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Overview

For a long time, it has been a common rule in hospitals that you could not eat or drink during labor. The main reason women were initially discouraged from eating during labor is not as relevant now, and a lot of research does not support policies limiting food or drinks during labor. In the past few years, this rule has improved to allow drinking clear liquids, but not every doctor is on board with eating during labor. In contrast, women who give birth at a birth center or home are encouraged to eat and drink during labor. This article examines the energy and hydration requirements of your body during labor, and the evidence to support why you should or should not eat and drink. If you decide that you want to have food or drinks at your birth, this article covers the right things to bring, and how to navigate current hospital policies.

Article and Resources

Why Food Was Discouraged During Labor and Birth

The main reason food and drink were discouraged during labor was to prevent aspiration. The thinking of barring women in labor from food and drinks was in the event they needed an emergency cesarean. Aspiration occurs when someone is under general anesthesia, and they vomit while under anesthesia and inhale the vomit. This can create severe complications and, in some cases, can be fatal. In the 1940s, a doctor suggested that you could avoid aspiration during general anesthesia by restricting oral intake during labor. If you have an empty stomach, you reduce the likelihood of vomiting.

General Anesthesia and Cesarean Birth

Today, the majority of cesarean births are done with an epidural or a spinal block, not with general anesthesia. According to the Society for Obstetric Anesthesia and Perinatology, less than 5% of cesarean births use general anesthesia. Some of the reasons general anesthesia would be used instead of an epidural are if you have problems with your brain, nerves, or spinal cord, or if there are problems with an epidural. Most often, general anesthesia is used in an emergency scenario when there is not enough time to administer an epidural. If you are in labor and already have an epidural placed, your doctor can adjust the medication in the epidural to allow for a cesarean birth.

Risk of Aspiration

When doctors use general anesthesia, safety measures are put in place to prevent aspiration. Today, aspiration is almost non-existent. According to the American Society for Anesthesiologists between 2005 and 2013 in the United States, there was only one case of aspiration during labor in the United States. That was the best statistic I could find because this is a rare event.

Official Opinions on Eating and Drinking During Labor

Let’s examine the current positions of some professional organizations that contribute to making policies like limiting food during labor:

ACOG Committee Opinion

In February of 2019, the American College of Obstetricians and Gynecologists reaffirmed their position that they do not support eating during labor. They state that current guidance supports the oral intake of moderate amounts of clear liquids by women in labor who do not have complications. However, particulate-containing fluids and solid food should be avoided. They acknowledge that these restrictions have recently been questioned, citing the low incidence of aspiration with current obstetric anesthesia techniques.

Thankfully, ACOG supports drinking clear fluids based on their acknowledgment that intravenous hydration limits freedom of movement and may not be necessary. Oral hydration can be encouraged to meet hydration and caloric needs.

American College of Nurse Midwives

In 2008 the American College of Nurse Midwives stated that eating and drinking during labor could provide women with the energy they need and should not be routinely restricted. In 2016 the ACNM revised its guidelines with a seven-page document outlining the history of restricting food and drinks and the current evidence that is the basis for their current recommendations. To briefly summarize their long list of recommendations, the ACNM says that care providers should discuss the very small risk of aspiration during birth. They state that anesthesia should be identified as the causal factor that increases the risk for aspiration, not oral intake. They go on to state that providers should also discuss the benefits of oral intake during labor. This is informed consent. You should consider the risks and the benefits, and ultimately, the decision is yours.

American Society of Anesthesiologists

The American Society of Anesthesiologists stated in 2015 that most healthy women would benefit from a light meal during labor. A light meal could include fruit, light soups, toast, light sandwiches (no large slices of meat), juice, and water. This opinion was from researchers who analyzed 385 studies published in 1990 or later that focused on women who gave birth in a hospital. The research suggests that the energy and caloric demands of laboring women are similar to those of marathon runners. They went on to state that without adequate nutrition, bodies will begin to use fat as an energy source, increasing acidity of the blood in the mother and 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 placenta, lengthening labor, and contributing to the distress of the fetus.

Interestingly, different groups have different opinions. When hospitals are crafting their policies, they are drawing from a lot of sources, and it must be challenging when different groups who should be informing policies do not agree.

Energy Requirements During Labor

I have referred to labor being a marathon throughout this podcast, and it is. Your body needs fuel for all of the energy that is required to birth a baby, and you need to stay hydrated. So how does this play out if you cannot eat or drink?

I tried to find some stat on how many calories you burn during labor, just to give you an idea of how much energy you are expending, but I couldn’t find any reliable figure. If we are comparing birth to a marathon, runners tend to burn about 100 calories per mile, of course, this will change based upon a lot of different variables. Using this example that adds up to 2600 calories throughout a race. You do not know how long your labor will last. You could end up with really short labor, but it could go all day or night. During labor, you are not sleeping. You expend energy from your muscles in different labor positions, and your uterus is consuming a massive amount of energy by contracting.

Marathon runners do not fast for their race. They drink water at different points along the course. They replenish some energy with gel packets or a carbohydrate source to replace those carbs they are burning during the run. Should you do the same thing during your marathon of labor?

Digestion During Labor

Food takes longer to digest during labor. This makes sense because so much of your body’s energy is being focused on your labor. If you have an epidural, some medications can also slow down digestion.

Evidence on Drinking During Labor

In the U.S., it is pretty standard practice to routinely use IV fluids during labor, especially in a hospital setting. IV Fluids are not routine at a home birth or a birth center. Although, if IV fluids are needed, a midwife at a home or birth center, birth should be able to administer them. Part of the reason IV fluids are used is because of the policies restricting fluid intake during labor.

The majority of studies around IV fluids during birth compare different IV solutions or compare IV fluids to not drinking any liquids. The few studies that do compare IV fluids to oral intake do show a reduced length of labor with IV fluids. In a 2013 review, researchers noted that when comparing IV fluids to no liquids by mouth, IV fluids did result in shorter labor. They also note that it may be possible for women to simply increase their oral intake rather than being attached to a drip.

A 2017 meta-analysis found that labor times were shorter when IV fluids were administered at a rate of 250 ml/hour, compared to 125 ml/hour. The higher rate also resulted in a reduced risk of cesarean section.  The researchers did note that further study is needed regarding risks and benefits of increased hydration among women with restricted oral intake.

IV Fluids During Labor

The takeaway from this evidence is that it is crucial to stay hydrated during labor. You can hydrate with IV fluids, but this intervention also comes with downsides. The first is that being hooked up to an IV can restrict your mobility. A drip delivers IV fluids, so a small amount is being given over some time, so you remain attached to an IV pole. You can still move around; you just need to be aware of the IV. Over hydrating with IVs can cause edema, which is swelling due to excess fluids in your body. This can be uncomfortable if you have swelling until your body gets rid of these excess fluids in the days after your birth.

IV fluids can also cause your baby to maintain higher fluid levels at birth, leading to more excess fluid loss after birth, which your doctor may see as weight loss due to not eating enough. Babies will naturally lose weight after birth before they start gaining. In general, your care provider doesn’t want to see your baby lose more than 10% of their birth weight, and your baby should be back at their birth weight within two weeks. Please keep this in mind if you have IV fluids during your labor. There is a full episode on the evidence on IV fluids if you want to get into more details.

The Evidence on Eating During Labor

In recent years a lot of research has come out that supports eating and drinking during labor. One review that included 19 studies concluded there is no justification for the restriction of fluids and food in labor for women at low risk of complications.

A study that looked at the consumption of simple carbohydrates (from dates and orange juice) during labor found that women who did eat had shorter second stages of labor. This study included 190 women who were all considered low-risk. As a reminder, the majority of pregnancies are low-risk. While it simplifies things to sum up a long study with one short conclusion, I always dig through the data. The average length of the second (pushing) stage of labor for the group who did consume dates or orange juice was 12.6 minutes. For the group who fasted, the second stage of labor was an average of 19.7 minutes. Overall, the difference was about 5 minutes. The pushing stage is the most challenging physically, and five minutes is a long time when you are working so hard. The bottom line, this study supported eating and drinking during labor and did not find any risks or harms in doing so.

Talking to Your Doctor or Midwife

The first thing you should do in regards to planning for eating and drinking during labor is to talk to your care provider. This podcast is not intended as medical advice. Remember, you are working with your doctor or midwife, and their advice does matter. Hopefully, you have a doctor or midwife who supports your choice to eat or drink during labor. If not, it could be a challenge to get them on board with it. You should know what their policy is beforehand so you can plan accordingly. You should be able to have clear liquids to stay hydrated, but not all doctors are going to be on board with solid foods. If you are getting a cesarean, your doctor will likely tell you not to eat. Most cesareans use an epidural, but in the event, you would need to go under general anesthesia, you could potentially have that risk of aspiration, even though it is very low. After you have talked to your doctor or midwife, you can decide whether you want to eat or drink during labor.

Tips for Eating or Drinking During Labor

Here are some tips if you would like to plan to eat food or drink fluids during your labor.

When to Eat and Drink

You are likely going to be more inclined to eat earlier on in your labor. As your labor progresses and you are in active labor, you are probably going to be less interested in eating. If you are hungry, eat; if not, that is okay. You want to make sure you say hydrated. In the earliest part of labor, you may want to stick to bland foods. My midwife recommended I stick to the BRAT diet, which stands for bananas, rice, applesauce, and toast. This may be helpful in the event you are nauseous or do vomit during your labor. I am not talking about vomiting under anesthesia that would put you at risk for aspiration, but it is common to throw up during labor.

What to Eat

Avoid foods really high in fat or sugar with no nutritional value. For example, you do not want to eat a piece of cake. You need healthy foods that will fuel your body. Rather than eating one big meal, it could be helpful to eat a little bit at a time. If you do eat, many providers recommend carbohydrates because they are easy to digest. Some ideas of foods to eat during labor are:

  • Smoothie
  • Banana or fresh fruit
  • Rice
  • Honey sticks
  • Apple sauce
  • Rice cakes, toast, bagels, you can add jam, nut butter
  • Oatmeal or cereal
  • Crackers or graham crackers
  • Granola bars or protein bars
  • Trail mix
  • Soup or broth
  • Eggs
  • Fruit juices
  • Popsicles

Where you are laboring plays a part in what foods you would eat, you have access to a lot more foods at home that you may in a hospital or birth center. It would be simple to add some snacks to your hospital or birth center bag. If you are planning a home birth, you will want plenty of snacks on hand and may also want to plan for the other people who will be in your home for the birth.

Another consideration is that your birth partner needs to eat during your labor. They may not be expending as many calories as you are, but they will be burning energy and need to stay fueled. You may not want them to bring in a pizza, but they should be eating to make sure they have the energy to keep up with you.

What to Drink

Any liquid will help you stay hydrated. Drinks could include broth, juice, tea, or even popsicles. Keep in mind that the official recommendation from ACOG is clear fluids. Water is always an excellent choice to stay hydrated. Since labor is physically intense, you may want to consider an isotonic drink. Isotonic drinks are those that contain electrolytes, like a sports drink. The first thing that comes to mind when I think of sports drinks is Gatorade. If Gatorade isn’t your thing, you can also use Emergen-C, a powder you mix with water that has electrolytes, or even coconut water. There are also a lot of recipes online to make an isotonic drink at home if you want to avoid some of the ingredients or high amounts of sugar in brands like Gatorade and Powerade. 

One study showed that drinking isotonic drinks during labor reduced an increase in ketone production when compared to water. When your body needs energy, the first place it pulls from is your glycogen stores. This comes from glucose, which comes from carbohydrates. Once those stores are depleted, which would happen if you were fasting, your body may go into ketosis. This is a metabolic state in which some of your energy supply comes from ketone bodies in the blood. A mild state of ketosis during labor is normal, but your care provider may be monitoring your ketone levels to make sure that you are staying adequately hydrated. All IV fluids are isotonic.

Tips to Make Staying Hydrated Easier

Some women find that it is easier to drink fluids from a straw. This also allows someone else to hold it to your mouth so you can take a sip, and you don’t have to be thinking about it and reaching for a cup and lifting it to drink. You may find you will drink more fluids with a straw, so that could be something to try.  

When you are in labor, it is easy to forget to drink. There are some strategies you can use to remind yourself to drink during your labor, like taking a drink after every contraction. Your birth partner can be a great reminder, and having drinks readily available and by your side can be a big help. Also, your partner needs to stay hydrated too, so if they are not reading this article, let them know they need to be drinking during your labor also.

Changes in Hospital Policies Due to COVID-19

Due to COVID-19 and recent changes to hospital policies, you may have some restrictions that limit how you can get food or drinks. Once the hospital admits you and your birth partner, you may not be able to leave your room. Likely, hospitals are also restricting any deliveries of food. This means that you need to bring any food or drinks with you. If your care provider or nurses support you eating, they may be able to bring you some food. Hospitals are not known for their amazing cuisine, and you may want to bring your food. If you have foods that need to be cold, you will need to bring a small cooler. You may not have access to a microwave or have any means of heating any food. If you are planning to bring treats or snacks for any staff, you probably do not want to bring home-baked goods. You could opt for protein or energy bars that come prepackaged in individual wrappers.

 

Thank you to 8 Sheep Organics for supporting this episode.

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