Eating and Drinking Lightly During Labor
It may seem like a silly question, but active labor can be a lengthy process. It's completely appropriate to ask your care provider whether you will be allowed to eat or drink lightly during labor, and under what circumstances that will not be safe.
Can I eat lightly or drink during labor?
If you are low risk (no meds, no inductions, fetal heart tones reassuring, no complications of pregnancy), you should be allowed to eat and drink; lighter foods in active labor are better tolerated— usually clears are preferred and better tolerated (teas, juices, soups, sports drinks, ice pops) because often there is vomiting if the stomach is full during transition (the blood supply to the stomach is preferentially shifted to where the activity is happening, mainly the uterus and pelvic areas, and stomach contents emptying is slowed down.) However, if the woman desires to eat, she should not be discouraged from doing so. Nothing by mouth (NPO) is indicated if there is an induction, Pitocin, or any other circumstance where there is a higher than normal risk of surgery. NPO is bad for low risk labors; women need calories, fluid and energy for the birthing marathon. The reason the medical community does not like laboring women to eat is due to the fear of Mendelson’s syndrome—that if they need general anesthesia, they theoretically might vomit and aspirate stomach contents into their lungs. Keeping a restriction on the food and fluid intake during labor however, does not guarantee reduced stomach content (Crawford 1956, Taylor and Pryse-Davies 1966, Roberts and Shirley 1976, Tettambel 1983, Mckay and Mahan 1988). Routine administration of antacids during labor cannot be relied on to prevent Mendelson's syndrome, neither does it affect the volume of gastric contents. So what is the risk of aspiration during general anesthesia for childbirth? As per evidencebasedbirth.com, in one study, authors examined 4097 maternal deaths that occurred in the U.S. from 1979 to 1990. The risk of aspiration during cesarean childbirth was 0.667 per million women, or approximately 7 events in 10 million births (Hawkins, Koonin et al. 1997). [Side note: The probability of this occurring is less likely than being struck by lightning!] In another study, researchers looked at 11,814 women who were given the freedom to eat and drink during labor, with some women requiring emergency C-sections. There were zero cases of morbidity or mortality reported from aspiration pneumonia, even though 22% of women had eaten solid food (Rooks, Weatherby et al. 1989). As there is no guarantee against Mendelson's syndrome, the correct approach for normal childbirth should include an assessment of the risk of general anesthesia. Based on the evidence, once categorized, the low risk birth can be managed without administration of antacids, and women should have the right to choose whether or not they would like to eat and drink during labor.
- Crawford JS. Some aspects of obstetric anaesthesia. Br J Anaesth 1956; 28:146-158, 201-208.
- Taylor G, Pryse-Davies J. The prophylactic use of antacids in the prevention of the acid-pulmonary-aspiration syndrome (Mendelson's syndrome). Lancet 1966; 1:288-291.
- Roberts RB, Shirley MA. The obstetrician's role in reducing the risk of aspiration pneumonitis. With particular reference to the use of oral antacids. Am J Obstet Gynaecol 1976; 124:611-617.
- Tettambel MA. Preoperative use of antacids to prevent Mendelson's syndrome in caesarean section, a pilot study. J Am Osteopath Assoc 1983; 82:858-860.
- Mckay S, Mahan C. Modifying the stomach contents of labouring women: why, how, with what success, and at what risks? How can aspiration of vomitus in obstetrics best be prevented? Birth 1988; 15(4):213-221.â€‹
- Hawkins, J. L., L. M. Koonin, et al. (1997). “Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990.” Anesthesiology 86(2): 277-284.â€‹
- Rooks, J. P., N. L. Weatherby, et al. (1989). “Outcomes of care in birth centers. The National Birth Center Study.” N Engl J Med 321(26): 1804-1811