Why do hospitals tell people they “can’t” eat or have to stick to clear fluids duirng labor? Is this evidence-based? Let’s unpack the research so you can make a choice that is best for you.
In this episode, we dive into the following:
Why do hospitals tell people they “can’t eat or drink during labor
What are the risks and benefits of eating during labor
How to navigate hospital policies that say you can’t eat of drink during labor
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Today we’re diving into one of the most debated topics in the childbirth community: eating and drinking during labor. It might seem surprising that this is such a controversial issue, but there’s a lot to unpack here. So, let's delve into why many hospitals advise against it, what the research says, and how you can make the best choice for yourself.
The Hospital Policy: NPO
In many hospitals, laboring individuals are often told not to eat or drink. This policy is known as NPO (nil per os), which means "nothing by mouth." A survey in 2014 found that 60% of people in U.S. hospitals reported not drinking during labor, and 80% did not eat (Declercq et al. 2014). Compare this to freestanding birth centers, where only 5% of laboring individuals chose not to eat or drink (Rooks et al. 1989).
The Uterus: A Muscle that Needs Fuel
Think of your uterus as a muscle—a very hardworking muscle, much like an athlete's during a marathon. Muscles need fuel to perform optimally, and the uterus is no different. During labor, the uterus is contracting and working hard to push your baby out. It needs adequate nutrition to meet its energy needs.
While there's limited research specifically on nutritional needs during labor, studies in sports nutrition have shown that consuming carbohydrates during exercise can improve performance and prevent fatigue (Rodriguez et al. 2009). A recent news release even compared the energy and calorie needs of laboring individuals to those of marathon runners.
Why Hospitals Restrict Eating and Drinking
The primary concern hospitals have is the risk of aspiration. Aspiration happens when stomach contents are vomited into the mouth and then breathed into the airways, which can lead to severe complications. Hopitals are concerned this might happen in the case someone needs general anesthesia during an emergency cesarean. However, this concern is based on outdated practices from the 1940s.
Modern Anesthesia and Aspiration Risk
Research has shown that the risk of death from aspiration during childbirth is extremely rare. A study (Hawkins et al., 1997) found the risk of death because of aspiration during Cesarean was 1 death for every 1.4 million births. An update in 2011 also highlighted the rarity of aspiration-related deaths where the authors calculated that there were 6.5 deaths per million uses of general anesthetics. The United Kingdom, which revised its guidelines in 2007 to encourage eating and drinking during labor for low-risk individuals, reported only one aspiration-related death out of over six million births between 2000 and 2008.
The Impact of NPO Policies on Birth
A Cochrane review in 2013 combined evidence from five trials involving over 3,000 participants. It found no significant harms or benefits to restricting food and drink during labor for low-risk individuals (Singata et al. 2013). However, other studies suggest that allowing food and drink can improve satisfaction during labor.
Professional Guidelines and Personal Choice
Several professional organizations, including the World Health Organization and the American College of Nurse Midwives, recommend that low-risk individuals should be allowed to eat and drink as desired during labor. Other organizations, like the American College of Obstetricians and Gynecologists, recommend avoiding solid food but allowing clear liquids.
Your Right to Choose
Ultimately, the decision to eat or drink during labor is yours. Hospital policies are not legally binding, and you have the right to make choices about your body. If your provider advises against eating, ask them to provide evidence supporting their recommendation (HINT: ask them for the absolute risk). Share articles and research, such as the detailed one by Evidence-Based Birth, to show that you are making an informed choice.
Snack Recommendations for Labor
If you decide to eat during labor, opt for light, nutritious snacks. Heavy meals can be had to digest. Here are some recommendations:
Date fruit (LaraBars are also a great option)
Coconut Water
Honey Sticks
Yogurt
Bread, biscuits
Vegetables
Roasted okra
Tortillas with a honey or tahini spread
Tostones (platano power!)
Fried plantain (maduros) bites in light oil
Labor-Aide! (see a recipe below)
Fruits
Soup
Fruit juices
Cereal and milk
Toast with butter/jam
Hard Cheeses
Chocolate
Boiled eggs
Navigating your birth experience involves making choices that are best for you and your baby. Whether you decide to eat and drink during labor should be based on evidence and your personal comfort. Remember, you have the autonomy to make these decisions, and it's essential to advocate for your true desires.
Stay tuned for our next episode, and as always, take care and stay mindful!
Red Raspberry Leaf Labor-Aid Recipe
2 cups of water
2 cups of coconut water
½ cup of Red raspberry leaf (or 8 tea bags)
⅓ to ½ cup of honey
Boil roughly two cups of water. Add hot water and red raspberry leaf to a mason
jar. Cover and shake (be sure to use a towel to hold the jar as the glass will heat up). Allow the tea to steep for 4 hours or overnight. If you don’t have time to let the infusion sit for 4+ hours, you can boil the herbs for 20 minutes in water on the stove.
Strain the red raspberry leaf infusion so that you just have the liquid tea. Combine the infused tea with coconut water and honey. Mix to combine and enjoy.
References:
Declercq, E. R., Sakala, C., Corry, M. P., Applebaum, S., & Herrlich, A. (2014). Major Survey Findings of Listening to Mothers(SM) III: Pregnancy and Birth: Report of the Third National U.S. Survey of Women’s Childbearing Experiences. J Perinat Educ, 23(1), 9-16.
Hawkins, J. L., Chang, J., Palmer, S. K., Gibbs, C. P., & Callaghan, W. M. (2011). Anesthesia-related maternal mortality in the United States: 1979-2002. Obstet Gynecol, 117(1), 69-74.
Hawkins, J. L., Koonin, L. M., Palmer, S. K., & Gibbs, C. P. (1997). Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990. Anesthesiology, 86(2), 277-284.
Manizheh, P., & Leila, P. (2009). Perceived environmental stressors and pain perception during labor among primiparous and multiparous women. J Reprod Infertil, 10(3), 217-223.
Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. (2016). Anesthesiology, 124(2), 270-300.
Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. (2017).
Rodriguez, N. R., Di Marco, N. M., Langley, S., Association, D., Canada, D. o., & Medicine, A. C. o. S. (2009). American College of Sports Medicine position stand. Nutrition and athletic performance. Med Sci Sports Exerc, 41(3), 709-731.
Rooks, J. P., Weatherby, N. L., Ernst, E. K., Stapleton, S., Rosen, D., & Rosenfield, A. (1989). Outcomes of care in birth centers. The National Birth Center Study. N Engl J Med, 321(26), 1804-1811.
Singata, M., Tranmer, J., & Gyte, G. M. L. (2013). Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews(8).
Goodall, U., & Wallymahmed, A. H. (2006). Unpublished.
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