Can You Eat While in Labour?
If you’re pregnant and planning a hospital birth, you may have been told that you can’t eat during labour and birth. The reason for this policy is that there is a risk of aspiration should you require anesthesia. Yet at the same time, we also know that nutritional needs during labour are incredibly high. As scientific research acknowledges both nutritional needs during labour and the extremely low risk of aspiration, some hospitals are changing their policies and allowing patients to eat during labour.
Can you eat while in labour? Ultimately, the decision is up to you. Since we’re all about informed decision-making here at Aubergine & Olive, in this blog post I’m sharing important information that you need to know about eating while in labour so that you are able to decide for yourself whether eating during labour is right for you.
Why Hospitals Require Fasting During Labour
While things are definitely changing, the majority of hospitals around the world still having an NPO (nil per os = latin for ‘nothng by mouth”) policy in effect for women admitted for labour and childbirth. This is due to a risk of aspiration: essentially, when a person vomits while under anestheisa and the vomit then goes down the ‘wrong tube’ and into the airway or lungs, potentially leading to infection and breathing problems.
This policy originated back in the 1940s, when aspiration was recognized as a major risk during childbirth. This was at a time when women were often put to sleep with general anesthesia during labour (also known as twilight sleep), and when anesthesiologists used relatively primitive tools (if they used any at all) to keep the patient’s airway open while under anesthesia. As a result of studies conducted on this issue at that time, NPO policy became the norm in hospitals.
Yet although general anesthesia use during labour and childbirth has drastically declined and new procedures and techniques have been implemented to keep the airway safe during anesthesia, many hospitals have not updated their policies and continue to implement an NPO policy. And the policy is often applied to everyone admitted for labour; since it’s not possible to predict who will need a c-section under general anesthesia during childbirth, everyone is assumed to be at risk of aspiration.
“The NPO practice has persisted, becoming a part of hospital culture, even though the modern population is nothing like the people who gave birth back in [that] time, who were exposed to general anesthesia all the time, without airway protection”
What Are the Actual Risks of Aspiration During Labour?
Numerous studies have been done over the past 40+ years on the risk of aspiration during labour and childbirth, with consistent conclusions that it is extremely rare. A few examples of these studies include:
a large study of 45 million births in the US from 1979-1990. During this period, 33 people died from aspiration while under anesthesia during a c-section, equating to approximately 1 death for every 1.4 million births
A follow-up study in the US from 1991-2002 found that anesthesia-related deaths fell by 60% over that period
A study in the American state of Michigan from 1985-2003 reported 8 anesthesia-related deaths among pregnant women. Five of those deaths involved anesthesia but none were related to aspiration
In the UK, where food and drink are often encouraged during labour, a study looking at the years 2013-2015 found 9 confirmed cases of aspiration, including 1 death, out of 1.5 million pregnancies
The bottom line: aspiration during childbirth, or really any complications from eating or drinking while in labour, is extremely rare.
A small caveat here: some medical conditions may increase the risk of aspiration. These include eclampsia, pre-eclampsia, and the use of IV opioids (e.g. morphine) for pain management. However, studies have not shown any evidence that fasting lowers the risk of aspiration in these cases.
Does Fasting Actually Reduce the Risk of Aspiration?
This is a rather large question, but I wanted to raise it in terms of the results of several studies that have addressed fasting during labour. These studies have concluded that digestion in general and the movement of food from the stomach into the intestines slows down when labour starts, to the point where fasting for even 24 hours after contractions begin does not necessarily guarantee an empty stomach should general anesthesia be administered. Since the risk of aspiration comes from food in the stomach, these studies indicate that fasting is not always effective in creating an empty stomach situation, and therefore may not necessarily reduce the risk of aspiration.
“Fasting as soon as contractions begin may still not guarantee an empty stomach during birth”
Nutritional Needs During Labour
Let’s switch gears a bit and look at the other side of the picture: do you actually need to eat during labour? The short answer to this question is that it completely depends on your situation.
The longer answer is this: while there hasn’t been a ton of research done on nutritional needs during labour, studies have shown that your energy and calorie needs during labour are equivalent to those of a marathon runner. This makes logical sense, as labour and childbirth are physically demanding, and our bodies need to have enough fuel to meet those physical demands. Now whether or not you actually need to eat will depend on a variety of factors, including how long you’re in labour for, how strenuous labour and childbirth are for you, when and what you last ate prior to the onset of labour, your nutritional status during pregnancy, your overall health and wellness, etc.
One thing to keep in mind during labour is fluid needs. Our bodies require a huge amount of fluids to support our muscles during this process. Many hospitals and practitioners recognize this and encourage women to consume small amounts of fluids during labour. Again, how much fluids your body requires during labour depends on a variety of individual factors, but chances are that this amount is significantly higher than an occasional mouthful of ice chips.
What if You Have Gestational Diabetes or Pre-Existing Diabetes?
While eating during labour for those with gestational or pre-existing diabetes has not been thoroughly studied, there are some general blood sugar-related issues and guidelines that can be applied. If you have gestational diabetes or pre-existing diabetes, make sure to discuss how you will manage your blood sugar during labour with your healthcare practitioner, and make this a clear part of your birth plan.
Here are some things to consider:
Labour has a glucose-lowering effect, similar to exercise. This is particularly important for those who use insulin to consider, as the amount of insulin you usually need may drop during labour
It is very important to avoid becoming hyperglycemic (high blood sugar) during labour, as this can impact your baby and potentially result in newborn hypoglycemia
If you plan to deliver in a hospital with an NPO policy, you’ll need to do some careful planning in terms of blood sugar management in the absence of food. This is especially important if you manage your gestational diabetes through diet alone
It’s also important to know in advance which types of liquids will be offered to you during labour, for example, if your only options will be sugary fluids such as popsicles and juice, so that you can plan accordingly
What The Professional Guidelines Have to Say on Eating While in Labour
The major childbirth-related professional guidelines- including those issued by the WHO, the American College of Nurse-Midwives (ACNM), and the Society of Obstetricians and Gynecologists of Canada (SOGC) all make the same recommendation: that low-risk birthing women eat and drink as they desire during labour.
My Own Professional Recommendation
As a holistic pregnancy nutritionist, my bottom line is this:
It is up to YOU to decide if eating while in labour is best for you
You know your body best, and you are in charge of it. You are responsible enough to take the information out there on the risks and benefits of eating during pregnancy to make an informed decision on what is best for you. If you are not sure about those risks and benefits, ask your doctor or other healthcare practitioner. Ask a holistic practitioner such as me. And keep asking until you feel you have all the information you need to make a decision.
What to Eat During Labour
If you decide that eating while in labour is best for you, it’s also up to you to decide what to eat during labour: which foods make the most sense for your tastes and preferences. To help you choose, here are a list of my top foods to eat during labour:
dates
unflavoured yogurt
whole grain bread (plain or with nut butter)
raw fruit and vegetables
soups and broths
cheese
chocolate
scrambled or boiled eggs
homemade energy balls (this is my favourite energy ball recipe)
smoothies
Something to keep in mind is that even if you plan to eat while in labour, you might find that you don’t want to. In fact, many women experience nausea and vomiting at the onset of active labour (the only time I vomited during my pregnancies was at the start of active labour!) and have no interest in food. Listen to your body, and have foods readily available if and when you decide that it’s time to refuel. And if you don’t end up eating them during labour, you’ll have nutritious snacks waiting for you afterwards.
Some fine print:
The information in this post is not intended as medical advice, nor is it intended to replace the care of a qualified healthcare professional. Read my full disclaimer policy
The information presented in this post is drawn from Rebecca Dekker’s incredible article “Evidence On: Eating and Drinking During Labor”. Check out the Evidenced Based Birth website for a ton of other great, objective information on pregnancy and childbirth issues