To eat or not to eat?

Historically, women have eaten during their labors to maintain strength through contractions and often difficult deliveries. A widely women-attended and supported event, childbirth often included a laboring mother, her midwife, and female members of the community who gathered together during labor to share food and stories. As we still do for many events in life, women used food as a comfort and source of sustenance during a trying time. But noshing between contractions isn’t a sight often seen in modern day. In fact, eating is typically off-limits.

What’s the big deal?
Around the 1940s, attitudes toward eating during labor began to shift, beginning when Curtis L. Mendelson, MD, a New York-based obstetrician, described a condition in which the contents of patients’ stomachs ended up in their lungs after receiving general anesthesia during surgery. The condition, dubbed Mendelson’s syndrome, was often fatal and led obstetricians to begin restricting women’s oral and solid intake during labor in case of an emergency caesarean section.
Today, however, less than 5 percent of C-sections in the U.S. are performed under general anesthesia. Robert Gennaro, MD, an OB/GYN practicing in Stamford, Connecticut with more than 26 years of experience, estimates that “less than 2 percent” of his C-section patients receive general anesthesia. “We do mostly regional blocks (like an epidural),” explains Gennaro.
“It’s rare, but there are some situations where women will need general anesthesia, because a regional isn’t working for them or because their [blood] platelet count is low.” (Women with low platelets can’t receive epidurals because of the risk of bleeding.) Even though the percentage of women receiving general anesthesia is so low, “there’s always that risk,” he emphasizes.
Gennaro describes the guideline on eating during labor as a “one in a million” chance policy. “The problem with eating during labor comes down to this: At what point do you draw the line? If you knew everything would go according to plan, then sure, it would be fine to eat. But if you have an emergency and your epidural isn’t working well and you need that anesthesia, it’s just not good to have a stomach full of food.”
How risky is that hamburger?
According to statistics from the Centers for Disease Control and Prevention (CDC), maternal deaths related to anesthesia amount to less than 0.6 percent of the total deaths of pregnant women between 2006 and 2009. Gennaro even admits that in over 26 years of practice, he can only recall seeing “one or two” cases of complications from anesthesia-related aspiration that occurred in women with true obstetric emergencies. “We’re talking, they walked in and were whisked immediately back to have an emergency C-section,” Gennaro recounts.
However, because our C-sections rates in the U.S. are so much higher than the rest of the world, doctors have reason to be skeptical of that full stomach. The most recent statistics from the CDC cited the U.S. caesarean rate at 32.8 percent (in 2010) of all births, which according to the World Health Organization, is one of the highest in the world.
Although countless studies and reviews have established there simply is no evidence to support the fact that all women should be prohibited from eating during labor, the standard policy comes down to one thing: In the opinion of healthcare professionals, the benefits simply don’t outweigh the risks. For the average first-time mother, a labor of 12 to 24 hours is usually manageable without solid food. “I’ve never had anyone totally break down because they hadn’t eaten anything,” Gennaro says. “No one has ever really complained, especially because they are well hydrated with their IVs. Although if a husband comes in with a pizza for himself, we might hear a complaint or two!”
Will eating during labor make a woman sick?
As a labor and delivery nurse at McLaren Lapeer Region Medical Center in Michigan, one of the most common arguments I hear from doctors is that allowing patients to eat during their labors will only lead to making them sick. During one of my recent shifts, I had a patient, who had been induced for some time, ask me if she could have some dinner. With the patient barely dilated and, I’m sure, starving, I asked the physician caring for her if I could serve her some dinner. “No,” he replied. “She’ll just throw it up anyway.”
This widely held belief may be a mis-conception. A study by the British Medical Journal in 2009 found that there was no increased incidence of vomiting during labor with women who ate. The study also found that health outcomes for the newborns in both groups showed “no significant difference.”
Can the rules be bent?
In some instances, doctors do make exceptions, like in cases where a patient’s induction is dragging on for a day or two, a common scenario I see in the labor and delivery unit. “Sure, if you come in and have an induction but you’re not in active labor, we’ll let you have something to eat,” says Gennaro. “Once you are in a good pattern of labor, though, it’s ice chips only.”
The prevalence of prohibiting women to eat during labor is placed on the ever-elusive question: What if something goes wrong? The official policy on solid foods during labor from the American College of Obstetricians & Gynecologists (ACOG) states, “There is insufficient evidence to address the safety of any particular fasting period for solids in obstetric patients.” But because of the impossibility of predicting emergency C-sections, the ACOG still recommends that solid food should be prohibited for all laboring patients.
The ACOG does relax a bit when it comes to drinking during labor, allowing healthy women without any risk factors to drink “modest” amounts of clear liquids during uncomplicated labors. Even patients who have scheduled C-sections are permitted this privilege up until two hours before receiving anesthesia.
What about the other side?
Potentially life-altering risks aside, not everyone is in favor of restricting women from eating during labor. Across Europe, standards against women eating during labor are a lot less strict. In 2009, the Netherlands boasted the lowest rate of C-sections in the entire world and Dutch care providers also routinely allow pregnant women to eat during their labors.
And I personally have some experience with the whole eating-during-labor thing. While I definitely wasn’t craving a steak dinner, after a stalled 14-hour labor, the fact that my nurse-midwife allowed me to have a small snack of saltine crackers and popsicles made a world of difference. I was able to fight back the nausea that threatened to overwhelm me and find some shred of strength to go on.
Along with the fact that most women don’t really have the urge to wolf down a foot-long sub sandwich during labor is the argument that the risk for a C-section really doesn’t kick in until the later stages of labor. “Obstetric emergencies may occur during both the active phase [usually when a woman is dilated to around 4 centimeters] and during the time a patient is pushing for different reasons,” explains Ellen Schwartzbard, MD, an OB/GYN affiliated with South Miami Hospital in Florida. With most obstetric emergencies generally occurring during later stages of labor, restricting food early on may be counterproductive and only lead a woman to tire out quickly and stall in her labor.
In the end, with the majority of care providers erring on the side of caution during the business of baby catching, you might just have to wait until after the baby is born to enjoy your lunch. But the good news is, you’ll at least have someone new to share it with.