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Erschienen in: Current Anesthesiology Reports 1/2023

30.01.2023 | Obstetric Anesthesia (L Leffert, Section Editor)

To Eat or Not to Eat? A Review of Current Practices Regarding Food in Labor

verfasst von: Elisheva Fiszer, Carolyn F. Weiniger

Erschienen in: Current Anesthesiology Reports | Ausgabe 1/2023

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Abstract

Purpose of Review

Significant changes in the perception of women’s birth experience and increased importance of maternal satisfaction have questioned fasting policies in labor. This review presents current guidelines and developments regarding food in labor, highlighting the importance of finding a safe compromise between liberal and restrictive policies.

Recent Findings

Aspiration of gastric contents in the pregnant population is exceedingly rare, despite liberal food policies. Little evidence suggests epidural analgesia affects the risk for aspiration. No evidence supports benefits of eating for obstetric outcomes; however, eating increases maternal satisfaction. Gastric ultrasound may be a useful tool for evaluating a woman’s stomach content and aspiration risk.

Summary

Our interpretation of the literature supports that women at low risk for aspiration, peripartum surgery, or need for general anesthesia should be permitted light food during labor. It may be advisable to recommend that women at high risk for peripartum surgery avoid food and restrict consumption to carbohydrate-rich drinks. Gastric ultrasound may be useful to tailor patient-specific recommendations in the delivery ward.
Literatur
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Zurück zum Zitat •• Fiszer E, Ebrahimoff M, Axelrod M, Ioscovich A, Weiniger CF, Food in Labor Group. A multicenter interdisciplinary survey of practices and opinions regarding oral intake during labor. Int J Obstet Anesth 2022;52:103598. https://doi.org/10.1016/j.ijoa.2022.103598. (This is a recent survey investigating the practices and opinions regarding food in labor in all L&D in Israel, and comparing obstetricians, midwives, and anesthesiologists. It provides novel insight into the absence of clear institutional guidelines, the great variability in practices between disciplines and between different L&Ds, and the lack of awareness of staff regarding the risks of eating in labor.) •• Fiszer E, Ebrahimoff M, Axelrod M, Ioscovich A, Weiniger CF, Food in Labor Group. A multicenter interdisciplinary survey of practices and opinions regarding oral intake during labor. Int J Obstet Anesth 2022;52:103598. https://​doi.​org/​10.​1016/​j.​ijoa.​2022.​103598. (This is a recent survey investigating the practices and opinions regarding food in labor in all L&D in Israel, and comparing obstetricians, midwives, and anesthesiologists. It provides novel insight into the absence of clear institutional guidelines, the great variability in practices between disciplines and between different L&Ds, and the lack of awareness of staff regarding the risks of eating in labor.)
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Zurück zum Zitat •• Bouvet L, Garrigue J, Desgranges F-P, Piana F, Lamblin G, Chassard D. Women’s view on fasting during labor in a tertiary care obstetric unit. A prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2020;253:25–30. https://doi.org/10.1016/j.ejogrb.2020.07.041. (This survey investigates the wishes of women regarding food in labor, which is paramount when deciding on oral intake policies.) •• Bouvet L, Garrigue J, Desgranges F-P, Piana F, Lamblin G, Chassard D. Women’s view on fasting during labor in a tertiary care obstetric unit. A prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2020;253:25–30. https://​doi.​org/​10.​1016/​j.​ejogrb.​2020.​07.​041. (This survey investigates the wishes of women regarding food in labor, which is paramount when deciding on oral intake policies.)
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Zurück zum Zitat • Cantwell R, Clutton-Brock T, Cooper G, et al. Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer: 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011;118 Suppl 1:1–203. https://doi.org/10.1111/j.1471-0528.2010.02847.x. (An investigation of maternal anesthesia-related mortality and morbidity, underlining the exceedingly low incidence of aspiration.) • Cantwell R, Clutton-Brock T, Cooper G, et al. Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer: 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011;118 Suppl 1:1–203. https://​doi.​org/​10.​1111/​j.​1471-0528.​2010.​02847.​x. (An investigation of maternal anesthesia-related mortality and morbidity, underlining the exceedingly low incidence of aspiration.)
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Zurück zum Zitat • O’Sullivan G, Liu B, Hart D, Seed P, Shennan A. Effect of food intake during labour on obstetric outcome: randomised controlled trial. BMJ 2009;338:b784. https://doi.org/10.1136/bmj.b784. (Though this paper is less recent, it is an important randomized controlled trial investigating the risks and benefits of eating in labor.) • O’Sullivan G, Liu B, Hart D, Seed P, Shennan A. Effect of food intake during labour on obstetric outcome: randomised controlled trial. BMJ 2009;338:b784. https://​doi.​org/​10.​1136/​bmj.​b784. (Though this paper is less recent, it is an important randomized controlled trial investigating the risks and benefits of eating in labor.)
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Zurück zum Zitat •Ciardulli A, Saccone G, Anastasio H, Berghella V. Less-restrictive food intake during labor in low-risk singleton pregnancies: a systematic review and meta-analysis. Obstet Gynecol 2017;129:473–80https://doi.org/10.1097/AOG.0000000000001898 This meta-analysis investigates the potential benefits of eating in labor and found labors to be shorter when non-restrictive policies were in place, with no other differences in labor outcomes •Ciardulli A, Saccone G, Anastasio H, Berghella V. Less-restrictive food intake during labor in low-risk singleton pregnancies: a systematic review and meta-analysis. Obstet Gynecol 2017;129:473–80https://​doi.​org/​10.​1097/​AOG.​0000000000001898​ This meta-analysis investigates the potential benefits of eating in labor and found labors to be shorter when non-restrictive policies were in place, with no other differences in labor outcomes
30.
Zurück zum Zitat • Fiszer E, Aptekman B, Baar Y, Weiniger CF. The effect of high-dose versus low-dose epidural fentanyl on gastric emptying in nonfasted parturients: a double-blinded randomised controlled trial. Eur J Anaesthesiol 2022;39:50–7https://doi.org/10.1097/EJA.0000000000001514 This study supports the lack of evidence for differential eating policies when epidural analgesia is in place, while also underlining the feasibility of gastric ultrasound in laboring women in the supine position • Fiszer E, Aptekman B, Baar Y, Weiniger CF. The effect of high-dose versus low-dose epidural fentanyl on gastric emptying in nonfasted parturients: a double-blinded randomised controlled trial. Eur J Anaesthesiol 2022;39:50–7https://​doi.​org/​10.​1097/​EJA.​0000000000001514​ This study supports the lack of evidence for differential eating policies when epidural analgesia is in place, while also underlining the feasibility of gastric ultrasound in laboring women in the supine position
Metadaten
Titel
To Eat or Not to Eat? A Review of Current Practices Regarding Food in Labor
verfasst von
Elisheva Fiszer
Carolyn F. Weiniger
Publikationsdatum
30.01.2023
Verlag
Springer US
Erschienen in
Current Anesthesiology Reports / Ausgabe 1/2023
Elektronische ISSN: 2167-6275
DOI
https://doi.org/10.1007/s40140-023-00549-1

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