Eating in labour. A randomised controlled trial assessing the risks and benefits

Abstract

SummaryThe aim of this study was to determine whether permitting women in labour to eat a light diet would: (i) alter their metabolic profile, (ii) influence the outcome of labour, and (iii) increase residual gastric volume and consequent risk of pulmonary aspiration. Women were randomised to receive either a light diet (eating group, n ¼ 48) or water only (starved group, n ¼ 46) during labour. The light diet prevented the rise in plasma b-hydroxybutyrate (p ¼ 2.3 × 10 ¹5 ) and nonesterified fatty acids (p ¼ 9.3 × 10 ¹7 ) seen in the starved group. Plasma glucose (p ¼ 0.003) and insulin (p ¼ 0.017) rose in the eating group but there was no difference in plasma lactate (p ¼ 0.167) between the groups. There were no differences between the groups with respect to duration of first or second stage of labour, oxytocin requirements, mode of delivery, Apgar scores or umbilical artery and venous blood samples. Relative gastric volumes estimated by ultrasound measurement of gastric antral cross-sectional area were larger (p ¼ 0.001) in the eating group. This was supported by the observation that those from this group who vomited, vomited significantly larger volumes than those in the starved group (p ¼ 0.001). We conclude that eating in labour prevents the development of ketosis but significantly increases residual gastric volume.

Pre‐operative fasting guidelines: an update

“…Hence, fasting such patients will never make them 'fasted and elective'. The same applies to pregnant women in labour (50).…”

“…Despite this fact, most maternity wards encourage oral intake during labour (50). This may sound counter-productive for us as anesthesiologists, but to obstetricians, midwives and the women themselves, the small risk of an emergency Caesarean-section under general anaesthesia may not be a valid argument to impose unphysiological starvation during a natural process with a large need for calories (50).…”

Restricting oral fluid and food intake during labour

“…Of these, we have included five studies involving 3130 women in this review (Kubli 2002;Scheepers 2002;Scrutton 1999;Tranmer 2005), excluded two studies (Scheepers 2004;Shennan 2005 ) and assigned four studies as awaiting classification; we have attempted to contact these authors (Goodall 1999;Laifer 2000;Yiannouzis 1994;Zhao 1996).…”

Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 3: Interventions associated with oxytocin administration during spontaneous labor

“…The authors included 5 randomized trials that compared different interventions restricting oral intake vs free oral intake: 2 studies compared a restrictive policy including the possibility of drinking water to a policy encouraging women to eat and drink during labor [71,72]; 2 studies compared women who had only water with those who drank fluid carbohydrates during labor [73,74]; and another compared a restrictive policy with no fluid intake to a policy allowing women to eat and drink as they chose during labor [75]. The authors found no difference in oxytocin use between women subject to the restrictive policies and those for whom oral intake was authorized (n=3103; RR 1.02, 95% CI 0.95-1.09).…”