New Cochrane Review confirms that there is no benefit to eating in labor

A new Cochrane Review released yesterday confirms that there is no benefit to eating or drinking in labor. According to the authors of the paper, Restricting oral fluid and food intake during labour:

We identified five studies (3130 women). All studies looked at women in active labour and at low risk of potentially requiring a general anaesthetic. 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

When comparing any restriction of fluids and food versus women given some nutrition in labour, the meta-analysis was dominated by one study undertaken in a highly medicalised environment. There were no statistically significant differences identified in: caesarean section (average risk ratio (RR) 0.89, 95% confidence interval (CI) 0.63 to 1.25, five studies, 3103 women), operative vaginal births (average RR 0.98, 95% CI 0.88 to 1.10, five studies, 3103 women) and Apgar scores less than seven at five minutes (average RR 1.43, 95% CI 0.77 to 2.68, three studies, 2574 infants), nor in any of the other outcomes assessed.

Standard obstetric practice has been to restrict intake in labor to clear liquids or only water. That’s because pregnant women who undergo general anesthesia are particularly vulnerable to vomiting and aspirating vomit into their lungs. The authors explain these restrictions:

Most are based on historical, but important concerns, related to the risks of gastric content regurgitation and aspiration into the lungs during general anaesthesia, a risk first identified by Mendelson in the 1940s. The incidence is very rare with modern anaesthetic techniques and the use of regional anaesthesia rather then general anaesthesia. However, the syndrome is potentially fatal.

The authors also claimed that they found no risks of eating in labor, but the review is far to small to detect the risk of aspiration since very few if any women in the study underwent general anesthesia. So the claim that eating in labor has no risks has not really been addressed by this study.

Where does that leave us? There is certainly no evidence that eating in labor has any benefits. The risks are quite small since very few women undergo general anesthesia for C-section. The authors of this review suggest that the decision should be left up to women themselves.