In the United States when a woman labors in the hospital she will usually not be allowed to eat or drink. Length of labor varies with each woman and with each of one woman’s deliveries. A woman can labor for a quick three hours or have a long over 24 hour experience. Each labor will be ranked low to high risk of complication during labor and birth based on mother and baby’s health. These are important variations that should influence the care women receive while laboring. However, every mama is usually treated equally in the case of oral intake restrictions. Many mamas blindly accept this restriction without question. It’s time to stop and ask, does this make sense? Let’s explore the history of this routine and see if current research deems this practice medically necessary.
Many years ago general anesthesia was the only method used to perform cesarean sections (c-section) and was also used with forms of pain control for vaginal births. In 1946 Dr. Mendelson published work explaining that under general anesthesia there was a risk of stomach contents going into the lungs (aspiration). This can lead to complications such as aspiration pneumonia or even death. In response to these findings policies to restrict oral intake during labor became a widely accepted standard. This means that not being allowed to eat or drink during labor was not due to the labor itself but because the use of general anesthesia.
Throughout the 20th century general anesthesia became less commonly used. Epidurals and spinal anesthesia became more widely used for c-sections. Today, general anesthesia is used in emergency c-sections, if spinal anesthesia or epidural have been unsuccessful, certain health conditions that contraindicate a spinal or epidural, or per the woman’s request. In 2018, 31.9% of U.S. births were via c-section. About 5% of c-sections were performed with general anesthesia. When general anesthesia is used quality equipment is in place to maintain an open airway and reduce potential risk. Making it a safer practice than in the early 20th century. General anesthesia is not in anyway used for pain management with vaginal births. Instead women may choose an epidural or IV narcotics. Some facilities may also offer nitrous oxide, a gas delivered via face mask.
With decreased use of general anesthesia plus improved equipment and safety procedures, the risk of aspiration has decreased. Remember, the oral intake restrictions were never about labor itself but to prevent associated risks with the use of general anesthesia. But if low rates of women require general anesthesia, why is every mom who labors in a hospital told to not eat or drink? Some physicians and anesthesiologists believe they are proceeding with caution by enforcing this restriction on all laboring moms. Though complications from aspiration with general anesthesia is now a rare event, when it does happen the provider also has to worry about patient satisfaction related to the event, cries of malpractice, etc. For this reason the restriction is also a “C.Y.A.” situation.
No we cannot predict every emergency or how each labor will progress, but there are factors that give clues as to which mamas and babies are at greater risk. There have also been studies and reviews that have shown no harm resulting from eating and drinking while laboring. In a 2017 review, the American College of Obstetrics & Gynecology (ACOG) stated that women should be allowed to consume liquids while laboring. ¨Current guidance supports oral intake of moderate amounts of clear liquids by women in labor who do not have complications.” A complication includes pre-eclampsia, hypertension or anything that points to an increased risk of delivery via c-section. The World Health Organization (WHO) supports unrestricted eating and drinking during labor when there are no apparent risks. With these recommendations, throughout the US today some hospitals have or are in the process of adjusting policies related to oral intake during labor. Some allow clear liquids, jell-o or popsicles. Some may be accepting of more solids for low risks labors.
Rather it’s your first or fifth delivery, each one is different. Nor you or your provider can predict how you will feel during labor. You may desire to snack throughout labor. You may have absolutely no interest in food. Your labor might be so quick that there is no time to worry about eating. You may desire to only eat during early labor. If your pregnancy has remained healthy, low-risk and you want comfort in knowing that if you desire oral hydration and solids that you won’t be met with a fight against your care team, share your desires with your provider prior to labor. Investigate the facility’s usual procedures. Have an open conversation with your provider. Understand your providers views and comforts. Be ready to share resources, evidence based information to support your requests, questions and concerns. Know that if the facility and/or provider you initially choose is not willing to honor desires that are safe and important to you, it is within your rights to seek and select a new one at any time.
❤️Peace & Love from Your Hippie Nurse☮️
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