Eating and drinking during labour: is it possible?

In 2006, the French Society of Anaesthesia and Resuscitation also questioned fasting during labour, stating in its clinical practice guidelines that "a woman in labour benefiting from epidural analgesia may be permitted to consume non-particulate liquids (grade B agreement) except in cases of diabetes, morbid obesity or caesarean section" [1]. 

Examples of clear non-particulate liquids: water, fruit juice without pulp, fizzy drinks, clear tea, black coffee, sports drinks, etc.

In 2007, the American Society of Anesthesiologists stated that the oral intake of a modest amount of clear liquid may be permitted for patients in uncomplicated labour. The risk is increased more by the presence of solid particles in the ingested liquid than by the volume consumed [2]. In 2016, they stipulated that: "solid foods should be avoided during labour" [3].

In 2017, the Haute Autorité de Santé stated that: "The consumption of clear fluids (water, tea without milk / black coffee sweetened or not, still or sparkling drinks, fruit juice without pulp) is permitted throughout the entire duration of labour (including during the immediate post-partum period), without volume restriction, for patients with a low risk of general anaesthesia (grade B: scientific presumption based on intermediate levels of evidence)" [4].

However, regarding eating, they state that: "The consumption of solid foods does not appear to provide any maternal or foetal benefit, and contributes to increasing gastric content. It is recommended to avoid consuming solid foods during the active phase. Current data are insufficient to make a recommendation during the latent phase." 
 

The 2011 European recommendations are as follows. 

- Women in labour may drink clear fluids (water, fruit juice without pulp, tea or coffee without milk) as desired (level of evidence 1++, grade A recommendation) (limited to small volumes in cases of high-risk pregnancy)

- Solid food intake should be discouraged during labour (level of evidence 1+, grade A recommendation), particularly in cases of high-risk pregnancy. Nevertheless, low-risk patients may be permitted to consume small amounts of solid foods such as biscuits or crackers during labour.

A study examined the impact of eating and drinking during labour. 328 women were randomly assigned either to the intervention group (encouraged to eat and drink as they wished during labour) or to the control group (restricted to ice chips or water during labour). The incidence of dystocia (stagnation of dilation) was 36% in the intervention group and 44% in the usual care group, which is not a significant difference. Furthermore, there were no significant differences in the incidence of maternal or neonatal complications [10].

Studies show that it is very rare to experience complications from eating and drinking during labour. Researchers were able to combine 10 studies involving nearly 4,000 low-risk pregnant women, dividing them into 2 groups: 1 group with very strict restrictions on eating during labour and 1 group with fewer restrictions [11]. Women who gave birth without restrictions on eating and drinking during labour had a significantly shorter labour — by 16 minutes. No other differences were observed in terms of caesarean section rates, the baby's APGAR score (an assessment of a newborn's vitality based on empirical observation at the time of birth), vomiting, or any other complications.

Another analysis published in 2010, covering five studies (more than 3,000 women at low obstetric risk and low risk of requiring general anaesthesia) comparing strict fasting vs. unrestricted food and drink (one study), water vs. food and drink (two studies), and water vs. sugary drinks (two studies), reported no difference in caesarean rates, instrumental delivery rates, or Apgar scores, regardless of whether eating was permitted or restricted during labour. The authors concluded that since the evidence shows no benefit or harm, there is no justification for restricting fluids and food during labour for women at low risk of complications [12].

In a randomised study, the authors assessed the impact of a light meal on residual gastric volume compared with women taking water only [16]. Gastric volume was measured within the hour following delivery. This volume was significantly greater in the group permitted to eat compared with the group drinking water only. In the light meal group, vomiting was significantly more frequent — occurring twice as often — with a volume three times greater and the presence of undigested food debris. However, no cases of aspiration were reported, and eating prevented ketosis.

Isotonic drinks, which have been shown to empty from the stomach and be absorbed by the gastrointestinal tract quickly, may represent an alternative nutritional strategy during labour. The aforementioned study showed that consuming 925 ml of isotonic drink during labour, compared with 478 ml of water, had no impact on the incidence or volume of vomiting during labour and one hour after. In this study, the potential increased risk of aspiration syndrome was not found.
Staying hydrated is always beneficial: the ingestion of clear fluids accelerates gastric emptying and reduces gastric acidity, improves comfort, limits the stress caused by fluid restriction [17], and does not increase the risk of vomiting.