Literature review: Eating anddrinking in labour

By Lauren Hunt Autonomous Midwifery Practitioner

(July 2013) LBC

The aim of this literature review was to investigate whether women of low-risk status should be denied oral fluids and food intake during labour.

Objective: To improve outcome of mothers and neonates…

Method: Randomised controlled clinical trials…

Findings: This review discovered that there is no clear statement of findings restricting oral fluids and foods in labour…

In the 1940s, aspiration pneumonia—when foreign materials are breathed into the lungs—was the leading cause of maternal death in the USA (Rooks et al, 1999).

American obstetrician Mendelson (1946) observed high maternal mortality and morbidity in women under general anaesthesia for a caesarean section…

Mendelson proposed following recommendations…

Since these recommendations, hospital policies have forbidden eating and drinking in labour, apart from frequent sips of water (Rooks et al, 1989).

It is suggested that these restrictions are used routinely with all women, even without a specific medical reason but ‘just in case’ (Lamaze International, 2009).

These interventions interfere with the natural process of labour … (Lamaze International, 2009).

Elevated levels of ketone bodies accumulate … (Williamson, 1971)

The presence of ketonuria needs to be considered … (Johnson, 1989)

Speak (2002) supported the supposition that ketonuria leads to prolonged labour…

Sharp (1997) argues that evidence regarding gastric emptying is conflicting as various studies have reached different conclusions.

Moir and Thorburn (1986) who suggest that gastric emptying is variable.

Broach and Newton (1988) who state that the administration of narcotics rather than labour itself appears to delay gastric emptying.

Crawford (1984) advocates a low dietary regimen for normal low-risk labours

According to Gyte and Pengelley (2007) there is no strong evidence that safety is compromised if women eat and drink a ‘light diet’ in labour.

Ludka and Roberts (1993) are in agreement with this, stating that it aids maintenance of homeostasis in the mother and fetus.

Findings

• Delercq et al (2007)…

• O’Sullivan et al (2009)…

• National Childbirth Trust (2007)…

• Beggs and Stainton (2002)…

• Due to the different effects and interventions, there was

considerable degree of variability and therefore the random-effects model of meta-analysis was used…

• Scheepers et al (1998)…

Discussion• The study discovered that there is no clear statement of

findings restricting oral fluids and foods in labour…

• No systematic review of any adverse outcomes could be measured…

• Lewis (1991) argued that the policy of oral intake in labour appears to be that of professional attitude….

• Crawford (1984), an anaesthetist, has a different perspective and states that there is no reason for such restriction...

• Singata et al, (2010) suggesting that they should have the freedom to choose…

Recommendations for practice

• The Confidential Enquiry into Maternal and Child Health

(CEMACH 2007) aims to identify any gaps that may exist in the provision of care, and no associated problems with eating and drinking in labour were found.

• Reports of adverse effects for the mother and baby were if very large volumes of fluids were drunk (7–8 litres) in labour, causing water intoxication and babies to become hyponatremic (Gyte and Pengelley, 2007)

The Royal College of Midwives (RCM 2005) states: ‘There is insufficient evidence to support the practice of starving women in labour in order to lessen the risk of gastric aspirations. Women who wish to eat and drink in labour should be offered a light, nutritious diet’ (RCM, 2005:2)

Midwives are expected to take into account National Institute for Health and Care Excellence (NICE 2007) guidelines when exercising clinical judgment.

The Cochrane Pregnancy and Childbirth Group, recommends a diet of easy-to-digest foods and fluids during labour (Enkin et al, 2000)

Education regarding oral intake in labour is required in the development of appropriate polices, in keeping with available evidence for best practice. Antenatal education needs to include information within the birth plan on the benefits and risks of oral intake in labour, enabling women to have informed choice.

Conclusion

• When undertaking this literature review, found limited studies looking at eating and drinking in labour…

• The issue of whether women should eat and drink in labour is controversial.

• This literature review and analysis has found no evidence, unless medically indicated, as to why low-risk women with informed choice cannot determine whether they would like to eat and drink in labour. This diet restriction is a precaution for women who are at high risk of requiring a caesarean section (general anaesthesia) and, with modern techniques, the prevalence of gastric content aspiration has become extremely small (McKay, 1988; RCM, 2012).

Key points

• This review identified insufficient evidence to support the practice of starving women in labour in order to lessen the risk of gastric acid aspiration

• When there are no risk factors suggesting the need for general anaesthesia, women who wish to eat and drink in labour—or not— should be encouraged to do so

• Fasting may result in dehydration and acidosis, while eating and drinking in labour keeps energy levels high and can minimise complications in assisted deliveries caused by maternal exhaustion

• Evaluating their own practices, midwives should review the policy of eating and drinking in labour within their own Trust, and take into

account the recommendations for practice

Thank you

References

Beggs JA, Stainton MC (2002) Eat, drink, and belabouring? Journal of Perinatal Education 11(1): 1–13

Broach J, Newton N (1988) Food and Beverages inLabour. Part 2: The effects of cessation of oral intakeduring labour. Birth 15(2): 88–92

Confidential Enquiry into Maternal and Child Health(2007) Saving Mothers’ Lives: Reviewing maternal deathsto make motherhood safer – 2003–2005. The SeventhReport of the Confidential Enquiries into MaternalDeaths in the United Kingdom. CEMACH, London

Crawford JS (1984) Principles and Practice of ObstetricAnaesthesia (5th edn.) Blackwell Science, Oxford

Declercq ER, Sakala C, Corry MP, Applebaum S (2007)Listening to mothers II: Report of the secondnational U.S. survey of women’s childbearingexperiences. Conducted January–February 2006for Childbirth Connection by Harris Interactive® inpartnership with Lamaze International. Journal ofPerinatal Education 16(4): 9–14

Enkin M, Keirse M, Neilson J, Crowther C, Duley L, Hodnett

E, Hofmeyr J (2000) Guide to effective care in pregnancyand childbirth. Oxford University Press, New York

Gyte G, Pengelley L (2007) NCT Evidence Based Briefing: Eatingand drinking in labour. New Digest January 2007: 25–9

Higgins JPT (2008) Cochrane Handbook for systematicReview of Interventions Version 5.0.1. www.cochranehandbook.org (accessed 17 June 2013)

Lamaze International (2009) Healthy Birth Practice 4:Avoid interventions that are not medically necessary.(adapted from The Official Lamaze Guide: GivingBirth with Confidence). www.lamazeinternational.org/p/cm/ld/fid=86 (accessed 17 June 2013)

Ludka L, Roberts C (1993) Eating and drinking in labour. Aliterature review. Journal of Nurse-Midwifery 38(4): 199–207

Lewis P (1991) Food for thought should women fast orfeed in Labour. Modern Midwife 1:14–6

McKay S, Mathan C (1988) Modifying the stomachcontents of labouring women. Birth 15(4): 213–21

Mendelson CL (1946) The aspiration of stomach contentsinto the lungs during obstetric anesthesia. AmericanJournal of Obstetrics and Gynaecology 52: 191–205

Moir DD,Thorburn J, Whittel MJ (1986) ObstetricAnaesthesia and Analgesia. Baillière Tindall, CaliforniaMichael S, Reilly CS, Caunt JA (1991) Policies for oralintake during labour. Anaesthesia 46(12): 1071–3

National Institute for Health and Care Excellence (2007)Intrapartum care: Care of healthy women and theirbabies during childbirth. NICE Clinical Guideline 55.www.nice.org.uk/cg55 (accessed 17 June 2013)

O’Sullivan G, Liu B, Hart D, Seed P, Shennan A (2009) Effectof food intake during labour on obstetric outcome:Randomised controlled trial. BMJ 24(338): b784

Parsons M. A midwifery practice dichotomy on oral intake inlabour. Midwifery2004;20:72-81

Rooks JP, Weatherby NL, Ernst EK, Stapleton S, RosenD, Rosenfield A (1989) Outcomes of care in birthcentres: The National Birth Centre Study. NewEngland Journal of Medicine 321(26): 1804–11

Royal College of Midwives (2005) Evidence-basedguidelines for midwifery-led care in labour. www.rcm.org.uk/college/policy-practice/evidence-basedguidelines/(accessed 17 June 2013)

Schuiling KD, Sipe TA, Fullerton J (2010) Findingsfrom the analysis of the American College of Nurse-Midwives’ membership surveys: 2006–2008. Journalof Midwifery and Women’s Health 55(4): 299–307

Sharp DA (1997) Restriction of oral intake for women inlabour. British Journal of Midwifery 5(7): 408–12Singata M, Tranmer J, Gyte GML (2010) Restrictingoral fluid and food intake during labour. CochraneDatabase of Systemic Reviews 20(1): CD003930

Scheepers HC, Essed GG, Brouns F (1998) Aspects offood and fluid intake during labour. Policies ofmidwives and obstetricians in The Netherlands.European Journal of Obstetrics, Gynecology andReproductive Biology 78(1): 37–40

Speak S (2002) Food intake in labour: the benefits anddrawbacks. Nursing Times 98(21): 42