ACMN publishes clinical guidelines for oral nutrition during labor

May 20 2008

The newest Clinical Bulletin from the American College of Nurse-Midwives reviews evidence relevant to providing oral nutrition to women in labor and concludes that drinking and eating during labor can provide women with the energy they need and should not be routinely restricted.

Currently, most U.S. hospitals have policies that restrict women's oral intake during labor. The debate over these policies is focused on the concern about possible detrimental effects of fasting on the labor process versus the risk of aspiration if general anesthesia is administered following oral intake. This Clinical Bulletin reviews energy utilization during labor, the effects of fasting during labor, recent randomized controlled trials that have evaluated the effects of food and fluids in labor, the rationale used to deny laboring women food and fluids, and the risks of aspiration if general anesthesia is administered.

"It is important that we don't unnecessarily restrict a women's ability to eat or drink during labor," said Deborah Anderson, CNM, Associate Clinical Professor from the University of California, San Francisco. "In addition to providing hydration, nutrition, and comfort, self-regulating intake decreases a women's stress level and provides her with a feeling of control."

Considerations for the determination of appropriate nutrition in labor must take into account the health status of the woman, the risk of surgical intervention, and the system in which the women gives birth. Additional recommendations from the Clinical Bulletin include:

• During antepartum care, discuss with women the very small but potentially serious risk of aspiration if general anesthesia is used.
• Promote self-determination by healthy women experiencing normal labors concerning oral intake.
• Evaluate all women who are at increased risk for operative birth for factors that could result in difficult intubation or aspiration.
• Continue to participate in research to confirm the safety of ad lib nutrition for normal laboring women.

About Clinical Bulletins

Clinical Bulletins are developed under the direction of the Clinical Practice Section of the Division of Standards and Practice of the American College of Nurse-Midwives (ACNM) as an educational aid to members of the ACNM. Clinical Bulletins are published in the Journal of Midwifery & Women's Health. They can be viewed and purchased at www.jmwh.com.