NPO for labor?

[2curlygirls]

If this has been recently covered, I apologize.

What are your policies regarding eating/drinking in labor? I just heard it claimed that eating prevents exhaustion and speeds up labor. Haven't found any evidence of speeding up labor but maybe I'm not looking in the right scientific arenas.

I was allowed to eat during both labors until I got my epidurals. Not that I was very interested in eating.

Thoughts?

[mekrn]

All I can say about this, from my personal experience, while in labor with my third daughter, after 21 hours of being NPO (yes, I said 21 hours!) I was craving apple juice so much that I was sometimes thinking about apple juice more that delivering! :beercuphe I really believe if I could have had a stinkin' 4 ounce cup of apple juice, I would have felt completely re-energized and possibly could have avoided the eventual c/s I had! If there was ever to be a #4, (which there will not be!) I would really fight that NPO thing to the death! It's not like I was looking for a Big Mac for cryin' out loud!

[SmilingBluEyes]

But it is so horrible to vomit clear fluids? I would think bile may be much worse, really.

[eden]

We do clear fluids, juice, jello and broth. They need some calories to keep up their energy.

[BonnieSc]

OK, I did some research--there's a TON of it out there, and I didn't find anything that specifically supported making patients NPO during labor; quite a few "inconclusives". It should be noted that these inconclusives are along the lines of "it might not do any harm to be NPO" rather than "it might be important that patients are NPO".

Also: I think the term "speed up labor" is misleading. What is more likely is that being NPO will slow down labor. Since NPO (and/or clear liquids) is the standard in this country, it's not necessarily wrong to say that eating will speed up labor (the implication is "from the usual length of labor"), but it is misleading.

Here's an abstract; I'm not sure of the rules regarding abstracts and this forum? But I'm sure someone will tell me if it's out of line.

From JOGNN:

Fasting in Labor: Relic or Requirement?

OBJECTIVE: To evaluate the scientific literature on restrictions of eating and drinking during labor. DATA SOURCES: Computerized searches in MEDLINE and CINAHL, as well as historical articles, texts, and references cited in published works. Key words used in the searches included anesthesia in labor, childbirth, eating and drinking, epidural, fasting, fasting in labor, fasting and pregnancy, gastric aspiration, gastric emptying, intrapartum, intravenous fluids, i.v.s in labor, ketonuria, ketonuria in labor, parturition, pregnancy, and stomach contents in labor. STUDY SELECTION: Articles from indexed journals, excluding single-person case studies. DATA EXTRACTION: Data were extracted and organized under the following headings: historical review, effects of fasting on labor, research on maternal mortality/morbidity from aspiration, research on gastric emptying in labor, intravenous hydration in labor, and implications for nursing research. DATA SYNTHESIS: Research does not support restricting food and fluids in labor to prevent gastric aspiration. Restricting oral intake during labor has unexpected negative outcomes. CONCLUSIONS: Little is known about the differences in labor progress, birth outcomes, and neonatal status between mothers who consume food and/or fluids during labor and women who fast during labor. Research also is needed on the effects of epidural opioids on gastric emptying, nutritional requirements during labor, and the physiologic implications of fasting during labor. Fasting during labor is a tradition that continues with no evidence of improved outcomes for mother or newborn. Many facilities (especially birth centers) do not restrict eating and drinking. Across the United States, most hospitals restrict intake, usually to ice chips and sips of clear liquids. Anesthesia studies have focused on gastric emptying, measured by various techniques, presuming that delayed gastric emptying predisposes women to aspiration. Narcotic analgesia delays gastric emptying, but results are conflicting on the effect of normal labor and of epidural anesthesia on gastric emptying. The effect of fasting in labor on the fetus and newborn and on the course of labor has not been studied adequately. Only one study evaluated the probable risk of maternal aspiration mortality, which is approximately 7 in 10 million births.

--Sleutel M; Golden SS. Fasting in Labor: Relic or Requirement? Journal of Obstetric, Gynecologic, and Neonatal Nursing. 1999 Sep-Oct; 28(5): 507-12

[babycatcher2B]

I work in a free-standing birth center and moms can eat and drink to their hearts content. We actually encourage it b/c if she's been NPO for the last day and a half d/t excitement and/or just plain not feeling like eating she's bound to be positive for ketones...and that means we'd have to infuse fluids. I'm much rather her be drinking her Gatorade than have to give her some D5LR, yk? We rarely see moms wanting to eat/drink as they get more active and more often than not they need to be reminded to do so.

It is my understanding that clear liquids leave the stomach almost immediately and there's a much lower aspiration risk w/ regional anesthesia. Also, in a emergency pressing on the cricoid can prevent aspiraton if it becomes a threat.

[Elvish, BSN, DNP, RN, NP]

I think the NPO thing is cruel myself. Where I am we do NPO x ice chips & then wonder why moms don't have the energy to push, or to keep their babies in the rooms with them afterward. It's not like they'd be ordering and eating a whole pizza...just a cup of jello or apple juice here. I plan to eat and drink whatever I want next time around.

[rdnkmommy]

I am working on a paper now on this issue for my RN-BSN. Not only is my hospital NPO accept ice chips but we run LR instead of D5LR. My hospital has a 10-12% c-section rate so I don't think the "just in case" rationale works. I could understand for a VBAC maybe...

Aside from pain, it is the biggest complaints from mom I hear.

[CEG]

All the research supports not being NPO for labor. Vomiting in labor shouldn't really even be a consideration. We all know laboring women who are NPO vomit just the same as those who have eaten.

Even ACOG supports clear liquids in labor- and that says a lot- we all know ACOG is not exactly cutting edge EBP.

This is a provider failure to keep up with evidence/maintain current practice.

[tewdles, RN]

Of course this is a good example of medicine not being focused on the patient but rather being focused on some fear or anxiety...

Even though evidence does not support the practice it continues...because of the fear or anxiety...

Dehydrated and exhausted women labor poorly...seems that if diploma prepared nurses know this it should be pretty straightforward knowledge for an Doctor of Medicine.

When my daughter labored they made her NPO, then she "stalled" so they gave her pit...and still NPO...her CSection risk became a self-fulfilling prophecy under the care and direction of the surgeon (OB/GYN).

[rickdon19]

Hi,

Clear Liquids per the OB. One Anesthesiologist prefers NPO. Midwives feel like meals are appropriate and the patient will change to ice or clear liquids as she progresses in labor.

D

[LDRNMOMMY, BSN, RN]

The first hospital I worked at was ice chips only. My last job was clear liquid trays with broth, jello, juice, and popsicle when in labor or with an epidural. I thought that was much nicer than ice chips!

[klone, MSN, RN]

Our policy depends on the provider. For OB, sips and chips. For the midwives, light foods.

When pts ask, I always say to listen to their body, and what they may eat when I'm not in the room, I don't know about. Unless I have a sense we might be doing a C/S at some point, in which case I would limit them to water.