Eating in Labor

Eating and drinking in labour Updated [8/22/13] - from the Cochrane Collaboration. "Thus, given these findings, women should be free to eat and drink in labour, or not, as they wish."

Thus, given these findings, women should be free to eat and drink in labour, or not, as they wish. - See more at: http://summaries.cochrane.org/CD003930/eating-and-drinking-in-labour#sthash.eLQ1n4bn.dpuf

Importance of Hydration

Garite TJ, Weeks J, Peters-Phair K, Pattillo C, Brewster WR
Am J Obstet Gynecol 2000 Dec;183(6):1544-8

I wonder if this is related to the way in which laboring in water also shortens labor; deep water immersion increases blood volume in a way similar to good oral or IV hydration.

To Alleviate Vomiting

Benadryl makes a dye free gel cap - puncture and give sublingually ( antiemetic action, also sedating)
retention enema - gatorade type stuff

The actual recipe is:
1/2 tsp salt
1/2 tsp baking soda
3 Tablespoons sweetener (honey preferably)
juice of 1 lemon
1 quart of water

I only carry the salt and baking soda with me because parents usually have the sweetener and water. If they have the lemon that's great but we can do without it.

I like to see the mom start out drinking at least 4 ounces. I then have her sip on the rest as she can.

Excessive vomiting during labor is a real problem..... We had this same problem a few months ago. As much as I hate the thought of medications in labor, I thinks a phenergan suppository would have worked wonders. Preferable to transporting anyway.

We carry dimehydrinate (Gravol) for the same reason. Have used IM Gravol with some success and with the unexpected side effect of making the mom drowsy enough to provide some relaxation and pain relief. Had a G1P0 who was beginning to get real insistent about having an epidural (when I gave her the Gravol), and it was a good thing she didn't, because she had a 10 lb baby, and needed all the oomph she had to push her out! Also used IV rehydration as well.

When I'm working with women who vomit in labor, I tell them to bear down rather than vomit. It stops it. My feeling is that you can vomit or bear down. Bearing down will stop the vomiting and move the dilation along the same as vomiting.

Food and Eating in Labor

For decades, women entering the hospital for labor and birth have been told not to eat or drink, typically receiving only ice chips and sips of water from the time they enter the hospital until the baby is born. The reason for this policy is to avoid the risk of a rare but serious problem in the event that the laboring woman needs emergency general anesthesia. Research conducted in the 1940’s showed a heightened risk under general anesthesia of vomiting and inhaling the stomach contents into the lungs, where its high acidity can cause damage to the lung tissue (a condition called Mendelson’s syndrome). While some women in active labor do not feel like eating or drinking, others may be hungry or thirsty, or need to replenish their energy during a long labor. In recent years, regional anesthesia is most often used during labor and birth, and general anesthesia techniques have improved in cases of emergency.

A new Cochrane systematic review looked at the pooled results of 5 experimental trials including 3130 women at low risk for complications requiring general anesthesia. The review compared the outcomes for women whose intake was restricted to water only to those who were allowed to eat and drink various substances. No statistically significant differences were found for any of the outcomes studied. These included, as primary outcomes, cesarean birth, operative delivery and Apgar scores, and secondarily, maternal nausea and vomiting, use of pain medication, length of labor, labor augmentation and NICU admissions. Mendelson’s syndrome is so rare that it was impossible to assess whether eating and drinking in labor made any difference to the incidence of this problem.

The take-away: Many people have questioned the basis for restricting women’s oral intake at a time when they are exerting great physical and metabolic energy and when exhaustion and dehydration can negatively impact the progress and outcomes of labor and birth. None of the studies in the review assessed how women in labor feel about policies that do not allow them to eat or drink during labor. The results of this review support allowing women at low risk for surgical complications to make their own choices about dietary intake during labor and birth, eating and drinking to their own comfort level.

AUTHORS' CONCLUSIONS: Since the evidence shows no benefits or harms, there is no justification for the restriction of fluids and food in labour for women at low risk of complications. No studies looked specifically at women at increased risk of complications, hence there is no evidence to support restrictions in this group of women. Conflicting evidence on carbohydrate solutions means further studies are needed and it is critical in any future studies to assess women's views.

CONCLUSIONS: Consumption of a light diet during labour did not influence obstetric or neonatal outcomes in participants, nor did it increase the incidence of vomiting. Women who are allowed to eat in labour have similar lengths of labour and operative delivery rates to those allowed water only.

". . . [W]omen in the eating group were advised to consume a low fat, low residue diet at will during their labour. The emphasis was on small regular amounts of food rather than eating set regular meals. Suggested foods included bread, biscuits, vegetables, fruits, low fat yoghurt, soup, isotonic drinks, and fruit juice"

CONCLUSIONS: Little is known about the differences in labor progress, birth outcomes, and neonatal status between mothers who consume food and/or fluids during labor and women who fast during labor.

I just did an article on nourishment during labor for our local childbirth consumer group. According to the medical literature the risk of aspiration with a properly intubated client is practically nil and that they have done studies which show that withholding food does not decrease stomach contents below 25ccs which is the amount to reduce the risk of aspiration. Also, aspiration is a worse complication, the more acidic the stomach contents are so an empty stomach is more acidic than one with food in it. It drives me crazy how they starve women in labor. I almost got kicked out of a hospital while working as a doula because my client ate three bites of a sandwich in early labor after she hadn't eaten for 15 hours! I also had a client who had lots of drugs and a strong epidural for labor who said, "The only thing that hurts are the hunger pains in my stomach". I snuck her crackers when I could.

Various Favorites

It seems to me that women in very active labor don't want to eat (although some do). Very easy to digest foods are good, miso, yogurt, fresh-squeezed fruit juices are great, I had one mom use ginseng, it really seemed to make a difference. Carbohydrates are good, whole grain toast with fruit spread - just a bite here and there.

We frequently ask moms to have grape juice included in their birth supplies. It is easily digestible and a good source for quick energy. And, if they have to throw up, it is not too irritating (and tastes the same as when it went down). In light of recent evidence on the benefits of grape juice in preventing heart attacks, I might now question its use during labor. According to a John Folts, M.D., University of Wisconsin Medical School, red grape juice slows clotting. "Folts discovered that aspirin and red wine slowed the clotting of platelets by 45%, whereas red grape juice slowed clotting by 75%." (Energy Times, May 1997) I know, I know...It was a freebie at the store where I get my chlorophyll. :) So, what do you think?

I advise white grape juice in labor rather than red, because of the tannins and anticlotting factors. If you reread the item, it stated that it was RED grape juice that had the anti-platelet factor. (this research was originally started as an investigation into why the French have so little heart disease on a very high cholesterol diet).

I often bring a big bag of M&Ms to long births, for the birth team, the kids, the dad, and the mom. A little bit of sugar, caffeine, and endorphin boost chocolate brings is helpful. The other thing I do is give women coffee for long labors. One of my clients had had a previous birth with a TBA in South America and I asked her lots of questions on what the midwife did, and the main thing she did different is give her lots of strong very sweet coffee during labor. Funny I had to hear about it that way before I would recommend it. It is most effective for non coffee drinkers.

I use honey for my exhausted moms also. To make it easier to get it in them, I buy the honey sticks from co-op. It's so easy for the moms to suck on these. Can get them by the 100's and they are easy to keep in my bag without the sticky mess.

Helping a Laboring Mom As If She Were An Athlete

Labor Aide - RECHARGE has no corn syrup

Kubli et al. An evaluation of isotonic sports drinks during labor. Anesthesia Analg, 2002, Volume 94 404-408

Bottom line, they were addressing the "starvation" mode that our labor patients are in during labor. Anyway, they found that Isotonic drinks reduce maternal ketosis in labor without increasing gastric volume, therefore the risk of aspiration was mitigated. The incidence of vomiting and the volume was not affected.

Using ginseng extract, the kind you get in health food store with royal jelly and honey, is great to use in labor as energy booster for anyone, but especially "older" moms.

We know that giving birth is an athletic event--well I am a mother and an athlete and I've learned a lot about our energy systems and how they work when they are being called upon. I compete in road races on my bicycle. The races are 50 or more miles long, and take at least three hours to complete. My average heartrate during the race is 170. It's not quite like labor because it is a sustained effort at that rate, but I do work out doing intervals in that heartrate zone and higher with a recovery between efforts and I appreciate a great similarity with these workouts and second stage labor. Liver glycogen lasts only about 2 hours, after that point one "hits the wall" or in cycling terminology, "bonks." Fat stores cannot supply enough energy quickly enough to keep the legs going, so the blood glucose has to be increased with additional intake. That, of course, is why the honey helps. Us cyclists, at least the smart ones, drink water at least every 15 minutes during exercise. During rides over 2 hours we add glucose replacers such as athletic drinks and the new energy gels. The drinks, while they provide electrolytes, don't have many calories and some can cause GI upset due to high fructose levels, so we've found the new energy gels work really well. We use them every 15 minutes washed down with several mouthfuls of water. They are quickly assimilated and well tolerated, and they taste yummy, too. They contain 28g carbs (approx. 110 calories). Best of all, they are readily available at sporting goods and athletic stores and are fairly cheap (about $1 each, I imagine less expensive than the specialty diabetic gels). They are sold under such names as Power Gel, GU and Pocket Rocket. The three-way replacement system (water to hydrate, sport drink to replace electrolytes and gel to replace glucose) keeps me powered up and in great condition even during the long races in the middle of summer when the temp is over 100 degrees. As you know, bonking can be very discouraging, but once the gel takes effect the attitude really improves and sometimes that's what you really need the most. I think exercise physiologists have a lot they could teach those of us who work with laboring women.

I use something called GU. It is made for long distance bicycle riders, marathoners, etc. It is high in glucose and carbs and is very easy to digest. Some women can keep it down when they are throwing up everything else. Comes in flavors and in plain.

I also use spirulina mixed in the water bottle for long labors. This seems to help keep moms going too.

Have any of ya'll used the protein drinks like Ensure to keep up protein levels in labor? One of my moms really relied (mentally as well as physically) on these during her very long labor.