Restricting food and drink in labor is not justified

by Amy Romano, CNM (Originally published on Science and Sensibility for Lamaze International)

Listen to this great podcast about the new Cochrane review showing that the policy of restricting food and drink in labor is not justified. It’s a nice summary of how and why the research was conducted. In addition, I particularly liked these tidbits:

1. Rather than asking “is eating and drinking in labor safe?” the reviewers turned the question around to ask “is there any justification for restricting food and drink in labor?” This is not just a nuance. How a researcher asks a question can influence both the findings and the conclusions, as I have discussed previously.

2. Since they identified no benefits (nor harms) of restricting oral intake, the reviewers concluded that women should be able to eat and drink according to their preference.

3. It was her experience teaching antenatal classes that led one of the reviewers to study food and drink in labor. Listening to women’s concerns and anxieties made her question the justification for restricting women’s autonomy in labor.

In perusing the web to try to find an image for this post, I came across this heartbreaking picture of a woman begging for a drink in labor and being told no. (I’d post it here but it is copyrighted.) When the researchers said they found “no harms” of restricting food and drink in labor, they pointed out that no one had actually studied women’s preferences or experiences. I’m heartened to know that some of those who tout evidence based care are beginning to recognize that emotional distress is itself a harm. If there is no counterbalancing benefit, the conclusion is clear.

ACOG Encourages Laboring Women to Quench Their Thirst

Women who decide to give birth in a hospital may soon have access to more than ice chips during labor. The American College of Obstetricians and Gynecologists (ACOG) just released a committee opinion recommending that clear liquids (water, juice, sports drinks, etc.) be provided to women who have uncomplicated labor or are scheduled for a planned cesarean.

ACNM has long supported a liberal approach to providing oral nutrition to women in labor, including drinks and solid food. But for decades, many hospitals have restricted women’s oral intake for fear of aspiration—a potentially fatal occurrence that involves stomach contents entering the lungs while a woman is under anesthesia. Thanks to improvements in anesthesia, aspiration in pregnant women is now extremely rare.

Midwives emphasize that birth is a normal process that under normal circumstances does not require fasting. They educate clients about the small but potentially serious risk of aspiration and watch women throughout labor to identify when food and drink need to be restricted. While ACOG’s latest weigh-in is old news to midwives, hopefully it will encourage more hospitals to adopt less restrictive, more woman-centered policies.