NPO/clear liquid status during labor - evidenced-based?

NicuGal, MSN, RN · Jul 2, 2011

Ours says clear liquids or NPO. We just had a kid in our unit that the mom lied and told them she hadn't eaten...she ended up crashed because the kid was stuck and when they went to intubate her she aspirated. She is still up in MICU on a vent with ARDS. I'd rather not risk that!

And I agree...puking up clear liquids would be easier than a Big Mac lol

Double-Helix, BSN, RN · Jul 2, 2011

Where I did clinicals, clear liquids was the policy for all laboring mothers (who, of course, can refuse to comply with this policy and eat or drink whatever they want).

The possibility of surgery or general anesthesia is one reason. Sometimes general anesthesia is used in energency c-sections if there is no epidural or spinal in place. It also may be needed in the event of a hemorrage that requires a hysterectomy.

The other reason that I saw for it was that some medications, and the labor process in general, tends to cause nausea. So to reduce vomiting, an NPO or clear liquid diet is policy.

I don't have any articles or research to back it up, but it sounds like it would be a great topic to research!

klone, MSN, RN · Jul 2, 2011

Generally, most of our patients are allowed regular diet during labor. If they get an epidural, they are restricted to clears, but if they're hungry, I will sometimes say that what happens in the room when I'm not around, I don't know about. The exception to that is if it looks as though she might end up on the OR, then we'll restrict to chips and sips or NPO.

I'm a believer in listening to your body. Most women in active labor are generally not particularly hungry. Women vomit during labor, it's just sort of a fact of life. It happens even if she hasn't eaten anything. If she's hungry, she should eat.

ischialspines · Jul 2, 2011

I suppose I should also research how many folks end up aspirating under general anesthesia for other emergency procedures (like surgeries in the OR) where they may not have been NPO.

As for me - I was hungry and eating spoonfuls of yogurt during a longish second stage with my oldest daughter (she was born at home). I also prefer to throw up *something* rather than dry heave in labor!

If I find any evidence-based practice I will let you know. Eating a Big Mac before your induction does not sound like a good idea, however :) But maybe a few crackers and juice might not be so bad...

sweetnepenthe · Jul 2, 2011

It would be great if we had a crystal ball and could know which cases would turn into sections and which would not.

I don't remember being hungry when I had my kids in the 1970s. Americans nowadays cannot seem to go even a few hours without stuffing their faces :-(.

I do anesthesia. I recommend your shadowing a CRNA doing c-sections. Vomiting is extremely common even with epidural or spinal anesthesia, let alone general anesthesia. Is food and/or fluid worth potential aspiration and death? Is someone going to starve to death in labor?

Modern anesthesia has become so good that people have become blind to the very real risks that are still inherent in each and every procedure. I have had some hair-raising, sphincter tightening experiences during sections, but handled it without having the patients having any idea that they narrowly escaped a problem--for example, having the pts HR and BP drop into the basement(responded to atropine, thankfully) and all they knew was that they vomited--which I assured them was quite common.

ischialspines · Jul 2, 2011

Also I recall reading somewhere about using D5W in non-diabetic mothers for IV fluids, I wonder if that has any effect. During homebirths we may suggest to moms to have some honey straws or those glucose packs if they need a little boost, seems to help them.

ischialspines · Jul 2, 2011

@sweetnepenthe, how much better is clear fluids in terms of vomiting during anesthesia? In your opinion, are juices/electrolyte drinks and/or small glucose things 'ok'? I know that in labor it can be like running a marathon. You sometimes just end up depleting your glucose stores and get exhausted.

sweetnepenthe · Jul 3, 2011

Not opposed to small amounts ice chips/clear colorless liquids/glucose. Operative word being "small". :-)

Vomiting is awful under any circumstances, but if you are having a section and paralyzed and flat on your back, it is scary and dangerous as well.

I do sympathize with the ladies in labor, having had kids myself. But the discomfort and delayed gratification are temporary--even if it doesn't seem like it while it is going on.

I may seem hardline sometimes, but you have to remember that I have been doing anesthesia for a long time and have seen most of the things that appear just theoretical to you. You have not lived until you have suctioned split pea soup from someone's lungs:-(

Elvish, BSN, DNP, RN, NP · Jul 3, 2011

At the hospital where I delivered my kids, most recently my daughter, the OB told me I could have clears during labor as long as I promised to sip, not chug them. This last time around, I progressed so quickly and was concentrating so much on trying to stay on top of the contractions, food was the furthest thing from my mind. Ice chips were about all I could handle.

The place where I work, you have to fight tooth and nail to get anything above ice chips. :down:

But I believe the evidence is out there that suggests clears get passed through the digestive system just as quickly as water/ice and don't pose an additional aspiration risk in the event of a crash. Like a previous poster said, I don't think it's fair to ask women to do essentially the equivalent of running a marathon and, hey, while you're at it, you can't have any nourishment. Would I support pizza and big macs during labor? No. But most of us don't want that anyway.

If you know you're having a surgery and you know you're going to be under general, then yes of course, NPO is good. But if it's better odds that you're going to be in a MVC on the way to the hospital in labor than have general for a crash section, I'm not in favor of NPO in labor.

nursie_pants · Jul 3, 2011

Honestly, I don't work on an L&D floor, but I'm quite sure the NPO/clear liquid orders are *not* evidence-based. It's completely ridiculous. Fancy getting enough energy to push out a baby from only h20, jello, or a Popsicle. I

'm preggo but planning on delivering with a midwife at a facility that, I think, does not require pts to be NPO/clr liquids. Otherwise, guess I'll just be "non-compliant". :)

littleneoRN · Jul 3, 2011

Honestly, I don't work on an L&D floor, but I'm quite sure the NPO/clear liquid orders are *not* evidence-based. . :)

Have you done any actual research on this, or is this just your personal feeling?

I'm not necessarily in support of NPO/clears, but I will chime in this. As a NICU nurse, I can assure you that crash sections happen entirely more frequently than many would like to think. At any given small facility, it may not happen much. But as a major referral center, we see babies born under emergent general anesthesia fairly regularly.