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Childbirth is an energy-intensive physiological process, requiring sustained effort comparable in intensity to moderate physical activity. Studies suggest that providing an available energy source during labor, such as dextrose infusion or natural carbohydrate-rich foods such as dates, may shorten the duration of labor and improve cervical dilation without adversely affecting obstetric outcomes. The primary objective of the study is to examine whether giving chocolate during labor affects the duration of the second stage of labor, compared to a control group that will not receive a nutritional intervention. The study is a prospective, randomized, controlled trial that will be conducted in the delivery room of Hillel Yaffe Medical Center. Healthy pregnant women with a singleton pregnancy at ≥37 weeks gestational age, in spontaneous or induced labor, without diabetes (pre/gestational), will be recruited to participate. Participants in the intervention group will receive one serving of 50 grams of milk chocolate (cocoa content 25-30%, without filling or additives) at a cervical dilation of 6 cm or more (and not yet fully dilated). The mother will be asked to consume the serving gradually over 30 minutes. Milk chocolate was chosen because it is better tolerated compared to dark chocolate, has a more gentle profile of active ingredients (which can increase nausea and heartburn) and provides a source of available carbohydrates. The study will be conducted in accordance with the guidelines of the Ministry of Health's procedure for medical experiments on humans, and will be conducted after approval by the Institutional Helsinki Committee.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 50 g of milk chocolate cocoa content 25-30% | Experimental | . Participants in the intervention group will receive one serving of 50 grams of milk chocolate (cocoa content 25-30%, without filling or additives) at a cervical dilation of 6 cm or more. The mother will be asked to consume the serving gradually over 30 minutes. |
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| control group - no intervention | No Intervention | Participants in the control group will receive routine care as is customary in the delivery room, without any proactive nutritional supplementation. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| 50 g of milk chocolate cocoa content 25-30% | Other | Milk chocolate was chosen as it is better tolerated compared to dark chocolate, has a milder profile of active ingredients (which can increase nausea and heartburn) and provides a source of available carbohydrates. A dose of 50 grams was chosen that provides 25-30 grams of simple carbohydrates - sufficient for a significant increase in blood glucose but low enough to prevent a sudden sugar load or nausea. The intervention will be given at 6-9 cm dilation, towards the transition to the second phase - to allow the absorption of glucose and neurochemicals to be deafened at a time when the body needs increased energy and alertness. Giving it earlier may result in the effect of the chocolate wearing off before the second phase, and later - there will be no time for effective absorption. |
| Measure | Description | Time Frame |
|---|---|---|
| Duration of second stage of labor | The duration of the second stage of labor, defined as the time in minutes from full cervical dulation (10cm) to delivery of the neonate. | From full cervical dilation to delivery |
| Measure | Description | Time Frame |
|---|---|---|
| Mode of delivery | Mode of delivery categorized as spontanous vaginal delivery, operative vaginal delivery (vacuum), or cesarean delivery | At delivery |
| Maternal nausea or vomiting during labor | The occurrence of maternal nausea or vomiting during labor following the assigned intervention, as documented in the medical record |
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Inclusion Criteria:
Exclusion Criteria:
It is limited due to the ability to give birth
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Libby O Madar, M.D | Contact | +972-4-7744602 | NoaAl@hymc.gov.il | |
| Rinat Gabbay-Benziv, M.D | Contact | +972-4-7744514 |
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This is a randomized, parallel-group interventional study. Eligible participants will be randomized in a 1:1 ratio to receive either oral carbohydrate supplementation (chocolate) prior to second stage of labor, or standard intrapartum care. Outcomes will be compared between groups. The primary outcome is the duration of second stage of labor, with secondary maternal and neonatal outcomes assessed.
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This is an open-label study. Masking is not feasible due to the nature of the intervention. However, the primary outcome is an objective measure, minimizing the risk of assessment bias.
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| From intervention administration untill discharge from labor room |
| Neonatal Apgar score at 1 and 5 minutes | The Apgar score is assessed at 1 and 5 minutes after delivery. The total score ranges from 0 to 10, with higher scores indicating better neonatal condition. | 1 and 5 minutes after delivery |
| Umbilical cord blood glucose level | Umbilical cord blood glucose concentration measured from umbelical blood collected immediately after delivery (when a cord blood sample is obtained per routine practice | at delivery |
| Maternal heart rate | Maternal heart rate measured in beats per minute as recorded by continous intrapartum maternal monitorind | During the second stage of labor |
| Umbelical cord blood PH | Umbelical cord blood PH measures immediatley after delivery | At delivery |