Fasting in labor: relic or requirement

Vaginal Birth at Term - Part 1. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/083, December 2020)

Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. This first part presents recommendations and statements about patient information and counselling, general patient care, monitoring of patients, pain management and quality control measures for vaginal birth. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG 190 guideline "Intrapartum care for healthy women and babies". Other international guidelines were also consulted in specific cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions, if this was considered necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of the additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.

Oral fluid intake during the first stage of labour: A randomised trial

BACKGROUND

Obstetric anaesthesia has been associated with concern for the inhalation of gastric contents for many years, justifying fasting during labour. However, many anaesthesiologists and obstetricians now allow fluid intake during labour.

OBJECTIVE(S)

We hypothesised that allowing oral fluid intake during labour is not associated with increased gastric contents. We used ultrasound assessment of gastric contents to evaluate this hypothesis.

DESIGN

A randomised, single-blind and intention-to-treat noninferiority trial comparing antral area measured by ultrasound in fasting parturients and in those who were allowed to drink fluid for 90 min after randomisation.

SETTING

Tenon University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.

PATIENTS

Pregnant women, aged from 18 to 40 years and from week 36 of an uncomplicated singleton gestation, were randomised into a fasting group and a fluid intake group after admission to the delivery room. Of the 184 patients screened, data from 125 were analysed: fasting group (62), fluid intake group (63).

INTERVENTION

Women in the fluid intake group were allowed to drink up to 400 ml of apple juice for 90 min after randomisation.

MAIN OUTCOME MEASURE

We compared the percentage of women with an 'empty stomach' between the two groups: empty stomach was defined as an antral cross-sectional area (CSA) less than 300 mm assessed in a semirecumbent position with a 45-degree head-up tilt.

RESULTS

At full cervical dilatation an antral CSA less than 300 mm was measured in 76 and 79% of the parturients in the fasting group and the fluid intake groups respectively (P = 0.633).

CONCLUSION

The current study reveals that the percentage of pregnant women with an 'empty stomach', defined by an antral CSA less than 300 mm in a semirecumbent position with a 45-degree head-up tilt, was comparable at full cervical dilation among those who remained nil by mouth and those allowed to drink up to 400 ml for 90 min after their randomisation.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT02362815.

[Normal childbirth: physiologic labor support and medical procedures. Guidelines of the French National Authority for Health (HAS) with the collaboration of the French College of Gynaecologists and Obstetricians (CNGOF) and the French College of Midwives (CNSF) - Mother's wellbeing and regional or systemic analgesia for labor]

INTRODUCTION

These guidelines deal with the parturient wellbeing in terms of hydration and regional and systemic pain management during labour.

METHOD

Guidelines were established based on literature analysis and experts consensus.

RESULTS

Clear liquids consumption is permitted all along labor and postpartum, without volume limitation, in patients at low risk of general anesthesia (grade B). The consumption of solid foods is not recommended during the active stage of labor (consensus agreement). It is recommended to promote on regional analgesia to prevent inhalation (grade A). Pain relief using regional analgesia is a part of normal childbirth. It is recommended to provide regional analgesia to parturient who wish these technics. Regional analgesia is the safest and most effective analgesic method for the mother (grade A) and the child (grade B). It is recommended to inform women on the analgesic technics, to respect their choice and consider the right for a parturient to change her strategy in obstetrical circumstances or in cases of untractable pain (consensus agreement). It is recommended to perform a "low-dose" regional analgesia that respects the experience of childbirth (grade A) and maintain it with a patient controlled epidural analgesia technics (grade A). There is no minimum cervical dilation to allow epidural analgesia (grade A). In cases of rapid labor or after delivery for revision, spinal or combined spinal epidural can be used (grade C). Epidural has not to be ended before birth (consensus agreement). Blood pressure and fetal heart rate must be monitored every 3minutes after induction and/or each 10mL bolus then hourly (consensus agreement). Systematic and preventive fluid loading is not needed if only due to regional analgesia (grade B). Deambulation or postures are allowed in the absence of motor block and must be traced and do not alter the distribution of the regional analgesia (grade C). The postures of childbirth do not alter regional analgesia spread (NP2). There is no effect low dose regional analgesia on the duration of obstetric labor, nor the rate of instrumental births or caesarean section (NP1). Systematic use of oxytocin due to epidural analgesia is neither useful nor recommended (AE). Regional analgesia has no side effect on the fetus or newborn (NP1). If regional analgesia is contraindicated or during the waiting time, alternatives analgesic drugs (entonox, nalbuphine and tramadol or pudendal block) can be used but their analgesic efficiency remains mediocre to moderate and they are associated with adverse maternal and especially neonatal side effects (NP2). Remifentanil, ketamine and volatile anesthetics are excluded from these recommendations.

CONCLUSION

The present guidelines were established to update wellbeing of normal parturient during normal labor: hydration is recommended and low dose patient-controlled regional (epidural and spinal) analgesia is the most effective and safest analgesic method.

Investigation on the status of oral intake management measures during labor in China

The World Health Organization recommended that the oral intake of low-risk pregnant women during labor should not be restricted. Hospitals in different countries take different measures to manage the intake during labor, but it is not clear about the current situation of oral intake management measures in the hospital during labor in China. Thus, the objective of this study was to investigate the current situation of oral intake management measures during labor in China, so as not only provide references for developing appropriate midwifery technology training and formulating relevant policies, but also provide a basis for exploring and implementing better oral intake management measures in the future.A cross-sectional survey was conducted. From December 2017 to November 2018, the oral intake management measures of 1213 hospitals in 22 provinces, cities, and autonomous regions in China were investigated by a self-designed questionnaire. χ test was used for statistical analysis.Different hospitals in China have adopted different oral intake management measures. Among the 1213 hospitals, 939(77.4%) hospitals took measures to allow pregnant women to bring the easily digestible food, 813(67.0%) hospitals took measures to allow pregnant women to eat what she wanted to eat. Few hospitals provide pregnant women with oral nutrition solution or provide a suitable diet for pregnant women. Thirty-four (2.8%) hospitals still restrict pregnant women's fluid intake.Oral intake management measures that are more suitable for Chinese pregnant women should be explored to better ensure the women energy needs and they safely go through childbirth.

Effects of date fruit (Phoenix dactylifera L.) on labor and delivery outcomes: a systematic review and meta-analysis

BACKGROUND

The rate of cesarean section is increasing in all over the world with different drafts in various countries. This growth increases unpleasant outcomes of delivery. Recent studies explained the benefits of date palm fruit on labor process improvement. Date fruit can be considered as a factor for increasing vaginal delivery and also reducing the frequency of caesarean section in order to prevent its great complications. This systematic review has been designed to review clinical studies that investigate the effects of date palm fruit on labor outcomes (duration of labor stages, bishop score, and frequency of cesarean section) compared with routine cares.

METHODS

This study was performed in 2019. Required data has been collected from electronic databases and manual searches. All randomized clinical trials evaluating the effects of date palm fruit on labor and delivery that were published from January 2000 to August 2019 in English and Persian languages, were incorporated in this systematic review. The methodological quality of the included studies was evaluated according to the risk of bias assessment of Cochrane handbook of systematic reviews, and were then reported using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.

RESULTS

Eight studies were included in the qualitative and quantitative synthesis. Meta-Analysis showed that date fruit consumption can significantly reduce active phase of labor (three trials with 380 participants; (MD = - 109.3, 95%CI (- 196.32, - 22.29; I² = 89%), P = 0.01), and also it can significantly improve the bishop score (two trials with 320 participants; MD = 2.45, 95%CI (1.87, 3.04; I² = 0%), P < 0.00001). Date fruit consumption had no effects on the duration of first, second, and third stages of labor, and the frequency of cesarean section.

CONCLUSION

Date can reduce the duration of active phase and improve the bishop score; however, due to from the low to mediate quality of the studies; it seems that the other studies are needed to prove these results better than this.

Effect of Oral Carbohydrate Intake During Labor on the Rate of Instrumental Vaginal Delivery: A Multicenter, Randomized Controlled Trial

BACKGROUND

Carbohydrate intake during physical exercise improves muscle performance and decreases fatigue. We hypothesized that carbohydrate intake during labor, which is a period of significant physical activity, can decrease the instrumental vaginal delivery rate.

METHODS

In a multicenter, prospective, randomized, controlled trial, healthy adult pregnant women presenting with spontaneous labor were assigned to a "Carbohydrate" group (advised to drink 200 mL of apple or grape juice without pulp every 3 hours) or a "Fasting" group (water only). The primary outcome was the instrumental vaginal delivery rate. Secondary outcomes included duration of labor, rate of cesarean delivery, evaluation of maternal hunger, thirst, stress, fatigue, and overall feeling during labor by numeric rating scale (0 worst rating to 10 best rating), rate of vomiting, and hospital length of stay. Statistical analysis was performed on an intention-to-treat basis. The primary outcome was tested with the "Fasting" group as the reference group. The P values for secondary outcomes were adjusted for multiple comparisons. The differences between groups are reported with 99% confidence interval (CI).

RESULTS

A total of 3984 women were analyzed (2014 in the Carbohydrate group and 1970 in the Fasting group). There was no difference in the rate of instrumental delivery between the Carbohydrate (21.0%) and the Fasting (22.4%) groups (difference, -1.4%; 99% CI, -4.9 to 2.2). No differences were found between the Carbohydrate and the Fasting groups for the duration of labor (difference, -7 minutes; 99% CI, -25 to 11), the rate of cesarean delivery (difference, -0.3%; 99% CI, -2.4 to 3.0), the rate of vomiting (difference, 2.8%; 99% CI, 0.2-5.7), the degree of self-reported fatigue (difference, 1; 99% CI, 0-2), self-reported hunger (difference, 0; 99% CI, -1 to 1), thirst (difference, 0; 99% CI, -1 to 1), stress (difference, 0; 99% CI, -1 to 1), overall feeling (difference, 0; 99% CI, 0-0), and the length of hospitalization (difference, 0; 99% CI, -1 to 0).

CONCLUSIONS

Carbohydrate intake during labor did not modify the rate of instrumental vaginal delivery.

Intrauterine Resuscitation During Labor: Review of Current Methods and Supportive Evidence

When the fetal heart rate pattern is suggestive of fetal compromise during labor, various methods to promote fetal well-being are traditionally initiated. They include maternal repositioning, reduction of uterine activity, an intravenous fluid bolus, oxygen administration, correction of maternal hypotension, amnioinfusion, and alteration of second-stage labor pushing efforts. Although these intrauterine resuscitation techniques are commonly used, and in some cases considered standard care, supportive data could be more robust. Nevertheless, there is enough evidence to suggest they are beneficial to the fetus and there is minimal risk of harm when used with clinical common sense. Until more data are available, it seems reasonable to err on the side of fetal safety by using these techniques when appropriate, based on the specific fetal heart rate pattern.

Effect of food intake during labour on obstetric outcome: randomised controlled trial

OBJECTIVE

To investigate the effect of feeding during labour on obstetric and neonatal outcomes.

DESIGN

Prospective randomised controlled trial.

SETTING

Birth centre in London teaching hospital.

PARTICIPANTS

2426 nulliparous, non-diabetic women at term, with a singleton cephalic presenting fetus and in labour with a cervical dilatation of less than 6 cm.

INTERVENTION

Consumption of a light diet or water during labour.

MAIN OUTCOME MEASURES

The primary outcome measure was spontaneous vaginal delivery rate. Other outcomes measured included duration of labour, need for augmentation of labour, instrumental and caesarean delivery rates, incidence of vomiting, and neonatal outcome.

RESULTS

The spontaneous vaginal delivery rate was the same in both groups (44%; relative risk 0.99, 95% confidence interval 0.90 to 1.08). No clinically important differences were found in the duration of labour (geometric mean: eating, 597 min v water, 612 min; ratio of geometric means 0.98, 95% confidence interval 0.93 to 1.03), the caesarean delivery rate (30% v 30%; relative risk 0.99, 0.87 to 1.12), or the incidence of vomiting (35% v 34%; relative risk 1.05, 0.9 to 1.2). Neonatal outcomes were also similar.

CONCLUSIONS

Consumption of a light diet during labour did not influence obstetric or neonatal outcomes in participants, nor did it increase the incidence of vomiting. Women who are allowed to eat in labour have similar lengths of labour and operative delivery rates to those allowed water only.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN33298015.

Measuring the energy spent by parturient women in fasting and in ingesting caloric replacement (Honey)

This research aims to measure the energy spending in parturient women of low gestation risk. Participants were selected randomly and submitted to fasting (n=15; Group I) or honey ingestion (n=15; Group II). Data were collected by means of capillary blood values and heart frequency monitoring. The paired t-test with a 5% significance level and Tukey's method were used in statistical analysis. The results showed that honey ingestion did not promote an overload in the mother's glucose; the lactate response demonstrated that the substrate offered was well used; the cardiorespiratory rate demonstrated good performance for both groups; the total energy spent during labor demonstrated that carbohydrate ingestion exerts significant influence, improving maternal anaerobic performance; the group which remained in fasting presented, immediately after labor, higher levels of lactate, showing the organism's efforts to compensate for the energy spent.

Routine prophylactic drugs in normal labour for reducing gastric aspiration and its effects

BACKGROUND

Women in normal labour may sometimes go on to have general anaesthesia if labour becomes abnormal, for example if a caesarean section is required. General anaesthesia carries a very small risk of regurgitation and inhalation of stomach contents into the lungs. This can cause inflammation, particularly if the fluid is acidic, and can lead to severe morbidity and very occasionally mortality. Labour hormones increase the risk of gastric aspiration or Mendelsohn's syndrome, though the exact incidence is unknown. The routine administration of acid prophylaxis drugs to all women in normal labour is commonly practiced worldwide, to reduce gastric aspiration by reducing the volume and acidity of stomach contents.

OBJECTIVES

To assess the effectiveness of routine prophylaxis drugs for women in normal labour to reduce gastric aspiration and its effects.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group Trials Register (December 2005), EMBASE (1974 to April 2005) and CINAHL (1982 to April 2005).

SELECTION CRITERIA

Randomised and quasi-randomised controlled trials of women in normal labour assessing the routine administration of drugs (antacids, H(2) receptor antagonists, dopamine antagonists and proton-pump inhibitors) compared with placebo/no treatment, and compared with other drugs for reducing gastric aspiration.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed eligibility, quality, extracted data and performed double-data entry.

MAIN RESULTS

Three trials were included, involving 2465 women, assessing the effects of antacids, H(2) receptor antagonists and dopamine antagonists. There were no trials on proton-pump inhibitors. None of the trials were of good quality, and none assessed the incidence of gastric aspiration, Mendelsohn's syndrome or their consequences. All the studies assessed vomiting, and there was limited evidence that vomiting may be reduced by antacids (relative risk (RR) 0.46, 95% confidence interval (CI) 0.27 to 0.77, n = 578, one trial) or by dopamine antagonists given alongside pethidine (RR 0.40, 95% CI 0.23 to 0.68, n = 584, one trial). Comparisons between different drugs showed no significant differences, though the number of participants was small. There was no evidence that H(2) receptor antagonists improved outcomes compared with antacids, though only one trial addressed this issue.

AUTHORS' CONCLUSIONS

There is no good evidence to support the routine administration of acid prophylaxis drugs in normal labour to prevent gastric aspiration and its consequences. Giving such drugs to women once a decision to give general anaesthesia is made, is assessed in another Cochrane review.

Actual versus instructed fasting times and associated discomforts in women having scheduled cesarean birth

OBJECTIVES

To measure actual and instructed preoperative fasting durations in women undergoing scheduled cesarean birth, to compare these times with national guidelines for healthy patients undergoing elective procedures, and to describe discomforts associated with preoperative fasting.

DESIGN

One group, nonexperimental, comparative, descriptive.

SETTING

Nonprofit private medical center in Texas with 6,000 births/year.

PATIENTS

Convenience sample of 51 hospitalized postpartum women.

INTERVENTIONS

Participants were interviewed an average of 44 hours after their cesarean birth, and their medical records were reviewed for fasting information.

MAIN OUTCOME MEASURES

Duration of actual and instructed fasting, comparison with national guidelines, and ratings of thirst and hunger.

RESULTS

The participants fasted from liquids and solids an average of 11 and 13 hours, respectively. Both actual and instructed fasting durations were significantly longer than national guidelines. Most participants (70%) were instructed to be nulla per os after midnight whether they were to have a.m. or p.m. surgery. Thirst and hunger scores averaged 5 and 4, respectively, on a 0-10 scale.

CONCLUSION

Patients having scheduled cesarean birth fast for unnecessarily long periods. Nurses should be knowledgeable about evidence-based preoperative fasting practices and collaborate with physicians to implement them.

Apports alimentaires per os durant le travail obstétrical : éléments objectifs et subjectifs

Fasting during labour is questioned in France despite the historical recommendations by Curtis Mendelson. Solid food diet increases maternal nausea and vomiting of non digested food associated with a theoretical risk of severe aspiration syndrome. Clear fluids may improve the comfort of some parturients but it remains uncertain whether or not the obstetric consequences (i.e. duration of labour, Caesarean section rate) of carbohydrate supplementation are beneficial.

The effect of unrestricted oral carbohydrate intake on labor progress

OBJECTIVE

To determine if unrestricted oral carbohydrate intake during labor reduced the incidence of dystocia in low-risk nulliparous women.

DESIGN AND SETTING

A randomized clinical trial at a university-affiliated hospital in southeastern Ontario. Low-risk nulliparous women were randomized between 30 and 40 weeks gestation to either an intervention or usual care group.

INTERVENTION

Women in the intervention group received, prenatally, guidelines about food and fluid intake during labor and were encouraged to eat and drink as they pleased during labor. Women in the usual care group received no prelabor information and were restricted to ice chips and water during labor in the hospital.

MAIN OUTCOME MEASURE

The incidence of dystocia, defined as a cervical dilatation rate of less than 0.5 cm/hr for a period of 4 hrs after a cervical dilatation of 3 cm.

RESULTS

Three hundred twenty-eight women were randomized to the intervention (n = 163) or usual care (n = 165) groups. Women in the intervention group reported a significantly different pattern of oral intake during early labor in the hospital (chi(2) = 40.7, p < .001). The incidence of dystocia was 36% (n = 58) in the intervention group and 44% (n = 72) in the usual care group and was not significantly different (OR = 0.71, 95% CI = 0.46, 1.11). There were no significant differences in the other secondary outcomes or in the incidence of adverse maternal or neonatal complications.

CONCLUSION

Eating and drinking early in labor had no significant impact on the incidence of dystocia and/or adverse maternal or neonatal outcomes.

A midwifery practice dichotomy on oral intake in labour

OBJECTIVE

to assess the views and practices of midwives regarding oral intake in labour for women with low-risk pregnancies.

DESIGN

an exploratory survey design including open- and closed-ended questions.

SETTING

four hospitals in Sydney, Australia.

PARTICIPANTS

89 practising midwives who provided care for labouring women.

FINDINGS

midwives were divided on the issue of what and when labouring women should, or should not, be allowed to eat and drink. The views and practices of these midwives were influenced by the accepted practice in the hospital in which they were employed and the types of midwifery models in which they have practised.

KEY CONCLUSIONS

there is insufficient conclusive research evidence to support any stance on oral intake for labouring women. Most information purported by supporters of oral intake is based on anecdotal evidence and assumptions based on the physiology of the body. 'Nil by mouth' policies have never been researched while clear fluid policies are based on research performed with non-obstetric patients.

IMPLICATIONS FOR PRACTICE

without reliable research evidence for the management of oral intake for labouring women no hospital practice or policy is valid. This leaves midwives with the responsibility of deciding what they believe is the best management for the oral intake of labouring women in their care.

Midwifery dilemma: to fast or feed the labouring woman Part 2: the case supporting oral intake in labour

This article has, so far, explored the phenomenon of aspiration associated with obstetric general anaesthesia (see Part 1). Part 2 examines the literature pertaining to the history of dietary regimes for labour and the physiological and psychological effect of restricting or allowing food and fluids during labour. The increasing trend among some health professionals to allow food and fluids during labour and research conducted to investigate the effect of the labouring woman's oral intake on the labour and birth outcomes is also discussed.

Midwifery dilemma: to fast or feed the labouring woman. Part I: The case for restricting oral intake in labour

This paper presents a literature review which pursues both sides of the labouring woman's oral intake debate--to fast or to feed the labouring woman. Part 1 provides an exploration of the phenomenon of gastric content aspiration associated with general anaesthesia and its historical and physiological underpinnings. Part 2 provides an examination of the literature concerning the benefits of fasting labouring women.

Intrapartum care in the twenty-first century

Women will continue seeking obstetrical care from nurses, midwives, and physicians throughout the twenty-first century. In many areas of the country, they will be able to find a midwife who will assist them in having a very personal birth experience. The ACNM remains committed to producing more midwives. More midwives may mean that practitioners educated in normal pregnancy will attend the vast majority of normal births, freeing physician colleagues to best use their skills and expertise in caring for women with medical and obstetrical problems. As most midwives are likely to continue working in hospital settings, those settings will continue to change, offering women more of the comforts and amenities of home. Home birth and water birth may continue to be available with midwives in attendance, though the forces of economics and insurers may restrict the availability of these options for women. Women desiring care in a birth center may find it difficult to locate one within a reasonable distance. The in-hospital "birthing suite", with a midwife in attendance, will be the most likely setting for the vast majority of midwifery attended births. A collection of more evidence through research will stir debate amongst health care providers. Increased access to that information will bring consumers into the debate as well. In the twenty-first century, information will be a very powerful force of change in obstetrical health care. In recent years, legal liability and economics have strongly influenced obstetrical practice. Though this may continue to be true, the impact of more evidence on which to base practice, and the new access that women have to that information, will undoubtedly affect the way care is delivered. A central slogan of the ACNM is "Listen to Women". That will happen more than ever in the twenty-first century. There will be more midwives, more evidence to support midwifery care, and more women learning that birth can and should be a personal, healthy, and empowering experience. These women will seek midwives who practice wisely, blending science with art and intuition. They will learn that the childbirth wisdom that has been passed down through the ages, from woman to midwife to healer to nurse and to midwife, again, delivers the birth experience back to the mother and the healthy baby to the world [3,7].

Fetal and maternal energy metabolism during labor in relation to the available caloric substrate

AIM

To discuss maternal and fetal metabolic events during labor and the possible role of glucose administration.

RESULTS

The oxidative pathway covers the largest part of the energy demand of labor, although in the second stage or, in polysystolic labor, the non-oxidative pathway becomes important as well. Glucose is the main maternal energy source, but the rise in ketobodies, even during normal labor, suggests a relative shortage. In the first stage of labor, a combination of a respiratory alkalosis, and to a lesser extent, a metabolic acidosis, result in a rise in the maternal pH. In the second stage of labor, the maternal pH decreases due to an increasing metabolic acidosis. Glucose is also the main fetal energetic fuel. In fetal hypoxia, lactate is produced, which in most cases is transferred to the maternal circulation. High maternal lactate concentrations, however, may interfere with this process. Furthermore, fetal hyperglycemia may lead to an increased fetal lactate production.

CONCLUSIONS

Maternal hyperglycemia, may lead to an increase in maternal and fetal lactate production resulting in metabolic acidosis. Unlike high dosage intravenous glucose administration, it is not likely that oral intake of carbohydrates leads to maternal and fetal hyperglycemia and subsequently to metabolic acidosis, but studies are rare.

Policy or tradition: oral intake in labour

Oral intake restrictions have varied over time and around the world with written hospital policies for this issue often being non-existent. As there are differing views on this issue within hospitals overseas, a survey was conducted of 109 maternity units in New South Wales, Australia during early 2000 to identify the trends across the state. In New South Wales 81.7% of hospitals did not have a written policy for oral intake in labour. The remaining 18.3% had written policies which varied in their oral intake allowances from ice only to whatever women feel like eating and drinking. Of the 109 hospitals in this survey 60.5% leave food and fluid requirements to the individual woman's discretion, providing they have no increased risk of general anaesthetic.

Eating and drinking in labor: the influence of caregiver advice on women's behavior

BACKGROUND

Although there is much debate about eating and drinking during labor, little scientific data about its influence on the course of labor exist. In The Netherlands, most midwives and obstetricians allow women to eat and drink during normal labor. The objective of this study was to examine whether or not women were actively advised to eat and drink and if this advice affected eating and drinking behavior.

METHODS

A randomly selected group of midwives and obstetricians from across The Netherlands identified 211 consecutive nulliparous women to participate in the study. In a questionnaire with open-ended questions, women were asked after their delivery whether or not they were advised about eating and drinking during labor, and if so, about the nature of this advice and what they had consumed. Data were analyzed at the Leyenburg Hospital in The Hague.

RESULTS

Sixty-six percent of the women were not given advice about eating and drinking during labor. Women who were given advice usually followed it. In the total group, 37 percent of the women had intake other than water and of these, 75 percent ate solid food. After adjusting for other prognostic factors, the incidence of an instrumental delivery due to a nonprogressing second stage was lower in women with caloric intake (13% vs 24%, p = 0.04).

CONCLUSION

The study design did not enable us to draw conclusions about the cause and effect between caloric intake and labor progress. Scientific data with respect to the giving of evidence-based advice about eating and drinking during labor are lacking. Should such advice become available, women are likely to follow it.