Eating and Drinking in Labour
Published: 17 June 2020
Published: 17 June 2020
Eating and drinking in labour is a controversial subject, with policies varying widely amongst practitioners.
Historically, eating has been discouraged during labour, yet today there is an increasing trend of allowing women to eat and drink as they wish despite a lack of research on how this might affect the course of their labour (Stentebjerg and Bor 2010).
Back in the mid-1900s, when anaesthetics were far less safe, the ‘nothing by mouth’ policy came about to prevent the dangerous consequences of aspiration with general anaesthesia.
Since then, however, the safety of anaesthetics has greatly improved, meaning hospital policies may need to be rewritten to reflect this (Maharaj 2009).
While the bulk of evidence supports fluid intake in labour, there is still a lack of conclusive research about the relationship between fasting times and the risk of pulmonary aspiration. As Maharaj (2009) notes, whether or not allowing food and fluid throughout labour is beneficial or harmful can only be determined by further research.
Should women of low-risk status be denied oral fluids and food intake during labour?
In trying to answer this question, Hunt (2013) conducted a literature review exploring whether withholding food and drink during labour decreased the risk of maternal morbidity from Mendelson's syndrome. Unhelpfully, the result was inconclusive and only served to question the validity of this practice even further.
Very little research exists into the nutritional needs of women in labour, but research into sports nutrition suggests that taking in carbohydrates during exercise improves performance and protects against fatigue and ketosis.
Could this also apply to labouring women? Dekker (2017) argues it does, and based on a recent Cochrane review, suggests that women labouring under less restrictive eating and drinking policies had shorter labours of about 16 minutes.
Interestingly, only one of the trials listed in the Cochrane review considered maternal satisfaction alongside physiological responses, even though it was found that participants in the group allowed to eat reported greater satisfaction compared to the women who were only given sips of water.
Poor nutritional balance can be associated with longer and more painful labours, and fasting does not seem to guarantee an empty stomach or less acidity should anaesthesia be needed.
For example, Singata, Tranmer and Gyte (2013) compared the effect of restricting fluids and food in labour to women who were allowed to eat and drink and found that there were no benefits or harms to women at low-risk of needing a general anaesthetic. They concluded that this group of women should be free to eat and drink in labour, or not, as they wish.
The main reason why some hospitals have a ‘nothing by mouth’ policy is to ensure labouring women have an empty stomach should they need emergency surgery.
Dekker (2017) questions this, asking, ‘Is the stomach really empty when women are not allowed to eat and drink during labour?’ Stomach emptying slows down once labour commences, so fasting for 8, 12 or even 24 hours after contractions begin may not guarantee an empty stomach at the time of birth.
Fasting may even be harmful, as it could cause gastric juices to become dangerously acidic if aspiration were to occur (Dekker 2017).
Conversely, Parsons (2004) suggests that there is still insufficient evidence to recommend any clear stance on oral intake as support for eating and drinking is based largely on anecdotal evidence and assumptions about physiology.
To summarise, ‘nil by mouth’ policies have never been adequately researched, and clear fluid policies are based on research performed with non-obstetric patients.
Taking all the available evidence into account, the Royal College of Midwives (2018) recommend that:
North Bristol NHS Trust (2011) also offers some helpful practice points:
Parsons (2004) suggests that without reliable research evidence for the management of oral intake during labour, no hospital policy is valid. In other words, there is no evidence to support restrictions for low-risk women and no reliable evidence at all when looking specifically at women at increased risk of complications.
This leaves midwives with the responsibility of deciding what they believe is the best management for oral intake of labouring women in their care.
The authors of the recent Cochrane review note that most women seem to naturally limit their intake as labour gets stronger, suggesting that low-risk women should have the right to choose whether or not they would like to eat and drink (Decker 2017).
Additionally, both The World Health Organization (WHO) and National Institute of Clinical Excellence (NICE) in the UK recommend that low-risk women eat or drink as they desire during labour. For high-risk women, the situation is different, as there is no evidence from randomised trials that could be applied to their situation.
Given the lack of high-quality research, the issue of whether women should eat and drink in labour remains controversial. Diet restrictions are still a sensible precaution for women who are at high risk of needing a caesarean section, however, for all other women, the current research suggests that there is little risk of harm in eating and drinking as labour progresses.
As Hunt (2013) suggests, perhaps it is now up to midwives to review their local policies and drive new research forward in this area.