Major Finding: In women at low risk of needing general anesthesia during childbirth, there was no significant association with eating and drinking during labor and the rate of cesarean section, operative vaginal birth, or Apgar scores of less than 7 at 5 minutes.
Data Source: A Cochrane database review of five randomized controlled trials comprising 3,130 women.
Disclosures: The review was sponsored by the University of the Witwatersrand and the University of Liverpool, as well as the National Institute for Health Research, and by a World Health Organization grant. One of the authors was the primary investigator on a study included in the review.
Women at low risk of complications during childbirth should be allowed to take food and water as they desire during active labor, a Cochrane database review has concluded.
“The review identified no benefits or harms of restricting foods and fluids during labor in women at low risk of needing anesthesia,” wrote lead author Mandisa Singata, R.N., and her associates. “Given these findings, women should be free to eat and drink in labor or not, as they wish” (Cochrane Database Syst. Rev. 2010;CD003930 [doi:10.1002/14651858.CD003930.pub2]).
The review of five studies comprising 3,130 women suggests that the prohibition on oral intake during labor may be based on outdated concerns, wrote Ms. Singata of the University of Witwatersrand, East London, South Africa, and her associates.
“Restricting oral food and fluid intake … is a strongly held obstetric and anesthetic tradition,” related to research performed in the 1940s on regurgitation under general anesthetic and resulting inhalation pneumonia. “Most [eating prohibitions] are based on historical, but important, concerns related to these risks. … The incidence is very rare with modern anesthetic techniques and the use of regional rather than general anesthesia.”
Ms. Singata and her colleagues identified five randomized controlled trials that examined this issue. The studies were conducted from 1999 to 2009.
All included women at low risk of requiring general anesthesia during childbirth. One study looked at restricting intake to ice chips and sips of water vs. full access to food and drink. Two compared water only to encouraging the consumption of some food and fluid, and two compared water only to carbohydrate drinks during labor.
The analysis was dominated by the largest and most recent study, which contained 2,443 women. The other four studies together comprised 687 women. The largest study was conducted in a “highly medicalized environment,” in which 30% of women had a cesarean section, over 50% had oxytocin, just under 70% received intravenous fluids and epidural anesthesia, and 27% underwent operative vaginal birth.
“In addition, 20% of the women in the water-only arm ate during labor and 295 in the food and fluid arm chose not to eat in labor. This clearly reflects the wide variation in women's wishes for food and fluids during labor,” the authors wrote.
When considering any restriction of food and fluid versus allowing them, the authors found no significant associations with the rate of cesarean section, operative vaginal birth, or Apgar scores of less than 7 at 5 minutes. Neither were there significant relationships with duration of labor, maternal nausea or vomiting, narcotic pain relief, or infant admission to intensive care.
None of the outcomes were significantly related in any of the other analyses: complete restriction of food and fluid vs. freedom to eat and drink, water only vs. freedom to eat and drink, or complete food and fluid restriction vs. carbohydrate-based fluid only.