The Cochrane Collaboration recently issued its finding on the topic of NPO or “nothing by mouth” [non per os], saying that restricting a woman in labor from eating if she’s hungry and drinking if she’s thirsty is not evidence-based. It also coincides with the recommendations made 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 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.”
Glad to see that obstetrics is finally catching up to what midwives have known all along. 🙂 Once this becomes ingrained, and routine starvation of women in labor is a distant memory, I’m sure Dr. Amy will point to that along with other hallmarks of “modern obstetrics” as being “midwives only doing what doctors are doing, so they shouldn’t claim any credit for the idea.” 😉
The sad thing to me, though, is that the current and modern practice of NPO is based on a study from 1940, as if nothing had changed in obstetrics or medicine since that time, which would render NPO obsolete, along with routine pubic shaves, enemas, etc., etc. Sheridan at EnjoyBirth wrote a post along these lines several months ago, titled, “Death by Cheeseburger?” which breaks it down this way:
So, while aspiration is a very, very, very small risk***
for Jane Doe, it could happen
If she needs an emergency cesarean
with general anesthesia
and if her anesthesiologist doesn’t intubate well
and she vomits
she may aspirate some vomit
which could cause complications
one of them potentially being death.
…So about 10 in 100,000 moms die due to childbirth in the US. (I found stats ranging from 9.3 to 11, but to make the math easier, I chose 10.) Which is the same as 100 in 1 million moms. So the only statistic I found that could be aspiration related said 6%. SO –
6 in 1 million moms, who die due to birth related causes, could be due to aspiration.
Which equals 0.000006% chance of dying from aspiration. Which numerically speaking is a very, very, very small risk.
The post was written because an obstetrician told a patient that aspiration was “the #1 cause of death during birth” is aspiration. Not hardly.
[Update: a 2006 study reported that little is known about eating and drinking in labor, saying, “Only one study evaluated the probable risk of maternal aspiration mortality, which is approximately 7 in 10 million births.”]
Some doctors will almost certainly still try to use this study to justify NPO, I suppose based on the lack of a recommendation to require eating, or that the measured results (which did not include maternal satisfaction, btw) were no different whether the women were assigned to eating or starving, so, “since it doesn’t make any difference,” why not continue restricting food and beverages? Um, sorry, BZZZZ wrong answer! It is the intervention which requires justification, not what is otherwise natural (eating when hungry, drinking when thirsty). You first have to prove that intervention is better than not intervening — that there is overriding benefit from the intervention. And if anyone disagrees with these results, then what they need to help fund a large, well-designed study that is somehow better than the studies already done, to prove a benefit to NPO, not just “a lack of harm.” Until there is proof that NPO is beneficial, or that eating and drinking as desired is harmful, then doctors have no evidence to restrict food or beverages from laboring women.