Eating Lightly During Labor May Not Affect Obstetric or Neonatal Outcomes

Laurie Barclay, MD

March 30, 2009

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March 30, 2009 — Eating a light diet during labor did not affect obstetric or neonatal outcomes or increase vomiting, according to the results of a prospective, randomized controlled trial reported online first in the March 25 issue of the British Medical Journal.

"The current rationale for women fasting during labour is to protect them from pulmonary aspiration should general anaesthesia be needed for an emergency operative delivery," write Geraldine O'Sullivan, MD, from St. Thomas' Hospital, Guy's and St. Thomas' National Health Service Foundation Trust in London, United Kingdom, and colleagues. "However, prolonged fasting in labour has never been proved to influence the incidence of pulmonary aspiration, and some clinicians and midwives consider that preventing food intake can be detrimental to the mother, her baby, and the progress of labour. Whether food intake in labour will influence the ability to deliver normally, the length of labour, or other obstetric and neonatal end points is not known."

The goal of this study was to evaluate the effect of feeding during labor on obstetric and neonatal outcomes. At a birth center in a London teaching hospital, 2426 participants at term were randomly assigned to receive a light diet or water during labor. The diet consisted of low-fat, low-residue foods eaten during regular intervals during labor. Foods included bread, biscuits, vegetables, fruit, yogurt, soup, and fruit juice. Inclusion criteria were nulliparity, lack of diabetes, singleton pregnancy, cephalic presentation, and cervical dilatation of less than 6 cm.

Spontaneous vaginal delivery rate was the main study endpoint, and secondary outcomes were duration of labor, need for augmentation of labor, rates of instrumental and cesarean delivery, incidence of vomiting, and neonatal outcomes.

Both groups had the same rate of spontaneous vaginal delivery (44%; relative risk, 0.99; 95% confidence interval [CI], 0.90 – 1.08) and similar neonatal outcomes. There were no clinically meaningful between-group differences in the duration of labor (geometric mean: eating, 597 minutes vs water, 612 minutes; ratio of geometric means, 0.98; 95% CI, 0.93 – 1.03), the cesarean delivery rate (30% vs 30%; relative risk, 0.99; 95% CI, 0.87 – 1.12), or the incidence of vomiting (35% vs 34%; relative risk, 1.05; 95% CI, 0.9 – 1.2).

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

Limitations of this study include insufficient power to show evidence of harm.

"Aspiration pneumonitis/pneumonia is significantly associated with intubation and ventilation," the study authors conclude. "In modern obstetric practice it is the use of regional anaesthesia, thereby avoiding intubation, rather [than] fasting regimens that is likely to have reduced mortality from aspiration. Although the National Institute for Health and Clinical Excellence has recommended, on the basis of consensus opinion, that women in normal labour may eat/drink in labour, our trial shows that this will not improve their obstetric and neonatal outcomes."

The Obstetric Anaesthetists' Association and the Special Trustees of the St Thomas' Hospital supported this study. One of the study authors is supported by Tommy's—The Baby Charity. The study authors have disclosed no relevant financial relationships.

BMJ. Published online March 25, 2009.

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