About Birth
No need for pregnant women to fast during labor
NEW YORK
(Reuters
Health) - There is no reason why pregnant women at low risk for
complications during delivery should be denied fluids and food
during labor, a new Cochrane research review concludes.
"Women should be free to eat and drink in labor, or not, as they
wish," the authors of the review wrote in the Cochrane Library, a
publication of the Cochrane Collaboration, an international
organization that evaluates medical research.
Dr. Jennifer Milosavljevic, a specialist in obstetrics and
gynecology at Henry Ford Health System, Detroit, who was not
involved in the Cochrane Review, agrees that pregnant women should
be allowed to eat and/or drink during labor.
"In my experience," she told Reuters Health in an email, "most
pregnant patients at Henry Ford are placed on a clear liquid diet
during labor which includes water, apple juice, cranberry juice and
broth. If a patient is brought in for a prolonged induction of
labor, she will typically be permitted to eat a regular diet and
order anything off the menu in between different induction
modalities."
Milosavlievic has "not seen any adverse outcomes by allowing women
the option of liquids and/or a regular diet in labor."
Standard hospital policy for many decades has been to allow only
tiny sips of water or ice chips for pregnant women in labor if they
were thirsty. Why? It was feared, and some studies in the 1940's
showed, that if a woman needed to undergo general anesthesia for a
cesarean delivery, she might inhale regurgitated liquids or food
particles that could lead to pneumonia and other lung damage.
But anesthesia practices have changed and improved since the 1940's,
with more use of regional anesthesia and safer general anesthesia.
And recently, attitudes on food and drink during labor have begun to
relax. Last September, the American College of Obstetricians and
Gynecologists (ACOG) released a "Committee Opinion" advising doctors
that women with a normal, uncomplicated labor may drink modest
amounts of clear liquids such as water, fruit juice without pulp,
carbonated beverages, clear tea, black coffee, and sports drinks.
They fell short of saying food was okay, however, advising that
women should avoid fluids with solid particles, such as soup.
"As for the continued restriction on food, the reality is that
eating is the last thing most women are going to want to do since
nausea and vomiting during labor is quite common," Dr. William H.
Barth, Jr., chair of ACOGs Committee on Obstetric Practice, noted in
a written statement at the time.
But based on the evidence, Mandisa Singata of the East London
Hospital Complex in East London, South Africa, an author on the new
Cochrane Review, says "women should be able to make their own
decisions about whether they want to eat or drink during labor, or
not."
Singata and colleagues systematically reviewed five studies
involving more than 3100 pregnant that looked at the evidence for
restricting food and drink in women who were considered unlikely to
need anesthesia. One study looked at complete restriction versus
giving women the freedom to eat and drink at will; two studies
looked at water only versus giving women specific fluids and foods
and two studies looked at water only versus giving women
carbohydrate drinks.
The evidence showed no benefits or harms of restricting foods and
fluids during labor in women at low risk of needing anesthesia.
Singata and colleagues acknowledge that many women may not feel like
eating or drinking during labor. However, research has shown that
some women find the food and drink restriction unpleasant. Poor
nutritional balance may be also associated with longer and more
painful labors. Drinking clear liquids in limited quantities has
been found to bring comfort to women in labor and does not increase
labor complications.
The researchers emphasize that they did not find any studies that
assessed the risks of eating and drinking for women with a higher
risk of needing anesthesia and so further research is need before
specific recommendations can be made for this group.
SOURCE: Cochrane Library, 2010.
'Behold, I will bring them from the north country, And gather them
from the ends of the earth,
Among them the blind and the lame,
The woman with child and The one who labors with child, together,
A
great throng shall return there...And My people shall be satisfied with My goodness, says the LORD.'
Jeremiah 31:8, 14
~~~
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February 2010
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