In a review of the literature on restrictions of eating and drinking during labor published in the Journal of Obstetric, Gynecologic, and Neonatal Nursing in 1999, authors Sleutal and Golden noted that the odds of dying of aspiration in labor are less than that of being struck by lightening twice in one year. Twice in one year! Yet, thirteen years later, policies regarding oral intake in labor continue to provoke heated controversy.
Since at least 1998, guidelines published by the American Society of Anesthesiologists (ASA) have allowed clear liquids for normal laboring women; however, in 2009, women in many hospitals in the United States are still limited to ice chips during labor.
In a committee opinion published in the September issue of Obstetrics and Gynecology, the American College of Obstetricians and Gynecologists (ACOG), has finally eased their recommendations regarding oral intake in labor. Women with normal, uncomplicated labors may drink modest amounts of clear liquids such as water, fruit juice without pulp, carbonated beverages, clear tea, black coffee, and sports drinks. Even women with uncomplicated pregnancies who are scheduled for cesarean surgery may drink these beverages up to two hours before anesthesia is administered. This last recommendation reflects guidelines issued more than 10 years ago by the ASA allowing clear liquids up to two hours before elective surgery.
Current evidence certainly supports not only a more liberal attitude towards liquids in labor, but also more liberal policies about eating in labor. Aspiration is a danger only with general anesthesia which is rare for childbirth today. Deaths due to aspiration have plummeted as anesthesia techniques have improved. Many experts state that the rare death from aspiration is due to faulty technique rather than the volume of gastric contents. According to a 1998 study, there are no more deaths due to aspiration in labor in the Netherlands where most (75%) providers allow food and fluids during labor than in other countries with more restrictive policies. A recent randomized controlled trial in Great Britain found no increase in complications for mother, baby, or labor progress when women were allowed a light diet during labor.
The new policy is a step forward towards bringing back the normalcy of birth. Since women will now (hopefully) be allowed to drink during labor, one can hope that fewer care providers will require IV fluids. Without being tethered to an IV pole and limited to ice chips, a laboring woman should feel less like a hospital “patient” and more like a woman experiencing a normal, physiological (albeit life-changing) experience.
We also hope that this is just a first step; that research will continue looking at lifting the restrictions on food during labor. In March of 2008, the American College of Nurse-Midwives (ACNM) published the clinical bulletin, Providing Oral Nutrition to Women in Labor, in the Journal of Midwifery & Women’s Health. They recommend that providers discuss with women the small but potentially serious risk of aspiration during antepartum care; then, during labor, allow women to make their own decisions about whether to eat or drink. We look forward to the day when the nation’s OBs will issue a similar recommendation.