Limiting food intake during labor (even with an epidural) is not evidenced based care
10.24.15 - Link to full article here
SAN DIEGO – Most healthy women can skip the fasting and, in fact, would benefit from eating a light meal during labor, suggests research being presented at the ANESTHESIOLOGY® 2015 annual meeting. Improvements in anesthesia care have made pain control during labor safer, reducing risks related to eating, researchers note.
Women traditionally have been told to avoid eating or drinking during labor due to concerns they may aspirate, or inhale liquid or food into their lungs, which can cause pneumonia. But advances in anesthesia care means most healthy women are highly unlikely to have this problem today and when researchers reviewed the literature of hundreds of studies on the topic, they determined that withholding food and liquids may be unnecessary for many women in labor.
“Our findings suggest a change in practice makes sense,” said Christopher Harty, BN, co-author of the study and a medical student at Memorial University, St. John’s, Newfoundland, Canada. “Physician anesthesiologists and obstetricians should work together to assess each patient individually. Those they determine are at low risk for aspiration can likely eat a light meal during labor. This gives expectant mothers more choices in their birthing experience and prevents them from being calorie deficient, helping to provide energy during labor.”
Researchers said aspiration today is almost nonexistent, especially in healthy patients. In the United States, there was only one case of aspiration associated with labor and delivery between 2005 and 2013, involving a complicated case of a woman who was obese and had pre-eclampsia (a precursor to eclampsia, or high blood pressure that can lead to seizures), according to the American Society of Anesthesiology’s Closed Claims Project database. Researchers also noted that no cases of death due to aspiration were reported in the United Kingdom between 2000 and 2005, compared to 1.5 cases per 1,000 during the 1940s. They say this is likely due to advances in anesthesia care, including increased use of epidurals and spinal blocks in place of providing anesthesia through a mask over the nose and mouth. Before these improvements, women were more likely to need a tube placed in the windpipe for breathing, which potentially increased the risk of aspiration.
Researchers analyzed 385 studies published in 1990 or later that focused on women who gave birth in a hospital. The research suggests that the energy and caloric demands of laboring women are similar to those of marathon runners, Harty said. Without adequate nutrition, women’s bodies will begin to use fat as an energy source, increasing acidity of the blood in the mother and infant, potentially reducing uterine contractions and leading to longer labor and lower health scores in newborns. Additionally, the studies suggest that fasting can cause emotional stress, potentially moving blood away from the uterus and placenta, lengthening labor and contributing to distress of the fetus.
“However, certain factors increase a laboring patient’s risk of aspiration which outweigh the risks of withholding nutrition,” said Erin Sprout, BN, co-author of the study and a medical student at Memorial University. These factors include eclampsia, pre-eclampsia, obesity and the use of opioids to manage labor pain, which delays stomach emptying, she said.
Healthy women who are not at risk for aspiration should ask their medical care providers (including their physician anesthesiologist and obstetrician) if eating a light meal during labor is safe for them. A light meal could include fruit, light soups, toast, light sandwiches (no large slices of meat), juice and water. Most women lose their appetites during very active labor, but can continue to drink fluids such as water and clear juices, researchers said.