by
Midwife Andrea Jordan
To Eat or Not To Eat in Labour-
That is the Question!
The birth process, whether we believe this or not, is very much a normal and natural phase of a woman’s life cycle, and not a medical procedure. In days gone by, when we truly understood this, our labouring women would have been encouraged to nourish their bodies and consume foods and drinks that would sustain and energise them through the birth process, which could sometimes be many hours in length. This is a vital way of ensuring that the body and mind had the support and nourishment needed for the mother-to-be in performing this awesome task.
This all seems pretty obvious, but fast forwarding to many present day birthing institutions, including our own hospitals here in Barbados, we discover that mothers are restricted from receiving any nourishment during their labours. This is despite the many studies showing for years now, that it is absolutely safe for a low-risk mother in labour to consume light food and drinks which ensure her body is energised, and well nourished throughout the process. It seems that the focus is more on the medical procedures that ensure the safety of birth, forgetting the humane side of care provision where mother has basic rights, needs and desires that should be met.
Imagine a pregnant (non-labouring) woman deciding to not eat for 18-24 hours (which is the average length of a first time labour). Now imagine her deciding to do so during a period that will be extremely physically strenuous on her body. Everyone would ask the question – why? Why would she decide to do this? Is she not thinking about the well-being of herself or her unborn child?
Pregnant women often express that being hungry or thirsty is a source of considerable discomfort; therefore, it seems nonsensical to restrict nourishment and essentially withhold energy at a time when it is most needed.
So what’s the rationale?
Picture this. Back in the 1940s in the US, when general anaesthetics were administered through face masks, and were also used for women having vaginal births as well as having surgery, doctors realised that patients were sometimes vomiting and inhaling food particles into the lungs. This condition, known as ‘aspiration’, was often a fatal complication, so doctors began restricting eating and drinking before any surgery and also during labour.
The practice of intubation (placing a breathing tube in the throat to protect the airway) is now modern day anaesthetic and obstetric practice, which means aspiration is extremely rare. And significantly reduced usage of general anaesthesia due to the preferred use of epidural and spinal for most C-sections has further reduced aspiration risk. Nevertheless, despite these major advances, withholding foods and fluids is still the norm in some places, including here in Barbados.
Evidence-based reasons for withholding food and drink in labour
• If opioid pain relief is used (IV pethidine), the woman in labour is a high-risk patient (has diabetes, pre-eclampsia or eclampsia etc.), or has a BMI of 40+, eating in labour is not recommended.
Evidence-based reasons for ‘allowing’ adequate nourishment in labour
• Fasting does not guarantee an empty stomach and undiluted stomach acid due to the withholding of nourishment, poses a severe hazard to lung tissue if aspiration does occur.
• Hunger and especially thirst can cause considerable emotional and physical stress to a labouring mother, worsening her perception of pain.
• Restricting food and drinks result in the body using fats as an energy source, which increases acidity of mothers and baby’s blood, and may increase newborn distress/ lower APGARS.
• Dehydration and starvation are associated with longer labours leading to increased use of oxytocin to stimulate more contractions; this may then lead to increased need for instrumental delivery (use of forceps or suction) or C-section as a result of mother’s low energy levels and reduced power for pushing.
Organisations like WHO (1997), The American College of Nurse Midwives (ACNM 2016), NICE Clinical Guidance for the U.K (2014), and The Society of Obstetricians and Gynaecologists of Canada (SOGC 2016) all recognise and recommend that LOW-RISK birthing women eat or drink as they desire during labour.
It’s time we stop hearing from a mother’s birth experiences about being discouraged from nourishing herself during labour. Our mothers and babies are ready for more humane birth practices, so let us be the change.
Andrea Bonita Jordan is a registered (independent) midwife, breastfeeding specialist and co-founder of two charities, The Breastfeeding and Child Nutrition Foundation (The BCNF charity # 1169) and Better Birthing in Bim Inc.
