Restricting food and drink during labor induction, often referred to as “nothing by mouth” (NPO), is a common hospital policy. Labor induction involves artificially starting the labor process, which can be lengthy and unpredictable. The restriction is primarily a safety measure designed to protect the patient from a severe complication should an urgent medical procedure become necessary. This practice is based on the physiological changes that occur during childbirth, though recent evidence has led to some liberalization of the rules.
Minimizing Aspiration Risk During General Anesthesia
The most important reason for the restriction is the risk of pulmonary aspiration during emergency general anesthesia. Pulmonary aspiration occurs when stomach contents, including food, liquid, and stomach acid, are inhaled into the lungs while a person is unconscious. This is a life-threatening complication that can cause severe inflammation or chemical pneumonitis.
While most deliveries proceed with regional anesthesia, an urgent situation may require a rapid switch to general anesthesia for an emergency cesarean delivery. When general anesthesia is administered, protective reflexes, such as coughing and swallowing, are temporarily lost. An empty stomach is necessary to minimize the volume and type of contents that could be regurgitated and inhaled.
Pregnant patients are already at an increased risk of aspiration compared to the general population. The enlarged uterus pushes upward on the stomach, and high progesterone levels relax the muscle at the bottom of the esophagus, making reflux easier. Solid food poses a greater threat than liquid, as particles can cause a more severe reaction and obstruct the airway.
How Labor Affects Gastrointestinal Function
Beyond the risk of surgery, the physiological process of labor slows down the digestive system, making food difficult to process. The intense physical and emotional stress of contractions triggers the release of stress hormones, such as catecholamines. These hormones divert blood flow away from the digestive tract, which slows down gastric motility.
This means the stomach takes much longer to empty its contents into the small intestine. This delayed emptying means that any solid food consumed remains in the stomach for an extended period. The prolonged presence of food increases the risk of nausea and vomiting, which further raises the risk of aspiration. Additionally, certain pain medications, particularly intravenous opioids, contribute to the slowing of the stomach’s ability to empty.
Evolving Guidelines on Clear Liquid Intake
While the restriction on solid food remains standard practice, guidelines regarding clear liquids have evolved significantly in recent years. Many hospitals now permit low-risk patients in uncomplicated labor to consume modest amounts of clear liquids. Clear liquids include water, clear fruit juices without pulp, tea without milk, and electrolyte-rich sports beverages.
The rationale for this change is that these liquids leave the stomach quickly, significantly reducing the volume and acidity of gastric contents compared to solids. Allowing clear liquid intake can improve the patient’s comfort and satisfaction. Carbohydrate-rich drinks can also help manage the accelerated starvation that can lead to ketosis during long labor periods. However, these privileges are typically revoked if the labor becomes high-risk or if the patient is deemed likely to require an immediate cesarean delivery.
Practical Strategies for Managing Hunger
A prolonged labor induction without solid food can be physically and mentally challenging, but several practical strategies can help manage hunger and discomfort. Patients should focus on maximizing the intake of permitted clear liquids, especially those containing electrolytes and carbohydrates, to maintain energy and hydration. Staying hydrated helps to avoid the negative effects of dehydration that can result from fasting.
Sucking on ice chips is often permitted and can provide relief from a dry mouth and offer a small psychological comfort. Using lip balm frequently can also help alleviate the dryness that comes with breathing heavily during contractions. Patients should maintain open communication with their care team, expressing their hunger or thirst, as staff can offer distraction techniques or adjust comfort measures.