Should women be allowed to eat and drink while in labor?(Pro & Con)

YES

We don't allow laboring women to eat or drink for fear they might aspirate should they need general anesthesia. What we call aspiration deaths today, however, are really due to badly managed airway problems that would result in death no matter what a woman has in her stomach.

For some background into this question I reviewed all of the published editions of a document called "Why Mothers Die: the Confidential Enquiries Into Maternal Deaths in the United Kingdom," which has been published every 3 years since 1952. In the first report, which covered 1952 through 1954, there were approximately 30 deaths from aspiration associated with general anesthesia during labor. In the report covering data for the United Kingdom from 1987 through 1999, there were five aspiration-related deaths in approximately 10 million maternities (pregnancies that result in live birth at any gestation or stillbirth after 24 weeks' gestation). Three of those mothers had received opioids. A fourth aspirated and died following her fifth general anesthetic, which occurred 3 days post partum following complications of cesarean delivery (Br. J. Anaesth. 89[3]:369-72, 2002).

In the mid-1960s, we saw a jump in deaths from airway problems. Rapid-sequence induction was introduced early in that decade, and at first we weren't very good at it, so in the mid-1960s the number of airway deaths increased. In the next confidential enquiry, which will be published in 2004, there will be a report of three airway deaths, none of which involved aspiration, and all of which were at the hands of young, inexperienced anesthesiologists who failed to manage the airway and provide these patients with adequate ventilation.

In research conducted at St. Thomas' Hospital in London, my colleagues and I compared the gastric volumes of women who either ate a light meal, consumed a sports drink, or drank only water while in labor. Their mean gastric volumes were greater than 300 mL, 280 mL, and 215 mL, respectively. This is quite a range, but it demonstrates that all of these women would have been at risk of aspiration had they required general anesthesia during the peridilatory period, even the one who drank nothing but water.

Research cited in the confidential enquiry and by Dr. Joy Hawkins, immediate past president of the Society for Obstetric Anesthesia and Perinatology, shows that aspiration often happens 3-5 minutes after beginning a difficult intubation. So I believe we need more emphasis on better airway training and less on food and drink.

I do not believe laboring women who wish to eat during labor should have a large meal or a gastronomic experience. But a fit, healthy young woman with a low risk of complications, who has not received any parenteral opioids, could have clear liquids, sports drinks, or some yogurt or sherbet during her labor to alleviate her hunger or thirst.