CMC Exclusive: Eating During Labor

Hospital Food Options
Food for hospital patients (Prepare a bowls of food in the trays for the patients to the hospital)

 

Eating During Labor – Navigating Your Needs 

Written by: Farrah Deselle, MSN, RN, CLC, CCE (BFW), The Mom’s Place at Catholic Medical Center

Many Ways of “Knowing”

When it comes to preparing for birth, there are three ways of knowing.  This idea comes directly from the Birthing From Within™ model of childbirth preparation.  To fully prepare for birth we need to know ourselves, we need to have modern knowing (like knowing about birth in our culture and birth at the place we will have our baby) and we need to have intuitive knowing (like knowing we need to just move a certain way, or get into a certain position to push our baby out).  When it comes to eating in labor, this is also the case.  There are some things we can learn and know from research or recommendations, things we need to know about policy and practice in our culture, and probably, some things about eating during labor that will come from intuitive knowing or knowing our bodies and what they need in the moment.

Basic Nutrition Principles

In last half century or so, we have learned a great deal more about nutrition.  We know the body needs nutrient dense foods to function optimally, to grow a healthy child, to fight off infections, to recover from illness or injury.  We know now that poverty is linked to poor nutrition, and that social supports such as the federally funded program Women Infants and Children (WIC) and supplemental food programs for women in need, lead to healthier outcomes for moms and babies, including lower rates of preterm birth and higher rates of breastfeeding.  Through improvements in athletic performances from extreme athletes, we have learned about the role of nutrition in building and utilizing muscle and in efficiently using calories.  We know food is really important, for our long-term health, but also for the short-term performance of our body and our brain.  Nutrition is important during labor too.

 

Current Recommendations and Why They Exist

For many first time moms-to-be, one of the most surprising restrictions imposed on women during labor in our culture is the restriction of food.  In the classes I teach, it is often on the top five list of most common labor concerns.  “What if my labor is really long, can I eat?” “when will I have to stop eating?”, “if I am induced, can I eat?” and, “if I have an epidural, can I eat?”

The American Congress of Obstetricians and Gynecologists (ACOG), the professional organization for Obstetricians in the United States, reaffirmed its 2009 committee opinion in 2015.  It states that solid food should be avoided during labor citing “insufficient evidence to address the safety of any particular fasting period for solids in obstetric patients.”  (2015)  Many obstetricians take a softer approach, and recommend against solid foods once a woman is in active labor.  However, the definition of active labor has been up for debate in recent years, with the identifying factors being somewhat variable.  ACOG’s most recent Committee Opinion (2017) “Approaches to Limit Interventions During Labor and Birth” states that for some women, active labor may not be occurring until a woman’s cervix is dilated 5 to 6cm, while in the past, active labor was at 4cm dilation.  There are many other variables that help determine active labor such as frequency and intensity of contractions.

So, why the restriction on eating during labor?  A little bit of history is needed to understand the answer. As labor and birth moved from home to hospital in the first quarter of the 20th century, a variety of anesthetics were tried with laboring women to limit (or eliminate) pain.  Some of the anesthesia used put women to sleep during labor and increased the risk of aspiration – the entry of fluids or food from the gastrointestinal tract to the respiratory system, a potentially life threatening occurrence.  Anesthetic that required the use of masks, as well as other conditions and medications also increased the risk for aspiration.  In order to protect all women, it became standard practice to not allow any woman to eat during labor.

Of course, we know now that many of these types of anesthetics were not safe for women and infants, and as medicine advanced, other safer pain relief options were developed and are now widely utilized.  There are some situations in which a woman can still be at higher risk for aspiration, although it is still a very rare occurrence.  Health conditions such as severe hypertension (high blood pressure), obesity and the use of opioids for pain management in labor can increase the risk.  Additionally, many providers will want to restrict food intake with the use of medical supports such as epidural, which increase the risk for cesarean birth.   During a cesarean birth it is believed that a mother’s risk for aspiration increases because she is receiving medications and lying flat.  Her digestive process slows, she may become nauseas and any contents from her stomach could cause her to aspirate.  With a high rate of epidural use in the U.S., frequent induction of labor and with a growing number of women who are considered “high-risk”, restriction of food during labor impacts many laboring women.  In some healthcare settings, it may be most women.  

So, has there been any recent research, exploring the risk of aspiration with the use of safer anesthetics and with today’s cesarean births.  What about women with low-risk pregnancies?  Is there a point in labor when they should stop eating?

One Size Does Not Fit All

The American Society of Anesthesiologists (ASA) published a press release in 2015 that highlighted recent research indicating the need to review current practice.  It reports there was only one case of aspiration during labor in the United States between 2005 and 2013 in a woman with a complicated medical history.  The researches also stated:

“research suggests that the energy and caloric demands of laboring women are similar to those of marathon runners.   Without adequate nutrition, women’s bodies will begin to use fat as an energy source, increasing acidity in the blood of the mother and the infant, potentially reducing uterine contractions and leading to longer labor, and lower health scores in newborns.  Additionally, the studies suggest that fasting can cause emotional stress, potentially moving blood away from the uterus and the placenta, lengthening labor and contributing to distress of the fetus.” (2015)

Although the ASA did not change their official position on eating during labor, and remain consistent with ACOG, the press release states that healthy women who are not at risk for aspiration, should check with their healthcare provider about eating a light meal during labor.  

The Journal of Obstetrics and Gynecology published a study this year to evaluate the benefits and harm of food intake during labor.  The study is sure to generate more dialogue about the topic and concluded that women with low-risk a pregnancy who ate freely during labor, had shorter labors and no increase in negative outcomes for themselves or their babies.  Eating freely during labor did not increase the incidence of vomiting even in the women who ended up needing a cesarean birth.  

Although ACOG’s official position statement on oral intake during labor recommends that health care providers caring for laboring women recommend against eating during labor at all, their most recent Committee Opinion “Approaches to Limit Interventions During Labor and Birth” suggests an ongoing review of eating during labor because of the low rates of complications associated with it.  

What Does It All Mean for Me?

Health care organizations are often slow to change practices based on best practice recommendations, even by trusted professional organizations. That is why consumers (you) are so important in asking questions and self-advocacy.  Build all of your ways of knowing.  Consider the following questions and suggestions as you prepare for labor and birth.

  • Talk with your health care provider about policies and practices in your birth place.  
  • If you are planning to take in nourishment during labor, what would it be for you?
  • What are nutrient dense foods you can keep handy for early labor?
  • If your plan is different than the recommendations of your provider or hospital, what are your options to negotiate?  
  • Know how you respond when what you believe is right for you is different from the recommendations of a health care professional.  Practice responding to that in pregnancy, instead of waiting for labor.  
  • When do you know to use your instinct on what you need, even it is different than what the professional recommendations are?  Talk with your provider about the possibility of that happening and what shared decision making means to them.  
  • Know your own body – do you tend to get nauseas easily? Do you get really hungry when you are active?
  • Everyone agrees that clear fluid is important and is recommended unless there is an expected cesarean birth.  Some clear fluids can provide more nourishment than water.

Ideas for nutrient dense clear fluids

  • Homemade broth
  • Homemade electrolyte drink
  • Fresh juices (strained orange juice, cherry juice, cranberry juice)
  • Blends of fluid – seltzer water with cranberry juice and lime
  • Herbal teas with honey
  • Homemade popsicles (without any fruit pieces.  You can make popsicles or ice cubes from any of the above fluids)

 

At The Mom’s Place, our classes are developed using the Birthing From Within ™ model (BFW) preparing parents in the body, mind and heart for the full range of childbirth.  Our childbirth educators are nurses who work at The Mom’s Place and in our Special Care Nursery and have received training as BFW mentors.  If you want to learn more about our offerings or schedule a welcome visit, call (603) 626-2626 or check out our website www.catholicmedicalcenter.org/moms-place.

 

Farrah Deselle is a Certified Birthing From Within ™ mentor and coordinator of Childbirth and Parenting Preparation, Education and Support Programs at The Mom’s Place at CMC. She teaches many of the classes and works at The Mom’s Place as a lactation consultant. She has a Master’s of Science in Nursing: Health Systems Leadership. For more questions email Farrah at: fdeselle@cmc-nh.org.

 

References

American College of Obstetrics and Gynecology. (2009).  Oral Intake During Labor  [Committee Opinion]. Retrieved from  http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Oral-Intake-During-Labor.  

 

American Society of Anesthesiologists.  (2015). Most healthy women would benefit from light meal during labor  [Press Release].  Retrieved from http://www.asahq.org/about-asa/newsroom/news-releases/2015/10/eating-a-light-meal-during-labor

 

Ciardulli, A., Gabriele, S., Anastasio, H., Berghella, V., Less-Restrictive Food Intake During Labor in Low-Risk Singleton Pregnancies.  Obstetrics and Gynecology.  2017; 129: 3.  Retrieved from http://journals.lww.com/greenjournal/Abstract/publishahead/Less_Restrictive_Food_Intake_During_Labor_in.98491.aspx

 

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