Belly Up

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Friday, June 17, 2011

Eat, Drink and Be Merry

For years women have been told not to drink or eat while they are in labor.  The main reason for this forced fasting was to lower mom's risk of aspirating the contents of her stomach if general anesthesia was required during the delivery.  While the food and drink restriction may then seem logical, the restriction didn't necessarily actually avoid the problem.  When the stomach is empty, the contents actually increase in acidity which then may increase the risk of aspiration and furthermore, withholding food specifically during labor does not insure that the stomach is empty as the hormones of labor slow digestion.  As soon as the body recognizes labor, it slows the digestive process to ensure that there is a reserve of energy in mom's stomach.  Unless a woman routinely avoids eating during the last weeks of pregnancy (as if!), an empty stomach cannot be assured.  It can however be assured that withholding food can result in dehydration and ketosis...both unpleasant for mom and baby during labor and both are much more common than the use of general anesthesia during labor, which is rare. 

This may not be the best choice!
Luckily the American College of Obstetricians and Gynecologists, fondly known as ACOG, recently (circa 2009) decided to reverse its policy on withholding beverages for laboring women.  This is good news except the new recommendations have not made their way into common practice in many hospitals around this country.  Women are still being routinely denied the opportunity to drink even water during labor, never mind something crazy like a cup of tea or juice and the reason still being given is the risk of aspiration.  Other moms are simply told that eating or drinking will make them throw up.

Vomiting does happen to some laboring women, usually regardless if she has eaten or not. As previously mentioned, when a woman eats as desired in the early hours of labor, that food will barely start to digest and instead it will stay in her stomach and will provide the energy needed by both mom and baby throughout labor.  Then during transition, those fun last 3 centimeters of dilation, glucose levels will decrease to protect the baby's brain from excessive lactic acid while the baby's head is compressed during its journey through the pelvis.  High levels of lactic acid in the uterus may also cause contractions to be less effective over time. So the reason some moms vomit in the late stages of labor may just be that her body seems to determine how much nutrition it needs and then effectively gets rid of the extra.  That's where the vomit comes in...or out so to speak.

So where do IV fluids fit into the equation?  IV fluids are helpful if mom is suffering from dehydration or if she needs other medication during labor (ie pitocin or an epidural).  Of course if mom is unable to drink due to hospital policy then mom is indeed at risk of dealing with dehydration and may then need IV fluids, but IV fluids are not the same as food and drink.  For one they don't taste good or quench a dry mouth, but more importantly the use of IVs carry risk.  Having an IV decreases mobility and can be uncomfortable.  The biggest problem with IV fluids is the increased risk of fluid overload for both mom and baby and if the fluids used also contain glucose the baby's blood chemistry changes with increased insulin production which can cause problems immediately after birth.  Another concern is the risk of infection that is present anytime something is placed under the skin.  Bottom line, IV fluids do not provide a source of energy for a laboring mother and do not do a better job of hydrating during normal labor than allowing mom to just drink when she is thirsty.

I think the Cochrane Report from 2010 sums it up best,
Since the evidence shows no benefits or harms, there is no justification for the restriction of fluids and food in labour for women at low risk of complications. No studies looked specifically at women at increased risk of complications, hence there is no evidence to support restrictions in this group of women. 
So I say eat, drink and be merry during your labor!

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