“Nothing by mouth?” — not so fast!

Often when women are in labor, they are forbidden by the hospital from eating or drinking anything — perhaps they may be allowed to suck on ice chips or a popsicle or something like that, but everything else is forbidden. (Not every hospital is like that; and some hospitals have “official policies against it” but nurses may say “you’re not supposed to eat, but of course if I don’t see it, I can’t stop you”).

This arcane policy goes back to the days when women were routinely knocked out for birth, and of course before any planned surgery (in this case, the only “surgery” planned was the routine episiotomy — and, yes, the cutting of vaginas is technically a surgery) or any other procedure in which a person is given general anesthesia, it is accepted practice to prevent the patient from eating or drinking, to minimize nausea and vomiting while unconscious, and particularly the danger of breathing in the vomit, which may result in serious complications or even death. Of course, it is also standard practice to put a breathing tube down a person’s throat when s/he’s put under so as to eliminate even this small risk — especially since the stomach is never completely empty, and inhaling straight gastric juice is not good for you either!

But, even as routine “knock ’em out & drag ’em out” births went the way of the dodo, the practice of “nothing by mouth” (npo, non per os) remained. The technical reasoning for this was that some women may require general anesthesia during or after birth (emergency C-section, hysterectomy, etc.), so it was considered safer to keep all women from eating and drinking anything. Of course, the actual likelihood of these things happening (especially with local anesthesia and epidurals being much more common than general anesthesia), as opposed to risks and downsides from women and babies starving for hours is usually not discussed — interventions are easily begun but terribly difficult to stop.

Hypothetically, had the practice of food restriction never begun and become engrained and entrenched in American birth, do you think it would be started today? Food for thought. Why or why not? And furthermore, do you think that before it became widespread, it would be subjected to rigorous study before being implemented? I would like to think that, no, it would not even get started; but that if somebody had the “bright idea” to start it, that it would be subjected to studies before it became widespread. (Hey, I can hope, can’t I? Obstetrics is supposed to be evidence-based medicine, after all!)

But now, like so many things, something that is normal and natural (eating when hungry, drinking when thirsty) is forced to defend itself, and to prove that it is either beneficial or at least not harmful. At least they’re studying it! This is not the first study to look at maternal eating and drinking during labor, but it is the most recent one. The World Health Organization (see pp. 13-14 for the specific discussion on this) says that while a few women who are at high risk for the potential of general anesthesia may need to restrict food and drink in anticipation of such surgery, that restriction should not be extended to all women, since labor “requires enormous amounts of energy. As the length of labour and delivery cannot be predicted, the sources of energy need to be replenished in order to ensure fetal and maternal well-being.” They conclude the section by saying, “The correct approach seems to be not to interfere with the women’s wish for food and drink during labour and delivery, because in normal childbirth there should be a valid reason to interfere with the natural process. However, there are so many die-hard fears and routines all over the world that each needs to be dealt with in a different way.”

If you don’t want to eat or drink during labor, then that’s fine — I didn’t in my first labor, and threw up every time the midwife made me drink apple juice. (Being a first-time mom, she figured I’d take a long time to labor, so she wanted to make sure I didn’t dehydrate or get too weak or otherwise have a problem and end up having to transfer to the hospital.) And if you choose to eat or drink, make sure that whatever you consume will also come back up easily — in other words, no orange juice, because it’s nasty when vomited back up! If you’re trying to figure out what you should eat or drink in labor, pretend you’ve got a stomach virus and choose accordingly — nothing greasy or heavy — that sort of thing.

Oh, and print out a copy of pertinent documents to take with you to the hospital, so that if they pull the “it’s not safe for you to eat or drink while you’re in labor,” you can say, “Oh, yeah? Who says? — Not according to this!” 🙂

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3 Responses

  1. When I was in labor I remember being starving during labor. Of course I was NPO. I did sneak in a banana and a power bar which of course I ate. Hours later, I ended up with a C/S, with no complications because I ate. It is just not natural to starve a woman in labor. Think about how much calories you are using during the birthing process. Go ahead and eat. I won’t tell!

  2. It’s called labor because it is work, and to work your body needs FUEL! 🙂 I had my birth with a midwife so eating and drinking was recommended. I ate supper while still at home and laboring and sipped on apple juice and ate string cheese at the birth center while in the tub! I look back on eating string cheese in the tub and it makes me laugh. But, I was comfy and happy and had a great birth!
    Eat if you’re hungry ladies!

  3. […] by the World Health Organization’s guidelines for Safe Motherhood, which I wrote about in this post almost a year ago: The World Health Organization (see pp. 13-14 for the specific discussion on […]

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