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Running head: RESEARCH PROPOSAL: PART II
Research Proposal: Part II
Liberty University
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RESEARCH PROPOSAL: PART II
Research Proposal: Part II
Background
Delivery by cesarean section has become the most common surgical procedure performed
worldwide and, when done in necessity, can decrease perinatal morbidity and mortality
significantly (Montoya-Williams et al., 2017). However, a cesarean section is considered major
surgery and carries many risks, including surgical site infection, hemorrhage, complications in
future pregnancies, and even maternal and/or neonatal death. The most common reason that a
woman in labor undergoes delivery via cesarean section is due to dysfunctional labor, or
dystocia, in which labor does not progress and the cervix ceases to dilate (Murphy et al., 2015).
This occurs when the uterus no longer functions as it should and fails to create an adequate
contraction pattern in order to create cervical change needed for vaginal delivery.
Due to the unpredictability of labor and potential need for delivery by cesarean section,
women are traditionally barred from eating and instructed that they may consume ice chips only
or sometimes nothing at all. This policy became the practice standard in the 1940s and stems
from the unlikely potential that a woman may end up needing general anesthesia to undergo an
urgent or emergent cesarean section. This practice was said to decrease the risk of aspiration and
its associated pneumonia related to general anesthesia and intubation (Chackowicz, Spence, &
Abenhaim, 2016). However, with new research on this topic, this policy has become outdated
and could actually create adverse effects on the woman during labor and delivery, such as
nausea, vomiting, and operative vaginal delivery due to fatigue (Chackowicz, Spence, &
Abenhaim, 2016).
When these two concepts are married, the question of their correlation arises. With
uterine muscle fatigue, the switch from aerobic to anaerobic metabolism occurs, creating a
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RESEARCH PROPOSAL: PART II
buildup of intramuscular lactic acid, and subsequent decreased muscle activity and/or
effectiveness (Murphy et al., 2015). Furthermore, this could possibly lead to labor dystocia and
the need for delivery by cesarean section.
Significance
While much research has been done on decreasing cesarean section rates in nulliparous
women at term with a singleton pregnancy and vertex presentation (NTSV), very little has
occurred specifically related to decreasing cesarean section rates related to diet during labor. In
2020, The Joint Commission will begin reporting hospitals with cesarean section rates >30%,
forcing hospitals to analyze their labor management practices, which could include implementing
eating throughout labor as a standard practice. This study has the potential to identify a factor
that adds to the problem, which can then create a change in practice to decrease the rate of
cesarean section.
Research Question
Does implementation of a clear liquid diet decrease the primary cesarean section rate
in nulliparous laboring women?”
Key variables include:
Clear liquid diet (independent).
Primary cesarean section rate (dependent).
The population of interest for this study is nulliparous laboring women.
The purpose of this study is to identify a potential correlation between diet during labor
(NPO versus clear liquid) and primary cesarean section rates.
The hypothesis is that implementation of a clear liquid diet will, in fact, decrease primary
cesarean section rates in nulliparous laboring women.