No Need for Most Moms to Fast During Labor. Although conventional wisdom has long held that women shouldn’t eat or drink during labor, the scientific evidence suggests there’s no reason for the prohibition, according to a new meta-analysis. “Since the evidence shows no benefits or harms, there is no justification for the restriction of fluids and food in labor for women at low risk of complications,” Mandisa Singata, MBA, RM, RN, of the University of the Witwatersrand in East London, South Africa, and colleagues concluded in a Cochrane review. They identified five studies involving 3,130 women that examined whether food and drink during labor affected outcomes such as rates of cesarean section, operative vaginal births, or Apgar scores. No significant advantage was found for restricting access to food or liquids on any outcome, Singata and colleagues found. Until the 1940s, women were generally encouraged to eat and drink during labor — often specific foods and fluids — to keep up their strength. But a 1946 paper and other publications by Curtis Lewis Mendelson suggested that access to food increased the risk that women under anesthesia would aspirate acidic stomach contents during labor, potentially causing serious lung injury and even death. Mendelson’s work persuaded many obstetricians to urge that women fast until after delivery, according to Singata and colleagues. The researchers cited a 1988 survey of U.S. hospitals that found almost half allowed only ice chips, although more recent trends suggested that access to food and liquids had increased, at least in Great Britain. They noted that some women in labor don’t feel like eating but others regard restrictions as “unpleasant and sometimes harrowing.” One reason for revisiting Mendelson’s research is that anesthesia procedures have changed markedly since the 1940s,
with regurgitation of stomach contents now considered very rare. “The policy of routine restriction of foods and fluids in labor in many hospitals across the world generally does not reflect women’s preferences or cultural expectations,” Singata and colleagues wrote. “It is critical that any policy should be based on evidence of overall benefit to women and babies.” Searching the literature, Singata and colleagues found five randomized trials that had compared more versus less restrictive nutrition regimens. Only one of the trials tested free access to any kind of food and drink against restriction to ice chips or sips of water. The other four examined particular classes of nutritive foods or drinks. Two tested electrolyte-carbohydrate sports drinks and two others evaluated low-fat and/or low-residue foods, all against water or ice chips. Pooling data from the five studies, Singata and colleagues calculated relative risks for three major adverse outcomes for allowing access to nutrition, versus water or ice chips: * Cesarean section: RR 0.89, 95% CI 0.63 to 1.25 * Operative vaginal birth: RR 0.98, 95% CI 0.88 to 1.10 * Apgar scores <7 at five minutes: RR 1.43, 95% CI 0.77 to 2.68. The meta-analysis also examined eight other outcomes, such as maternal ketosis and nausea and vomiting, infant admission to intensive care, and augmentation of labor. There were no significant differences in any of these outcomes between allowing and restricting access to nutrition. The sole study comparing unlimited access to food and drink to water or ice chips, which had 330 participants, also found no effects on either primary or secondary outcomes in either direction. None of the studies examined women’s perceptions of the labor experience based on whether or not they had access to nutrition. Singata and colleagues called the overall quality of evidence “reasonable.”
But they noted that none of the studies enrolled women at increased risk of needing general anesthesia, so the conclusions should be interpreted as applying only to women at low risk of complications. The studies also left some questions unanswered. For example, one of the two sports drink studies found that C-section rates were lower in participants who drank plain water, but no such result was seen in the other. “It would be worth comparing the use of carbohydrate drinks … with freedom to eat and drink at will during labour to see if this really is a problem,” Singata and colleagues wrote. Moreover, they suggested, “a better approach” to the rare problem of inhaling regurgitated material while under anesthesia during labor may be to test treatments intended to reduce acidity and volume of stomach contents, now used during elective C-sections. Action Points * Explain to interested patients that standard practice and tradition for some 60 years has been to withhold food and drink from women during labor, except for water in small quantities. The purpose has been to reduce risk of inhaling acidic stomach contents if the women subsequently need to go under general anesthesia. * Explain that changes in anesthesia practice since the 1940s have made such risks very low and most hospital policies do not take women’s preferences into account. * Explain that this analysis combined data from five previously published studies, which examined different types of nutrition regimen. Because the study designs differed significantly, the results should be interpreted cautiously. Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner. news from medpagetoday.com
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