Drinking and Eating in Labor

January 26, 2010
In Labor, a Snack or a Sip?

By RONI CARYN RABIN

Maternity wards have long forbidden women in labor to eat or drink. Even when labor goes on and on, the bill of fare is usually limited to ice chips.

Now a systematic review of existing studies has found no evidence that the restrictions have any benefit for most healthy women and their babies.

The prohibitions are meant to reduce the risk of Mendelson’s syndrome (named for Dr. Curtis L. Mendelson, the New York obstetrician who first described it in the 1940s), which can occur if the contents of the stomach are drawn into the lungs while the patient is under general anesthesia.

While rare, the syndrome can be fatal. But nowadays the use of general anesthesia during labor and delivery is also rare. Caesarean sections are generally done using regional anesthesia.

“My own view of this has always been that you could say one shouldn’t eat or drink anything before getting into a car on the same basis, because you could be in an automobile accident and you might require general anesthesia,” said Dr. Marcie Richardson, an obstetrician and gynecologist at Harvard Vanguard Medical Associates in Boston, who was not connected to the new study.

Beth Israel Deaconess Medical Center, where Dr. Richardson delivers, estimates that just 1 to 2 percent of women in labor are given general anesthesia.

The restrictions date back almost seven decades, said Joan Tranmer, an associate professor of nursing at Queen’s University in Kingston, Ontario, an author of the new review, published last week by the Cochrane Collaboration.

“We thought it was time to question this, now that we’re in the 2000s,” said Dr. Tranmer, who said she had seen all too many women in labor complaining of thirst and dry mouth resort to sucking wet washcloths.

“With improved anesthetic techniques, we don’t do general anesthesia a lot anymore,” she said. “And even when they have to administer general anesthesia, they’ve improved the techniques, and the risk is very, very low.

“So we turned the question around and asked: Is there any benefit to restricting oral food and fluid during labor? And we found no benefit and no harm.”

The authors acknowledged that they found relatively little evidence to analyze: 11 studies, including just 5 randomized controlled trials encompassing 3,130 women.

All of the studies looked at women who were in active labor and at low risk of requiring general anesthesia. One compared complete restriction of food and drink with complete freedom to eat and drink at will, two compared water with other liquids and foods and two compared water with carbohydrate drinks.

There were no statistically significant differences in such primary outcomes as the rate of Caesarean sections and fetal Apgar scores, or in secondary outcomes, like the need for pain relief or duration of labor. One small study, however, did find an increase in C-sections among women taking carbohydrate drinks compared with those limited to drinking water.

Some hospitals have lifted restrictions on drinking during labor in recent months, since the American Congress of Obstetricians and Gynecologists issued new guidelines last August allowing patients to drink clear liquids. But the guidelines kept the restriction on solid foods.

“The problem is going to be for emergency C-sections, which are rare but not unheard of,” said Dr. William Henry Barth Jr., chairman of the society’s committee on obstetrics practice. “There’s just not time in that setting to stop and do regional anesthesia. And it can be unpredictable.”

Anesthesiologists were critical of the review, saying none of the studies were large enough to evaluate the impact of eating on risks during general anesthesia.

“From an anesthesiologist’s perspective, they missed the boat on this one,” said Dr. Craig M. Palmer, chairman of the committee on obstetrical anesthesia for the American Society of Anesthesiologists.

“They looked at the impact on the progression of labor, but to be honest, that’s not an issue for anesthesiologists. Our primary concern is patient safety.”

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