Labor is a physically demanding process that requires immense energy. For decades, birthing individuals were strictly prohibited from eating or drinking during labor, a practice known as nil per os (NPO), or “nothing by mouth.” This restriction was a significant concern for laboring people who needed fuel to sustain hours of intense muscle work. However, medical advice has changed significantly in recent years, with current evidence supporting a more liberal approach to oral intake for many individuals.
The Shift in Medical Guidelines
The long-standing ban on food and drink during labor originated with the work of Dr. Curtis Mendelson in 1946. He described a severe chemical pneumonitis, now called Mendelson’s Syndrome, which occurred when stomach contents were aspirated into the lungs during general anesthesia for delivery. Because the risk of aspiration was catastrophic and unpredictable, the blanket restriction was adopted to ensure patient safety.
Aspiration of gastric contents is dangerous because stomach acid and undigested food particles can cause severe lung injury or even death. However, the medical landscape has evolved dramatically since the 1940s, primarily due to the widespread adoption of regional anesthesia, such as epidurals. Today, only a small percentage of obstetric patients require general anesthesia, and modern anesthetic techniques have made the risk of fatal aspiration rare, estimated at approximately 1 in 350,000 anesthesia events. Studies on low-risk patients have found no evidence of harm from less-restrictive diets, leading to a shift in guidelines.
Clear Liquids vs. Light Solids
Current guidelines generally distinguish between clear liquids and light solids, with clear liquids being widely accepted for low-risk, uncomplicated labor. Clear liquids are defined as anything you can see through, and they are quickly absorbed by the body, leaving minimal gastric residue. Examples include plain water, fruit juices without pulp, clear broth, carbonated beverages, sports drinks, and tea or black coffee.
Some facilities and practitioners may also permit light solids, especially during the early stages of labor. Light solids are typically low in fat and protein, focusing instead on simple carbohydrates that provide quick energy and are easy to digest. Toast with jam, crackers, Jell-O, applesauce, or a small baked potato without toppings are common examples of permitted light meals. These options aim to prevent ketosis, a metabolic state that can occur when the body burns fat for energy due to carbohydrate restriction, potentially causing fatigue.
Why Food Intake is Still Restricted in Certain Cases
Despite the general trend toward liberalization, a strict NPO status remains necessary for individuals presenting with specific medical scenarios. These restrictions are in place because certain conditions significantly increase the likelihood of requiring emergency general anesthesia, which carries a higher aspiration risk. Patients who have high-risk pregnancies or pre-existing conditions often fall into this category.
For example, individuals with complicated medical histories such as severe preeclampsia, morbid obesity, or uncontrolled diabetes are often placed under stricter limitations. Restrictions also apply if labor is complicated by a non-reassuring fetal heart rate or a uterine infection, which may necessitate an immediate surgical delivery. In these situations, the risk of needing general anesthesia, which temporarily abolishes the protective laryngeal reflexes, outweighs the benefit of oral intake. Restricting intake helps ensure the stomach is as empty as possible in case a rapid sequence induction of general anesthesia is required.
Practical Tips for Staying Hydrated and Energized
Managing energy and hydration effectively during labor requires a strategic approach. It is often beneficial to consume a light meal high in simple carbohydrates early in labor, before contractions become too intense. As labor progresses, many people find their appetite decreases and the risk of nausea or vomiting increases, making smaller, more frequent sips of clear liquids preferable. Clear liquids should be sipped slowly between contractions to prevent dehydration.
Individuals who are unable to tolerate any oral intake can still find comfort and moisture from non-ingestible methods, such as sucking on ice chips or using lip balm for dry lips. Communicating openly with the care team about your hunger, thirst, and hospital policies ensures that your personal needs are balanced with medical safety guidelines throughout the entire labor process.