1. Potera, Carol


New report challenges restrictive policies.


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Most U.S. hospitals restrict women to sips of fluid or ice chips during childbirth. This practice, which dates back to the 1940s, is intended to prevent the aspiration of stomach contents in women who may need general anesthesia for a cesarean section. A new report from the American College of Nurse- Midwives (ACNM) challenges this restrictive policy toward drinking and eating during labor.


The report reviews studies from the United Kingdom and the Netherlands, where women in labor are allowed to drink and eat freely. The studies compared women who received some nourishment during childbirth with those whose intake was restricted. Drinking and eating during childbirth had no adverse effects on mothers or babies, and no significant differences were found between the groups in duration of labor, mode of delivery, complications like abnormal bleeding, or newboRNs' Apgar scores. In fact, it has been shown that drinking and eating during labor improve hydration, nutrition, and comfort and relieve stress by giving women a sense of control. More-over, cesarean sections today are largely performed under regional anesthesia, which carries a much lower risk of aspiration than general anesthesia.


"Aspiration has more to do with the use of general anesthesia and the skill of the anesthesiologist than with what the laboring woman eats or drinks," says Leslie Ludka, a senior technical advisor at the ACNM. She advises nurses to involve women in the decision-making process by discussing the risks of aspiration during prenatal visits.


The ACNM report suggests that a woman's health status, her risk of needing surgical intervention, and the policies in place where she gives birth be considered in deciding whether she should drink or eat during labor. The report also advises that women be informed of a small, yet serious, risk of aspiration if general anesthesia is required. Laboring mothers should not be allowed to eat or drink at will if they have any of the following risk factors for pulmonary aspiration: hypertension or preeclampsia, obesity, gastritis or ulcers, prolonged labor, or persistent vomiting.


Deborah Anderson, an associate clinical professor of obstetrics and gynecology at the University of California, San Francisco, and a coauthor of the ACNM report, notes the absence of a consistent U.S. policy on oral intake in laboring women. "Some obstetrics units have restrictive policies, and some leave the issue to be decided on a case-by-case basis," she says. "Unfortunately, little is known about what types of foods laboring women should or should not eat." Both Anderson and Ludka point to research as the key to changing the current restrictive practices in the U.S. and to developing safe, rational guidelines for intake during childbirth. "We need to continue to participate in research to confirm the safety of ad-lib nutrition for normal, low-risk laboring women," Anderson says. Nurses who work in settings that allow women to eat and drink during childbirth can help by "coming forward and sharing their outcomes," Ludka adds.

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J Midwifery Womens Health 2008;53(3);276-83.