 women withdrew after randomisation. 

Primary outcomes and clinical estimates, none from restricted group and 2 women lost from freedom to E&D group.

For data from questionnaires; 22% (72/330) lost - more than 20% loss so some risk of bias. Losses were 24% in ice chips group and 19% in free to E&D group.

Overall for clinical outcomes, loss of data probably not significant.                                                  

Selective reporting (reporting bias)Low riskAll pre-specified outcomes were reported and we assessed the protocol as set out in the author's thesis (Tranmer 2005).

Other biasUnclear riskOral intake was restricted when women developed intrapartum complications or had epidural analgesia. Epidural analgesia was used in 120/165 (73%) of women in the water-only group and 129/163 (79%) women in the freedom to eat group. It is unclear whether this impacted on outcomes.

Of the 78% who returned the questionnaire, 56% (63/119) of women in the unrestricted access group reported they ate or drank some source of carbohydrates, in comparison to only 13% (15/120) in the ice-chips/sips of water-only group

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Ciura 2012The purpose of this study was to assess if additional energy drinks could improve outcomes. Both groups of women were allowed additional oral food intake and there was no restriction of fluids and food.

Goodall 1999This was an RCT of women at low risk of complications randomised to sips of water or feeding in labour. We attempted to contact the author but without success. The publication was a trial registration form with no available data.

Kardel 2010The purpose of this study was to assess if additional energy, above women eating and drinking at will, might improve outcomes. There was no restriction of fluid and food in this study.

Laifer 2000This was an RCT of women at low risk of complications randomised to iced water plus IV hydration compared with women given clear oral liquids. This was a conference abstract only, and we tried to contact the authors but as yet with no success. It is unclear what 'clear liquids' meant and whether these contain sugars or not.

Scheepers 2004The study was not looking at the same participants as the review. The participants in the study were women at 8-10 cm dilatation given high glucose load.

Shennan 2005This is a discussion paper.

Yiannouzis 1994This was an RCT of women at low risk of complications randomised to water only or women offered a low-fat diet during labour. Through personal communication with the author we understand the data are no longer available. The study reported the following. There was no statistical difference identified between the 2 groups in the outcomes of labour except in the occurrence of vomiting and length of labour. Women in the low-fat diet group were twice as likely to vomit as those in the control group and their labours were longer.

Most women did not crave large amounts of food during labour. Some women commented that vomiting is less unpleasant if the stomach is not empty. The increased length of labour may not have been perceived as totally negative as women applauded the availability of choice and the improved social context of labour when food was offered.

Zhao 1996This was a quasi RCT of healthy nulliparous women in labour randomised to routine diet in labour or a high-energy liquid diet in labour. The study was published in Chinese and we had it translated but no data were presented.

 
Characteristics of studies awaiting assessment [ordered by study ID]
Kordi 2010

MethodsRCT - double blind.

ParticipantsNulliparous women in labour, at low-risk; singleton; vertex; spontaneous labour; > 4 cm dilation.

InterventionsIntervention: small quantities of water plus placebo.

Comparison: honey-date syrup.

OutcomesDuration of labour.

NotesWe are trying to contact the authors for information on how many women were in each group, standard deviations and information for the 'Risk of bias' assessment.

 
Characteristics of ongoing studies [ordered by study ID]
Davila-Exposito 2009

Trial name or titleDavila-Exposito study.

MethodsRCT.

ParticipantsIncluson criteria: women in labour attending 1 of the 2 hospitals (University Hospital “Joan XXIII” in Tarragona, and University Hospital “Verge de la Cinta” in Tortosa, Spain). Women at low or medium risk (of complications during labour), women in active labour, without epidural, who want to participate in the study.

Exclusion criteria: women > 5 cm dilated, women in labour using prostaglandins/oxytocins, women taking anxiolytics/antidepressants, women who want delayed cord clamping.

InterventionsIntervention: water.

Comparison: isotonic drinks (Gatorade, Isostar, Aquarius).

OutcomesDuration of labour; times vomited; maternal glycaemia – measured at beginning of labour and birth; level of maternal satisfaction; ketonuria; posture during dilation; variability; fetal wellbeing; neonatal glycaemia determined by testing the blood in the umbilical cord; Apgar score; pH of foetal blood tested in the umbilical cord.

Starting date

Contact informationA. Dávila Expósito. Correo electrónico: kilima78@gmail.com

NotesNew. Published protocol in Spanish.

Espinosa 2011

Trial name or titleEspinosa study.

MethodsRCT - open label.

ParticipantsInclusion criteria: women in labour, gestation > 37 weeks, cervical dilation < 5 cm (348 women).

Exclusion criteria: maternal pathologies (diabetes, heart disease, pre-eclampsia); breech presentation or any other condition that is an indication of caesarean section; premature rupture of membranes.

InterventionsIntervention: fasting - no intake of fluids during labour.

Comparison: oral intake of fluids during labour, from admission (dose: 2 cups of 8 ounces each of clear tea with little sugar).

OutcomesDuration of labour (measured in minutes from admission to delivery); number of caesarean sections due to prolonged second stage of labour; number of cases of broncho-aspiration.

Starting dateSeptember 2011.

Contact informationJorge Espinosa, Saint Thomas Hospital, Panama.

NotesClinicalTrials.gov: NCT01349686: http://clinicaltrials.gov/ct2/show/NCT01349686 (accessed 16 October 2012). Trial completed.

Heidari 2012

Trial name or titleHeidari study (The effect of oral honey intake on labour progress among nulliparous women).

MethodsRCT.

ParticipantsInclusion criteria: women on labour: age between 35-18 years, gestation between 37 and 42 completed weeks based on the first day since last menstrual period or ultrasound, as a physiologic delivery (no intervention) and the existence of at least 5 cm dilatation.

Exclusion criteria: lack of obstetric problems history (such as eclampsia, pre-eclampsia, placenta previa, placental abruption, multiple pregnancy, chorioamnionitis , meconium-stained amniotic fluid, polyhydramnios) and psychological problems (e.g. death of parents, spouse, child, separation from a spouse, serious differences with her husband, a major change in life situation, severe financial problems over the past month).

InterventionsIntervention: placebo and women can drink some water for thirst.

Comparison: honey: honey syrup, solution of honey (equivalent to 70 g of carbohydrate) and 140 cc water will be given a half hour after admission. The solution of honey (equivalent to 30 g of carbohydrate) and 600 cc water will be given every half hour (100 cc per each time).

OutcomesLabour progress.

Starting date21 April 2011.

Contact informationTooba Heidari, Arak University of Medical Science, Arak, Markazi, Iran. 4173503-7. heidari.m.831@gmail.com

NotesOther: IRCT201102041845N4: http://www.irct.ir/searchresult.php?id=1845&number=4 (accessed 16 October 2012). data collection complete.

Simonet 2012

Trial name or titleSOLISO (Evaluation of the Benefits of Glucose Drinks During Childbirth.

MethodsRCT - open label.

ParticipantsInclusion criteria: women in labour, 18 years or over.

Exclusion criteria: more of 8 cm of dilatation; caesarean section planned; natural delivery non-indicated; pre-partum haemostasis troubles; salicylic acid or anticoagulant treatment; pre-eclampsia or HELLP syndrome; diabetic neuropsy with troubles in gastric emptying; lack of understanding of the information; under guardianship.

InterventionsIntervention: fasting.

Comparison: glucose drink.

OutcomesInstrumental births.

Starting dateJanuary 2008.

Contact informationThérèse Simonet, University Hospital, Caen.

NotesClinicalTrials.gov: NCT01022697: http://clinicaltrials.gov/ct2/show/NCT01022697 (accessed 16 October 2012).

Yarvani 2011

Trial name or titleYarvani study (A randomized controlled trial to compare the effect of oral carbohydrate intake or fasting in low-risk women during labor progress).

MethodsRCT.

ParticipantsInclusion criteria: women in labour at low-risk; singleton cephalic presentation; and cervical dilatation 3-4 cm.

Exclusion criteria: caesarean section; fast labour; and fetal compromise.

InterventionsIntervention: water only.

Comparison: carbohydrates: women were advised to consume 3 medium dates with 110 mLwater; or 3 dates with 110 mL light tea without sugar; or 110 mL orange juice drink based on their preferences. The protocol is only run once but women ate and drank gradually before second stage of labour.

OutcomesDuration of active phase of labour: frequency and volume of vomiting; neonatal heart rate; Apgar scores; birthweight.

Starting date4 March 2008.

Contact informationRoghayeh Rahmani, 22 Bahman Hospital, Gonabad University of Medical Sciences, Gonabad, Razavi Khorasan 96916, Iran.

Email: roghaiehrahmany@yahoo.com

NotesOther: IRCT201105155805N2: http://www.irct.ir/searchresult.php?id=5805&number=2 (accessed 16 October 2012)

 
Comparison 1. Any restriction of oral fluid and food versus some fluid and food

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Caesarean section (primary outcome)53103Risk Ratio (M-H, Random, 95% CI)0.89 [0.63, 1.25]

    1.1 Women at low risk of caesarean/complications
53103Risk Ratio (M-H, Random, 95% CI)0.89 [0.63, 1.25]

   1.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   1.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 2 Operative vaginal birth (primary outcome)53103Risk Ratio (M-H, Random, 95% CI)0.98 [0.88, 1.10]

    2.1 Women at low risk of caesarean/complications
53103Risk Ratio (M-H, Random, 95% CI)0.98 [0.88, 1.10]

   2.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

3 Maternal satisfaction (primary outcome)00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   3.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   3.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   3.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 4 Apgar < 7 at 5 min (primary outcome)42902Risk Ratio (M-H, Random, 95% CI)1.43 [0.77, 2.68]

    4.1 Women at low risk of caesarean/complications
42902Risk Ratio (M-H, Random, 95% CI)1.43 [0.77, 2.68]

   4.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   4.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

5 Neonatal hypogylcaemia (primary outcome)00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   5.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   5.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   5.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 6 Maternal ketoacidosis1328Risk Ratio (M-H, Random, 95% CI)0.99 [0.66, 1.49]

    6.1 Women at low risk of caesarean/complications
1328Risk Ratio (M-H, Random, 95% CI)0.99 [0.66, 1.49]

   6.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   6.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

7 Maternal dehydration00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   7.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   7.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   7.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

8 Maternal hyponatraemia00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   8.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   8.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   8.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

9 Maternal hypoglycaemia00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   9.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   9.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   9.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 10 Duration of labour (hours)3476Mean Difference (IV, Random, 95% CI)-0.29 [-1.55, 0.97]

    10.1 Women at low risk of caesarean/complications
3476Mean Difference (IV, Random, 95% CI)-0.29 [-1.55, 0.97]

   10.2 Women at increased risk of caesarean/complications
00Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   10.3 Women with no defined risk status
00Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

11 Mobility in labour00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   11.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   11.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   11.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 12 Maternal nausea1255Risk Ratio (M-H, Random, 95% CI)0.80 [0.54, 1.18]

    12.1 Women at low risk of caesarean/complications
1255Risk Ratio (M-H, Random, 95% CI)0.80 [0.54, 1.18]

   12.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   12.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 13 Maternal vomiting32574Risk Ratio (M-H, Random, 95% CI)0.90 [0.62, 1.31]

    13.1 Women at low risk of caesarean/complications
32574Risk Ratio (M-H, Random, 95% CI)0.90 [0.62, 1.31]

   13.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   13.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 14 Augmentation of labour53103Risk Ratio (M-H, Random, 95% CI)1.02 [0.95, 1.09]

    14.1 Women at low risk of caesarean/complications
53103Risk Ratio (M-H, Random, 95% CI)1.02 [0.95, 1.09]

   14.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   14.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 15 Narcotic pain relief3349Risk Ratio (M-H, Random, 95% CI)0.94 [0.74, 1.21]

    15.1 Women at low risk of caesarean/complications
3349Risk Ratio (M-H, Random, 95% CI)0.94 [0.74, 1.21]

   15.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   15.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 16 Epidural analgesia53103Risk Ratio (M-H, Random, 95% CI)0.98 [0.91, 1.05]

    16.1 Women at low risk of caesarean/complications
53103Risk Ratio (M-H, Random, 95% CI)0.98 [0.91, 1.05]

   16.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   16.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

17 Poor maternal expulsive efforts00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   17.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   17.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   17.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 18 Regurgitation during general anaesthesia12426Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    18.1 Women at low risk of caesarean/complications
12426Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   18.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   18.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 19 Mendelson's syndrome22754Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    19.1 Women at low risk of caesarean/complications
22754Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   19.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   19.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

20 Maternal mortality00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   20.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   20.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   20.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

21 Postpartum haemorrhage (> 1000 ml)00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   21.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   21.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   21.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

22 Maternal admission to intensive care00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   22.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   22.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   22.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

23 Length of maternal hospital stay00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   23.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   23.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   23.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

24 Maternal comfort00Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   24.1 Women at low risk of caesarean/complications
00Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   24.2 Women at increased risk of caesarean/complications
00Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   24.3 Women with no defined risk status
00Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

25 Maternal feelings of pain, thirst or hunger00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   25.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   25.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   25.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

26 Fully breastfeeding at discharge00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   26.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   26.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   26.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

27 Maternal feelings of control00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   27.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   27.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   27.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

28 Fetal distress00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   28.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   28.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   28.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

29 Cord blood pH < 7.200Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   29.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   29.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   29.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

30 Infant hyperinsulinism00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   30.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   30.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   30.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

31 Infant hyponatraemia00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   31.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   31.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   31.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

32 Infant intravenous therapy00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   32.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   32.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   32.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

33 Infant gavage feeding00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   33.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   33.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   33.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 34 Infant admission to intensive care12426Risk Ratio (M-H, Random, 95% CI)1.03 [0.73, 1.45]

    34.1 Women at low risk of caesarean/complications
12426Risk Ratio (M-H, Random, 95% CI)1.03 [0.73, 1.45]

   34.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   34.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

35 Length of infant hospital stay00Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   35.1 Women at low risk of caesarean/complications
00Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   35.2 Women at increased risk of caesarean/complications
00Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   35.3 Women with no defined risk status
00Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

 
Comparison 2. Complete restriction of oral fluid and food (other than ice chips) versus freedom to eat and drink

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Caesarean section (primary outcome)1328Risk Ratio (M-H, Fixed, 95% CI)0.77 [0.51, 1.16]

    1.1 Women at low risk of caesarean/complications
1328Risk Ratio (M-H, Fixed, 95% CI)0.77 [0.51, 1.16]

   1.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   1.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 2 Operative vaginal birth (primary outcome)1328Risk Ratio (M-H, Fixed, 95% CI)0.99 [0.72, 1.35]

    2.1 Women at low risk of caesarean/complications
1328Risk Ratio (M-H, Fixed, 95% CI)0.99 [0.72, 1.35]

   2.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   2.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

3 Maternal satisfaction (primary outcome)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   3.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   3.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   3.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 4 Apgar < 7 at 5 min (primary outcome)1328Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

    4.1 Women at low risk of caesarean/complications
1328Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   4.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   4.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

5 Neonatal hypogylcaemia (primary outcome)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   5.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   5.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   5.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 6 Maternal ketoacidosis1328Risk Ratio (M-H, Fixed, 95% CI)0.99 [0.66, 1.49]

    6.1 Women at low risk of caesarean/complications
1328Risk Ratio (M-H, Fixed, 95% CI)0.99 [0.66, 1.49]

   6.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   6.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

7 Maternal dehydration00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   7.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   7.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   7.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

8 Maternal hypoglycaemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   8.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   8.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   8.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

9 Maternal hyponatraemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   9.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   9.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   9.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 10 Duration of labour (hours)1328Mean Difference (IV, Fixed, 95% CI)-0.80 [-2.13, 0.53]

    10.1 Women at low risk of caesarean/complications
1328Mean Difference (IV, Fixed, 95% CI)-0.80 [-2.13, 0.53]

   10.2 Women at increased risk of caesarean/complications
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   10.3 Women with no defined risk status
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

11 Mobility in labour00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   11.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   11.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   11.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 12 Maternal nausea1255Risk Ratio (M-H, Fixed, 95% CI)0.80 [0.54, 1.18]

    12.1 Women at low risk of caesarean/complications
1255Risk Ratio (M-H, Fixed, 95% CI)0.80 [0.54, 1.18]

   12.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   12.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

13 Maternal vomiting00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   13.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   13.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   13.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 14 Augmentation of labour1328Risk Ratio (M-H, Fixed, 95% CI)0.98 [0.81, 1.18]

    14.1 Women at low risk of caesarean/complications
1328Risk Ratio (M-H, Fixed, 95% CI)0.98 [0.81, 1.18]

   14.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   14.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

15 Narcotic pain relief00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   15.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   15.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   15.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 16 Epidural analgesia1328Risk Ratio (M-H, Fixed, 95% CI)0.92 [0.81, 1.04]

    16.1 Women at low risk of caesarean/complications
1328Risk Ratio (M-H, Fixed, 95% CI)0.92 [0.81, 1.04]

   16.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   16.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

17 Poor maternal expulsive efforts00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   17.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   17.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   17.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

18 Regurgitation during general anaesthesia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   18.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   18.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   18.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 19 Mendelson's syndrome1328Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

    19.1 Women at low risk of caesarean/complications
1328Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   19.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   19.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

20 Maternal mortality00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   20.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   20.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   20.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

21 Postpartum haemorrhage (> 1000 ml)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   21.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   21.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   21.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

22 Maternal admission to intensive care00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   22.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   22.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   22.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

23 Length of maternal hospital stay00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   23.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   23.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   23.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

24 Maternal comfort00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   24.1 Women at low risk of caesarean/complications
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   24.2 Women at increased risk of caesarean/complications
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   24.3 Women with no defined risk status
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

25 Maternal feelings of pain, thirst or hunger00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   25.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   25.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   25.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

26 Fully breastfeeding at discharge00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   26.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   26.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   26.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

27 Maternal feelings of control00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   27.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   27.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   27.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

28 Fetal distress00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   28.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   28.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   28.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

29 Cord blood pH < 7.200Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   29.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   29.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   29.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

30 Infant hyperinsulinism00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   30.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   30.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   30.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

31 Infant hyponatraemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   31.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   31.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   31.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

32 Infant intravenous therapy00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   32.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   32.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   32.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

33 Infant gavage feeding00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   33.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   33.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   33.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

34 Infant admission to intensive care00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   34.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   34.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   34.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

35 Length of infant hospital stay00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   35.1 Women at low risk of caesarean/complications
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   35.2 Women at increased risk of caesarean/complications
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   35.3 Women with no defined risk status
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 
Comparison 7. Water only versus specific oral fluid and food

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Caesarean section (primary outcome)22514Risk Ratio (M-H, Fixed, 95% CI)1.02 [0.91, 1.15]

    1.1 Women at low risk of caesarean/complications
22514Risk Ratio (M-H, Fixed, 95% CI)1.02 [0.91, 1.15]

   1.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   1.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 2 Operative vaginal birth (primary outcome)22514Risk Ratio (M-H, Fixed, 95% CI)0.96 [0.84, 1.10]

    2.1 Women at low risk of caesarean/complications
22514Risk Ratio (M-H, Fixed, 95% CI)0.96 [0.84, 1.10]

   2.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   2.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

3 Maternal satisfaction (primary outcome)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   3.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   3.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   3.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 4 Apgar < 7 at 5 min (primary outcome)22514Risk Ratio (M-H, Fixed, 95% CI)1.39 [0.73, 2.63]

    4.1 Women at low risk of caesarean/complications
22514Risk Ratio (M-H, Fixed, 95% CI)1.39 [0.73, 2.63]

   4.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   4.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

5 Neonatal hypogylcaemia (primary outcome)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   5.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   5.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   5.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

6 Maternal ketoacidosis00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   6.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   6.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   6.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

7 Maternal dehydration00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   7.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   7.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   7.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

8 Maternal hyponatraemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   8.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   8.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   8.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

9 Maternal hypoglycaemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   9.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   9.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   9.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 10 Duration of labour (hours)188Mean Difference (IV, Fixed, 95% CI)-1.10 [-2.66, 0.46]

    10.1 Women at low risk of caesarean/complications
188Mean Difference (IV, Fixed, 95% CI)-1.10 [-2.66, 0.46]

   10.2 Women at increased risk of caesarean/complications
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   10.3 Women with no defined risk status
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

11 Mobility in labour00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   11.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   11.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   11.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

12 Maternal nausea00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   12.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   12.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   12.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 13 Maternal vomiting22514Risk Ratio (M-H, Random, 95% CI)0.76 [0.41, 1.41]

    13.1 Women at low risk of caesarean/complications
22514Risk Ratio (M-H, Random, 95% CI)0.76 [0.41, 1.41]

   13.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   13.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 14 Augmentation of labour22514Risk Ratio (M-H, Random, 95% CI)0.97 [0.80, 1.19]

    14.1 Women at low risk of caesarean/complications
22514Risk Ratio (M-H, Random, 95% CI)0.97 [0.80, 1.19]

   14.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   14.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 15 Narcotic pain relief188Risk Ratio (M-H, Fixed, 95% CI)1.00 [0.91, 1.09]

    15.1 Women at low risk of caesarean/complications
188Risk Ratio (M-H, Fixed, 95% CI)1.00 [0.91, 1.09]

   15.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   15.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 16 Epidural analgesia22514Risk Ratio (M-H, Fixed, 95% CI)1.02 [0.97, 1.08]

    16.1 Women at low risk of caesarean/complications
22514Risk Ratio (M-H, Fixed, 95% CI)1.02 [0.97, 1.08]

   16.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   16.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

17 Poor maternal expulsive efforts00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   17.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   17.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   17.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 18 Regurgitation during general anaesthesia12426Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

    18.1 Women at low risk of caesarean/complications
12426Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   18.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   18.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 19 Mendelson's syndrome12426Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

    19.1 Women at low risk of caesarean/complications
12426Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   19.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   19.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

20 Maternal mortality00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   20.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   20.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   20.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

21 Postpartum haemorrhage (> 1000 ml)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   21.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   21.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   21.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

22 Maternal admission to intensive care00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   22.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   22.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   22.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

23 Length of maternal hospital stay00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   23.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   23.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   23.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

24 Maternal comfort00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   24.1 Women at low risk of caesarean/complications
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   24.2 Women at increased risk of caesarean/complications
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   24.3 Women with no defined risk status
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

25 Maternal feelings of pain, thirst or hunger00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   25.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   25.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   25.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

26 Fully breastfeeding at discharge00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   26.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   26.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   26.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

27 Maternal feelings of control00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   27.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   27.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   27.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

28 Fetal distress00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   28.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   28.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   28.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

29 Cord blood pH < 7.200Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   29.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   29.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   29.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

30 Infant hyperinsulinism00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   30.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   30.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   30.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

31 Infant hyponatraemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   31.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   31.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   31.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

32 Infant intravenous therapy00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   32.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   32.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   32.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

33 Infant gavage feeding00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   33.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   33.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   33.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 34 Infant admission to intensive care12426Risk Ratio (M-H, Fixed, 95% CI)1.03 [0.73, 1.45]

    34.1 Women at low risk of caesarean/complications
12426Risk Ratio (M-H, Fixed, 95% CI)1.03 [0.73, 1.45]

   34.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   34.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

35 Length of infant hospital stay00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   35.1 Women at low risk of caesarean/complications
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   35.2 Women at increased risk of caesarean/complications
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   35.3 Women with no defined risk status
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 
Comparison 10. Water only versus oral carbohydrate based fluids

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Caesarean section (primary outcome)2261Risk Ratio (M-H, Random, 95% CI)0.66 [0.17, 2.53]

    1.1 Women at low risk of caesarean/complications
2261Risk Ratio (M-H, Random, 95% CI)0.66 [0.17, 2.53]

   1.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   1.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 2 Operative vaginal birth (primary outcome)2261Risk Ratio (M-H, Fixed, 95% CI)1.17 [0.80, 1.71]

    2.1 Women at low risk of caesarean/complications
2261Risk Ratio (M-H, Fixed, 95% CI)1.17 [0.80, 1.71]

   2.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   2.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

3 Maternal satisfaction (primary outcome)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   3.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   3.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   3.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 4 Apgar < 7 at 5 min (primary outcome)160Risk Ratio (M-H, Fixed, 95% CI)3.0 [0.13, 70.83]

    4.1 Women at low risk of caesarean/complications
160Risk Ratio (M-H, Fixed, 95% CI)3.0 [0.13, 70.83]

   4.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   4.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

5 Neonatal hypoglycaemia (primary outcome)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   5.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   5.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   5.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

6 Maternal ketoacidosis00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   6.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   6.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   6.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

7 Maternal dehydration00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   7.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   7.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   7.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

8 Maternal hyponatraemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   8.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   8.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   8.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

9 Maternal hypoglycaemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   9.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   9.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   9.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 10 Duration of labour (hours)160Mean Difference (IV, Fixed, 95% CI)0.95 [-0.42, 2.32]

    10.1 Women at low risk of caesarean/complications
160Mean Difference (IV, Fixed, 95% CI)0.95 [-0.42, 2.32]

   10.2 Women at increased risk of caesarean/complications
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   10.3 Women with no defined risk status
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

11 Mobility in labour00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   11.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   11.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   11.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

12 Maternal nausea00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   12.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   12.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   12.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 13 Maternal vomiting160Risk Ratio (M-H, Fixed, 95% CI)1.27 [0.69, 2.33]

    13.1 Women at low risk of caesarean/complications
160Risk Ratio (M-H, Fixed, 95% CI)1.27 [0.69, 2.33]

   13.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   13.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 14 Augmentation of labour2261Risk Ratio (M-H, Fixed, 95% CI)1.07 [0.75, 1.52]

    14.1 Women at low risk of caesarean/complications
2261Risk Ratio (M-H, Fixed, 95% CI)1.07 [0.75, 1.52]

   14.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   14.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 15 Narcotic pain relief2261Risk Ratio (M-H, Random, 95% CI)0.86 [0.36, 2.06]

    15.1 Women at low risk of caesarean/complications
2261Risk Ratio (M-H, Random, 95% CI)0.86 [0.36, 2.06]

   15.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   15.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 16 Epidural analgesia2261Risk Ratio (M-H, Random, 95% CI)0.80 [0.44, 1.43]

    16.1 Women at low risk of caesarean/complications
2261Risk Ratio (M-H, Random, 95% CI)0.80 [0.44, 1.43]

   16.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   16.3 Women with no defined risk status
00Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

17 Poor maternal expulsive efforts00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   17.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   17.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   17.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

18 Regurgitation during general anaesthesia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   18.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   18.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   18.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

19 Mendelson's syndrome00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   19.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   19.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   19.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

20 Maternal mortality00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   20.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   20.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   20.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

21 Postpartum haemorrhage (> 1000 ml)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   21.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   21.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   21.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

22 Maternal admission to intensive care00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   22.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   22.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   22.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

23 Length of maternal hospital stay00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   23.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   23.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   23.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

24 Maternal comfort00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   24.1 Women at low risk of caesarean/complications
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   24.2 Women at increased risk of caesarean/complications
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   24.3 Women with no defined risk status
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

25 Maternal feelings of pain, thirst or hunger00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   25.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   25.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   25.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

26 Fully breastfeeding at discharge00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   26.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   26.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   26.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

27 Maternal feelings of control00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   27.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   27.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   27.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

28 Fetal distress00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   28.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   28.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   28.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

29 Cord blood pH < 7.200Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   29.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   29.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   29.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

30 Infant hyperinsulinism00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   30.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   30.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   30.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

31 Infant hyponatraemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   31.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   31.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   31.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

32 Infant intravenous therapy00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   32.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   32.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   32.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

33 Infant gavage feeding00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   33.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   33.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   33.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

34 Infant admission to intensive care00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   34.1 Women at low risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   34.2 Women at increased risk of caesarean/complications
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   34.3 Women with no defined risk status
00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

35 Length of infant hospital stay00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   35.1 Women at low risk of caesarean/complications
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   35.2 Women at increased risk of caesarean/complications
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   35.3 Women with no defined risk status
00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 
Table 1. Interventions during labour in women at low risk in O'Sullivan study

InterventionWater onlyFood in labour

Oxytocin augmentation56% (673/1207)53% (647/1219)

IV fluids in labour69% (838/1207)67% (820/1219)

Epidural67% (813/1207)66% (804/1219)

Caesarean section30% (363/1207)30% (362/1219)

Operative vaginal birth27% (310/1207)27% (324/1219)

 IV: intravenous