1. Literature review: Eating and
drinking in labour
By Lauren Hunt
Autonomous Midwifery Practitioner
(July 2013) LBC

2.  The aim of this literature review was to investigate
whether women of low-risk status should be denied oral
fluids and food intake during labour.
 Objective: To improve outcome of mothers and
neonates…
 Method: Randomised controlled clinical trials…
 Findings: This review discovered that there is no clear
statement of findings restricting oral fluids and foods in
labour…

3.  In the 1940s, aspiration pneumonia—when foreign
materials are breathed into the lungs—was the leading
cause of maternal death in the USA (Rooks et al, 1999).
 American obstetrician Mendelson (1946) observed high
maternal mortality and morbidity in women under
general anaesthesia for a caesarean section…

4.  Mendelson proposed following recommendations…
 Since these recommendations, hospital policies have
forbidden eating and drinking in labour, apart from
frequent sips of water (Rooks et al, 1989).

5.  It is suggested that these restrictions are used routinely
with all women, even without a specific medical reason
but ‘just in case’ (Lamaze International, 2009).
 These interventions interfere with the natural process of
labour … (Lamaze International, 2009).
 Elevated levels of ketone bodies accumulate …
(Williamson, 1971)
 The presence of ketonuria needs to be considered …
(Johnson, 1989)
 Speak (2002) supported the supposition that ketonuria
leads to prolonged labour…

6.  Sharp (1997) argues that evidence regarding gastric
emptying is conflicting as various studies have reached
different conclusions.
 Moir and Thorburn (1986) who suggest that gastric
emptying is variable.
 Broach and Newton (1988) who state that the
administration of narcotics rather than labour itself
appears to delay gastric emptying.
 Crawford (1984) advocates a low dietary regimen for
normal low-risk labours

7.  According to Gyte and Pengelley (2007) there is no
strong evidence that safety is compromised if women eat
and drink a ‘light diet’ in labour.
 Ludka and Roberts (1993) are in agreement with this,
stating that it aids maintenance of homeostasis in the
mother and fetus.

8. Findings
• Delercq et al (2007)…
• O’Sullivan et al (2009)…
• National Childbirth Trust (2007)…
• Beggs and Stainton (2002)…

9. • Due to the different effects and interventions, there was
considerable degree of variability and therefore the
random-effects model of meta-analysis was used…
• Scheepers et al (1998)…

10. Discussion
• The study discovered that there is no clear statement of
findings restricting oral fluids and foods in labour…
• No systematic review of any adverse outcomes could be
measured…
• Lewis (1991) argued that the policy of oral intake in
labour appears to be that of professional attitude….
• Crawford (1984), an anaesthetist, has a different
perspective and states that there is no reason for such
restriction...
• Singata et al, (2010) suggesting that they should have
the freedom to choose…

11. Recommendations for practice
• The Confidential Enquiry into Maternal and Child Health
(CEMACH 2007) aims to identify any gaps that may exist
in the provision of care, and no associated problems with
eating and drinking in labour were found.
• Reports of adverse effects for the mother and baby were
if very large volumes of fluids were drunk (7–8 litres) in
labour, causing water intoxication and babies to become
hyponatremic (Gyte and Pengelley, 2007)

12.  The Royal College of Midwives (RCM 2005) states: ‘There is
insufficient evidence to support the practice of starving women in
labour in order to lessen the risk of gastric aspirations. Women who
wish to eat and drink in labour should be offered a light, nutritious
diet’ (RCM, 2005:2)
 Midwives are expected to take into account National Institute for
Health and Care Excellence (NICE 2007) guidelines when
exercising clinical judgment.
 The Cochrane Pregnancy and Childbirth Group, recommends a diet
of easy-to-digest foods and fluids during labour (Enkin et al, 2000)
 Education regarding oral intake in labour is required in the
development of appropriate polices, in keeping with available
evidence for best practice. Antenatal education needs to include
information within the birth plan on the benefits and risks of oral
intake in labour, enabling women to have informed choice.

13. Conclusion
• When undertaking this literature review, found limited studies
looking at eating and drinking in labour…
• The issue of whether women should eat and drink in labour is
controversial.
• This literature review and analysis has found no evidence, unless
medically indicated, as to why low-risk women with informed choice
cannot determine whether they would like to eat and drink in labour.
This diet restriction is a precaution for women who are at high risk of
requiring a caesarean section (general anaesthesia) and, with
modern techniques, the prevalence of gastric content aspiration has
become extremely small (McKay, 1988; RCM, 2012).

14. Key points
• This review identified insufficient evidence to support the practice of
starving women in labour in order to lessen the risk of gastric acid
aspiration
• When there are no risk factors suggesting the need for general
anaesthesia, women who wish to eat and drink in labour—or not—
should be encouraged to do so
• Fasting may result in dehydration and acidosis, while eating and
drinking in labour keeps energy levels high and can minimise
complications in assisted deliveries caused by maternal exhaustion
• Evaluating their own practices, midwives should review the policy of
eating and drinking in labour within their own Trust, and take into
account the recommendations for practice
Thank you

15. References
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