A client had been in labor for close to twenty-four hours. She was working… hard. She was tired. Although she had been sipping fluids, it had been about twelve hours since she’d last had a snack. Her loving partner pulled a Greek yogurt from their cooler, opened it, and fed her small spoonfuls between contractions. A nurse walked into the room to take vitals, took one look at the yogurt, and proceeded to lose her shit.
“You can’t EAT!” She said it as though my client was juggling knives. “If there’s an emergency and we have to put you under general anesthesia, you’ll vomit, suck it into your lungs, and DIE!“
Seriously. Just eat the yogurt.
Despite many advances in obstetrics and anesthesia over the decades, most hospitals regrettably still shout a resounding “NO!” when it comes to women in labor eating… and often prohibit simply drinking fluids! Not only is there no common sense behind this stance, modern research doesn’t back it up either.
So let’s start with the common sense…
Labor is a big physical task. Many compare it to a marathon. The uterus is a muscle, and just like any other time a muscle is doing lots of work, it requires energy. In what other 12+ hour major physical event do we starve the participants and deprive them of oral fluid? Your body needs FUEL to function optimally. A fabulous article I would encourage you to read on the subject explains the physiologic importance of eating during labor:
“Starving laboring women may also result in ketosis–a condition of weakened muscle cells and alterations in the blood chemistry which results from too-rapid depletion of the laboring woman’s stores of glycogen, which then causes her to start using her fat stores as a form of energy; ketones are the by-products of this process; their unchecked buildup in the bloodstream causes the uterus to contract less efficiently and labor to slow down. When this happens, the usual hospital response is to speed up labor with the synthetic hormone pitocin, which entails its own set of risks…” http://www.birthingnaturally.net/barp/fasting.html
Many hospitals even restrict fluids, but women are often free to go nuts on as many ice chips as they’d like. Hear me, people… ice melts! Ice chips turn into water. I’ve heard the argument that ice chips take longer to consume, and therefore the volume consumed will be less than if you were to allow a woman liquid water. Have you ever seen a woman drink fluids during labor? She’s generally not chugging like it’s a beer bong. Women naturally take very small sips between contractions.
Another gem I’ve heard is that all of your blood goes to your uterus during labor, so you can’t digest food. First off, if ALL of your blood went to any one organ, you’d very promptly die. That’s not how the circulatory system works. However, digestion may, in fact, slow a little during labor, meaning foods take longer to digest. But women in labor aren’t usually eating piles of food Vegas-buffet-style. I see women eating small snacks of easy-to-digest foods, such a fruit, applesauce, a tiny bit of yogurt, a few crackers.
I’ve had a few nurses insist that women can’t eat during labor because they might just throw it back up once they’re in transition. So what?!?! You should starve yourself on the chance that you might throw up later? Throwing up is not the end of the world. It happens often during labor, and should not be cause to deprive yourself of fuel for the physical task you’re engaged in. Anyhow, in my experience, women that don’t eat are more often the ones who throw up – likely from lower blood sugar. Okay, and here’s the TMI part: have you ever thrown up when there is nothing in your stomach? ACID = YUCK! I personally would rather throw up a little food and fluids from eating, than taste straight acid from an empty stomach.
Now, on to the research…
From Cochrane.org
“…oral intake is restricted in response to work by Mendelson in the 1940s. … Since the 1940s, obstetrical anaesthesia has changed considerably, with better general anaesthetic techniques and a greater use of regional anaesthesia. … In addition, poor nutritional balance may be associated with longer and more painful labours, and fasting does not guarantee an empty stomach or less acidity. … Thus, given these findings, women should be free to eat and drink in labour, or not, as they wish.” http://summaries.cochrane.org/CD003930/eating-and-drinking-in-labour
- The “research” on which hospitals base restrictions on oral intake is 70 years old.
- The types of anesthesia and techniques used have evolved since then.
- Depriving women of food may lead to longer, more painful labors.
- Depriving women of food does not eliminate the risk of aspiration.
- Women should be free to eat and drink during labor if they so choose.
So, the way I see it, you have three options if you are giving birth at a hospital that restricts oral intake during labor:
- Don’t eat, even if you’re hungry and labor progress is slowing down from lack of fuel.
- Eat, but only when a staff member isn’t present. I have met many-a-nurse who’s stance is basically “We don’t permit laboring mothers to eat. I’m going to assume that’s dad’s cheese and crackers unless I directly see otherwise.” Basically “Don’t make my job harder by eating right in front of me, and I’ll pretend that I don’t know that you’re eating it the second I leave the room.”
- Understand that as an autonomous patient, you have every legal right to make the decision to eat or not eat, whether or not it is hospital policy. Let the staff know in advance that you prefer to have the option to eat if you’re hungry, and to drink fluids during labor. If there’s any resistance, provide them with current research that supports your preference. But always know that the final decision is up to you, whether or not they like it. This is my favorite option, since I feel that the more they are presented with women choosing to eat and drink freely during labor, the sooner hospital policy will catch up with the evidence. But I know not everyone enjoys confrontation as much as I do, so I understand that option 2 may be preferable for a lot of women.
So there you have it! Now eat, drink and be merry during labor!
Note: This information pertains to the vast majority of pregnancies, which are low-risk. In a high-risk situation, or a labor with special circumstances, the decision regarding oral intake should be made on a case-by-case basis with input from your care provider.
