Standard Care Series Part Two
Eating and drinking during labor
Let’s talk about eating and drinking during labor. It is common for hospitals to require fasting upon being admitted for labor, but what does the evidence say about this practice? If we cut right to the chase, we would find that evidence supports the safety of eating and drinking during labor, and that it should be up to the birthing person whether or not they have any oral intake in labor. Research has found benefits to include a shorter labor and higher satisfaction with the birth without a difference in any other health issues like rates of Cesareans, operative vaginal births, vomiting, or newborn APGAR scores. If this is the case, then why is it still common practice to restrict oral intake during labor?
Remember in our last post where we took a look at evidence based care and the evidence-practice gap? The restriction of eating and drinking in labor is a good example of the evidence-practice gap. In the 1940’s, it was more common for the birthing person to aspirate during a Cesarean causing illness or death, which is why the “nothing by mouth” came about. Since then, there have been advances in the techniques anesthesiologist use to keep a person’s airway open and it is uncommon for a person to be put under general anesthesia during a Cesarean. Today, it is more common for an epidural to be used, which allows the birthing person to remain conscious during the Cesarean. Common practice, in regards to eating and drinking during labor, has not yet caught up with the evidence.
Aside from the fact that studies have shown that eating and drinking during labor is safe for low risk women, I think it’s crucial to highlight it also increases maternal satisfaction with the birth. So many times, we look at the evidence for certain interventions, but maternal satisfaction is left out of the equation. A common birth scenario is the healthy birthing person going to the hospital, only to be told upon being admitted that they are no longer “allowed” to eat or drink (though there are some hospitals that “allow” clear fluids).
Okay, let’s hit pause on that scenario and think about it a different way. When marathon runners engage in their labor intensive marathons, no one is telling them they are not allowed to eat or drink during the marathon. In fact, if you do a quick Google search about eating and drinking during a marathon, you’ll find several links about properly fueling your body during this lengthy and taxing event. In other words, it’s encouraged. Why? Because you are expending lots of energy to run the race, and you’d need to ensure your body has adequate fuel and hydration for the muscles to function at their best.
There are a lot of parallels that can be drawn between the two above scenarios. In both cases, muscles are being used to complete a physically demanding task and “finish times” (if you will) will vary from individual to individual.
Now come back to our first scenario where oral intake is restricted or prohibited upon arriving at the hospital. I have heard numerous accounts of moms either already in labor or who went in for inductions (that sometimes lasted days) and they were told they were not allowed to eat anything during this time. Satisfaction, at least with that part of the birth, was low. When oral intake is restricted, it can also cause more discomfort and stress for the birthing person. Their bodies were denied the fuel needed to ensure stamina and productive contractions throughout the labor (enter interventions such as IV fluids, Pitocin® augmentation, and epidurals). This is not to say these interventions are inherently bad, but that they may be avoided if birthing people are able to listen to their bodies and fuel their bodies properly for the task at hand.
So often our culture places great value on the health of mom and baby (and obviously these are super important), but we need to do a better job humanizing birth and ensuring a positive experience as well.
One last (but probably the most important) note: The hospital is not allowed to not allow you to eat and drink in labor. As stated, research has shown eating and drinking to be safe during labor. It is the birthing person’s right to choose whether or not they’d like to eat and drink during labor (ie informed consent should be taking place). Hospital policies are hospital preferences.
You can find more on the evidence of eating and drinking during labor here.
iv fluids during labor
Another common intervention that may go hand-in-hand with the fasting requirement in a hospital setting is the use if IV fluids during labor. One of the most common questions I seem to get when we discuss birth plans is whether or not they have to get an IV (meaning they would prefer not to have the IV in their arm while laboring, but hospital policy is that an IV be in place). It may seem like a little thing; why not just comply and avoid any confrontation? But for some, it can be very distracting to have an IV in place during labor, both due to the discomfort of the needle upon placement and because it may be harder to move freely. So what does the evidence say?
To begin the conversation, we can look back to the above information about eating and drinking. Unfortunately, there are hospitals that still restrict oral intake or that limit consumption to approved clear fluids. As we discussed above, evidence shows that it is safe to eat and drink during labor, so fluids should not be restricted. If the hospital and providers are implementing evidence based care and the birthing person is able to eat and drink to their preference, then the IV fluids aren’t always needed because the birthing person is receiving adequate hydration from drinking fluids.
I would like to note that some find that they can compromise by having a saline lock in place “just in case.” This way, fluids or medication can be given through the IV in the event of an emergency. However, a L&D nurse shared that part of the skill of a L&D nurse is the ability to place an IV in the event of an emergency, and that just in case of an emergency isn’t a valid reason for placing an IV if the birthing person does not wish to have one.
Another consideration is that you may experience swelling following the birth, depending on how much fluid you received. For the mother, this can be uncomfortable, particularly if it contributes to engorgement of the breasts. Not only can this make breastfeeding uncomfortable (or even painful), but it can be harder for the baby to latch when the breast is so engorged, leading to potential nipple damage or poor milk transfer.
Not only that, but the baby received an excess of fluids as well, which research has found can cause an artificial weight drop in the baby after birth. Because of the extra fluids on board, when the baby’s birth weight is taken after birth and the baby pees out the extra fluid within the first 24 hours, it appears that the baby has a higher percentage of weight. This may cause anxiety for the parents and could lead to unnecessary supplementation. The authors of the research study suggest that if IV fluids were received during the birth, that the baby’s 24 hour weight be the weight used to calculate the weight loss, rather than the birth weight, in order to account for the excess fluid.
The bottom line: In the American Congress of Obstetricians and Gynecologists (ACOG) Committee Opinion on the Approaches to Limit Interventions During Labor and Birth, it is stated that “Women in spontaneously progressing labor may not require routine continuous infusion of intravenous fluids…Oral hydration can be encouraged to meet hydration and caloric needs” (2017). We want to ensure the birthing person is well hydrated. Ideally, that hydration comes from the freedom of eating and drinking fluids during labor. If the birthing person wishes to decline the IV fluids, then the birth team should encourage the birthing person to drink enough to stay hydrated.
You can find more on the evidence on IV Fluids here.
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*Disclaimer: These posts are not intended to be construed as medical advice and are for educational purposes only. Each pregnancy and labor is unique. If you have questions or concerns, please consult your provider.