Is it OK to eat and drink during labor?

Sometimes childbirth – the hours spent in labor – can last a long time. You can get thirsty. Or hungry. Is it OK to eat and drink during labor? If not, why not?

In any childbirth scenario there’s always the possibility that surgery – and general anesthesia — will be necessary. Under anesthesia there’s a risk of “aspiration” – inhaling something into the lungs other than air. That’s why US medical societies have said no, you shouldn’t eat or drink during labor.

It turns out there’s very little data on the dangers of aspiration. This has led other groups to advocate a more liberal policy, arguing that the psychological and physical benefits of food and drink outweigh the risks. Joan Tranmer, PhD, RN, coauthor of a review of the evidence, commented:

For low-risk women in labor, they should be offered the choice to eat and drink. … Now, most women in active labor are not going to want to eat, but some may find comfort in some toast or tea.

It’s a comfort thing

Before the mid-1940s, medical wisdom advocated food and fluids for the mother-to-be, since she needed to maintain all the stamina she could muster for the upcoming effort of delivery. This changed in 1946 when Dr. Curtis Mendelson first described aspiration of stomach contents during general anesthesia. This was a rare event during scheduled surgeries, since patients had been told not to eat beforehand. But going into labor is much less predictable, and problems arose more frequently with obstetric anesthesia. Offering toast was no longer an option.

Gradually, over the years, prohibitions against drinking and light eating were relaxed. Cesarean sections were increasingly performed under local anesthetics, and advances in anesthesiology made aspiration less likely. According to Eileen Ehudin Beard of the American College of Nurse-Midwives:

[T]he evidence does not support the idea that you should starve people in labor – and besides which, your stomach is never totally empty, so prolonged fasting can, in fact, cause an increase in gastric volume and an increase in acidity [that can lead to aspiration]. … I think there is a lot of benefit of eating and drinking during labor; the women experience an overall sense of well-being, a sense of control, hydration. It’s a comfort thing.

People are autonomous thinking adults

Current guidelines of the American Society of Anesthesiology (ASA) allow clear liquids – water, fruit juice with no pulp, clear tea, black coffee, sports drinks, carbonated beverages – in cases where no complications are anticipated. Women planning to deliver by cesarean section can have clear liquids up to two hours before the anesthesia is administered.

ASA guidelines recommend no solid food for women in labor and fasting for 6 to 8 hours before delivery when anticipating a cesarean section or tubal ligation. The ASA, according to an article in The Journal of the American Medical Association, prefers to err on the side of caution.

Until last summer, the American College of Obstetricians and Gynecologists (ACOG) recommended nothing more than ice chips during labor. They recently brought their guidelines more in line with the ASA. “[I]t was never a very popular policy,” according to ACOG’s William H. Barth Jr. He adds:

These are recommendations, not rules. … People can do what they want to do. People are autonomous thinking adults, but it is our job to promote patient safety.

There may never be a definitive answer to the question of whether there really is a danger associated with eating and drinking during labor. A randomized controlled trial would require studying a very large population of women, and the randomization part of it might even be considered unethical. Researchers are combing databases of past experiences for clues. Meanwhile, mothers-to-be must rely on their common sense.

Resources:

Photo: The birth of Allison

Mike Mitka, Experts, Organizations Debate Whether Women in Labor Can Safely Eat and Drink, The Journal of the American Medical Association, March 10, 2010 (abstract only)