“Can I get another apple juice, please?” I asked my labor and delivery nurse for the fifth time. At that point I was basically running off apple juice and IV fluids. It had been over two days since I arrived at the hospital for my induction, and in that time I had only had one true meal. I was well into the 41st week of my pregnancy and was already thinking about the burger and fries I planned to order once this was all over.
Luckily, my extra-long and extra-difficult labor and delivery experience finally came to an end with a healthy baby girl. In case you’re wondering, I did in fact get my Whataburger with baby in arms. While I am thankful that everything turned out okay in the end, I now question many aspects of my birth experience, including how I was nourished. Was it really best for me to have little to no food for more than 48 hours of labor? Would labor (and the first few hours of my daughter’s life, earthside) have been easier if I had been steadily nourished with healthy foods? And, if so, what kinds of foods should I have eaten during labor?
Most pregnant women are aware that many hospitals have restrictions on eating and sometimes drinking during labor, but the reasons behind this can be confusing. In this article, I’ll explore why these rules exist in the first place, if they still make sense for our modern medical context, why we should be allowing women to eat during labor, and what kinds of foods are ideal.
Why can’t you eat or drink during labor?
So why are so many women told they can’t eat or drink during labor? “Nihil per os,” Latin for “nothing by mouth,” (also known as NPO) policies started in the United States during the 1940s. At that time, labor in hospitals looked very different than it does today. At that time, many laboring women were sedated with a combination of IV medications known as “Twilight Sleep.” Gas anesthetics were also common, rendering women unconscious during the delivery of their babies, which often included an episiotomy and forceps. Due to this rampant usage of anesthetics during labor combined with a lack of effective airway protection (because, again, the mother was often unconscious), there was an increased risk for a particularly serious, albeit rare, complication: aspiration. Aspiration occurs when someone vomits while under anesthesia, and the vomit goes back down the airway. This can cause choking and, in severe cases, death due to lack of oxygen. In 1946, Dr. Curtis Mendelson studied aspiration during obstetric anesthesia in a landmark study that determined many hospital policies still in place today [1].
This 1946 study may be why you can’t eat during labor in 2023
Dr. Mendelson found a 0.15% aspiration rate in the 44,016 birthing women he studied from 1932 to 1945 (though it’s not clear in his study if these women did or did not have airway protection) [1]. The majority of the women in the study were given more anesthesia than what was typical, even at the time. Notably, the only two deaths recorded were women under general anesthesia without any airway protection. Still, based on his findings, Mendelson concluded that women should consume “nothing by mouth” during labor. He included both food and water in this standard, as it was possible to aspirate both solid food and liquids.
Nowadays, any woman undergoing general anesthesia is intubated, meaning that a tube is inserted down her throat to keep her airway open. The tube is hooked up to a ventilator that helps with her breathing. Despite these modern innovations in care, Mendelson’s prohibitive NPO policies, which were widely adopted by hospitals across the United States in the 1940s, remain in place today.
Do women still need to avoid eating or drinking during labor?
This begs the question: do NPO policies have any relevance in today’s modern labor and delivery units? After all, the women of today do not give birth like the women of the 1930s, 40s, and 50s. Use of general anesthetics during vaginal delivery has plummeted. Even during a Cesarean section, women are safer than they once were, and anesthesia is typically regional, not general.
One study recorded a drop in anesthesia-related deaths from 4.3 per million births during 1979-1981 to 1.7 per million in 1988-1990 [2]. A later study recorded a 59% decrease in deaths related to anesthesia between 1979 and 2002 [3]. Looking specifically at the risk of eating or drinking during labor, multiple other studies confirm the lack of aspiration risk.
What the research says
According to a group of researchers from Canada and the UK in 2013, a comprehensive literature review of studies on eating and drinking during active labor found “no statistically significant differences” in rates of C-sections, success of vaginal births, and Apgar scores for women who either followed an NPO policy or ate and drank freely [4]. In fact, these researchers were not able to assess the rate of how often Mendelson’s syndrome (aspiration due to anesthesia) occurred, simply because there were so few instances. They concluded that there were no harms associated with eating and drinking during labor. In other words: NPO policies are simply not evidence-based in the modern labor and delivery ward.
Luckily, the tide is starting to turn for anesthesiologists’ recommendations for laboring women. The American Society of Anesthesiologists is now beginning to ask if they have it right on limiting food and drink during labor [5]. New information points to the fact that the stomach actually empties faster in women with an epidural compared to pregnant women not in labor and nonpregnant women [6]. This further decreases any risk of aspiration. Furthermore, the ASA correctly notes that regional anesthesia (such as epidurals) is far more commonly used than general anesthesia during births today [5]. Even when general anesthesia is used, it is done more safely, and with appropriate airway protection. Aspiration during birth is now so rare in the United States that it is “difficult to answer the question” of how often it happens—a far cry from the (questionable) 0.15% that Mendelson recorded in the 1930s and 40s [5].
Pros and cons of eating and drinking during labor
In other words, there doesn’t seem to be good data to justify the continued existence of hospital NPO policies for laboring women, as the risk for aspiration–the original justification for these policies–is almost nonexistent. In fact, between the years 2005 and 2013, there was only one recorded case of aspiration in the entire United States.
Fortunately, the ASA now admits that low-risk women would even benefit from a “light meal” during labor. Without adequate nourishment during the marathon that is labor and delivery, the body will begin to use fat stores as an energy source. This can increase the acidity of the blood of both mother and baby, and actually reduce uterine contractions. In other words, not eating during labor may actually make your labor take longer! And there’s data to back this up: A 2017 study on low-risk births found that women had shorter labors when they were able to eat during labor, and they didn’t have higher rates of vomiting or C-sections [7]. Additionally, fasting increases perceived environmental stress, which negatively impacts labor [8].
Encouragingly, the number of medical institutions and organizations moving away from NPO policies is increasing. Many of them, like the American College of Obstetricians and Gynecologists (ACOG), recommend low-risk women avoid solid food during labor, but say that clear liquids (such as the apple juice I repeatedly requested) are fine. These institutions might further change their recommendations as more scientific literature shows the lack of risk and the benefits of both drinking and eating during labor. At present, though, many hospitals in the US still follow either NPO policies or allow clear liquids only.
What to do if your hospital does not allow eating or drinking during labor
If you are planning on giving birth in a hospital setting, it is important to speak with your doctor or midwife to understand what policies regarding eating and drinking are in place. Try to ask these questions early on in your pregnancy, as they can help you determine what provider and place of birth you want to choose. If you are set on your provider and hospital and they have restrictive policies on eating and drinking during labor, ask them to see the evidence for why the policies are in place, and see if they know about the updated research on aspiration rates and other purported risks.
Open communication is never a bad thing, and it will help both you and your provider better understand your expectations for labor and delivery (and may lead to improved patient experiences for other women in the future!). If the discussion ends with your doctor or midwife refusing to budge on the policy, know that hospitals have no legal binding authority to enforce NPO policies on patients. Hospital policy is binding on doctors and nurses, not patients. So while you can’t expect a hospital with outdated NPO policies to feed you, you have the right to feed yourself during labor if you so choose (in other words: bring snacks!).
Honesty is always the best policy
However, make sure to remain honest with your medical provider about your choices, no matter what they are. If this is the route you choose to take, it’s also imperative to discuss this with your spouse or birth partner to make sure they are on board and will support you. Having a frank discussion of the risks and benefits of eating during labor and the updated data from the ASA could be helpful. Also, consider hiring more professional birth support, such as a doula, who can help support you with birthing choices which may be more difficult to see through within a hospital setting.
What should I eat and drink during labor?
To sum: whether you are giving birth in a hospital, birthing center, or at home, there are a great number of benefits to eating and drinking during labor. The last thing to consider is specifically what you will want to eat and drink while you are laboring. Because labor is one of the most strenuous things your body will physically undergo, it’s important to think about nourishing yourself like an athlete would. Consider a balanced macronutrient profile that gives you quick energy, but also keeps your blood sugar balanced. That being said, giving birth is not the same as running a marathon, as there are emotional variables to consider as well.
Choose snacks and meals for labor that prioritize complex carbohydrates alongside protein and healthy fats. Try to keep in mind that you won’t know exactly what will sound good during the big day. Prepare a few varieties of snacks so you can have choices. Try different textures and flavors, but probably don’t try a brand new exotic food that you’ve never had before. Stick with basic, nourishing foods that you know and love.
Here are some great examples to consider:
- Mini quiches with sausage and veggies
- Orange slices or other cut up fruit
- Sourdough toast with nut butter and honey
- Full-fat yogurt with granola and berries
- Cheese cubes and zero-sugar beef jerky
- Homemade protein shakes or smoothies
- Hummus with wholegrain crackers or carrot sticks
- Grilled chicken with avocado and rice
If you don’t have access to a refrigerator during labor, not to worry! Try energy bars or protein bars made with nutritious, whole ingredients (keep an eye out for added sugar and seed oils!) or mixed nuts or dried fruit or fruit leather.
You have more drink options than plain water
Remember, it is also vitally important to stay hydrated during labor. You should be sipping water consistently throughout your labor, even if you are on IV fluids. Beyond water, try experimenting with other healthy and comforting liquids during labor.
Here are some examples:
- Bone broth
- Miso soup
- Coconut water
- Green or herbal teas
- Diluted fruit or vegetable juices
Keep this in mind as you eat and drink during labor
Overall, the key is remembering that the aim of eating and drinking is to help you have an easier and better labor. Fast food and highly caffeinated beverages are not going to be optimal during this time. They might even make you feel worse. Make a plan for (and stock your hospital bag with) the foods you are planning to eat during labor (even if you’re giving birth at home, just steps away from a stocked fridge and pantry). Have your spouse or birthing partner assist you in getting these items ready beforehand. Also know that you might not feel hungry at all during labor, and that foregoing food until baby is delivered is also a valid choice.
The bottom line on eating and drinking during labor
As you prepare for labor and birth, consider the question of how you will nourish and hydrate yourself, and what that will look like in your birthing place. Know that no matter what your hospital or birth center policy says, the data overwhelmingly favors both eating and drinking during labor. The good news is that hospital culture surrounding this topic is beginning to change, but until eating and drinking during labor becomes mainstream, you may have to advocate for (and bring) the nutrition and hydration you deserve.
A breakfast of spicy Italian sausage kick started active labor for my second child who was born at home less than two hours later.