Labor and delivery set to study eating during labor

  • Published
  • By Merrie Schilter-Lowe
  • 60th Air Mobility Wing Public Affairs

TRAVIS AIR FORCE BASE, Calif. – The labor and delivery unit at Travis Air Force Base, California, has searched since October for healthy pregnant volunteers who are at a low risk of a cesarean delivery to take part in a two-year research study to evaluate the impact of eating certain foods during labor. 

The study’s results will benefit the Air Force and the medical community in general “by supplying crucial data that will improve intrapartum care for all pregnant women,” said Maj. Jeannette Brogan, 60th Medical Group Maternal Child Flight perinatal clinical nurse specialist.  

While women have long expressed the desire to eat and drink while in labor, current guidelines from the American College of Obstetricians and Gynecologists and American Society of Anesthesiologists restrict oral intake to clear liquids.

“The practice of restricting low-risk laboring women to clear fluids during labor dates back to the 1940s, when Dr. Curtis Mendelson made the recommendation to restrict oral intake to avoid aspiration (choking) during general anesthesia,” said Brogan. 

Mendelson, who was both an obstetrician and a cardiologist, hypothesized that the cause of pneumonia following general anesthesia was aspiration of the stomach contents due to delayed gastric emptying in labor. He also noted that food could be vomited up to 48 hours after eating which could cause problems if the mother required a C-section.

“Since that time, anesthesia medications and methods have evolved significantly and general anesthesia – going to sleep – is no longer routinely used,” said Brogan.  “While the practice of restricting oral and fluid intake is still common in many U.S. hospitals, women are frequently allowed to eat and drink in birthing centers and home deliveries.”

Several recent studies show that eating during labor is not only safe, but may shorten labor, decrease the need for pain medications and increase patient satisfaction. 

A study presented at the 2015 ASA annual meeting also reported that women in labor need the same kind of energy and calories as marathon runners. When they don't get it, their bodies turn to fat for energy which can slow contractions and lead to longer labor and lower health scores in newborns.

According to the researchers, fasting during labor poses the risk of making stomach juices more dangerously acidic if the patient choked. Additionally, the researchers noted that between 2005 and 2013, there was only one case of aspiration in the United States and that occurred in a woman who was obese and had pre-eclampsia. 

Several aspects of oral intake during labor already have been studied, including gastric emptying times, energy requirements and the use of carbohydrate or protein drinks. 

“These studies have shown similar outcomes in nausea, vomiting, mode of delivery, length of labor, aspiration, neonatal (appearance, pulse, grimace response, activity and respiration) scores at five minutes of life as well as well as an increase in patient satisfaction.,” said Brogan. “This study intends to add to the knowledge base.”

 Labor and delivery hopes to recruit 200 women for its study at Travis AFB. 

“One-hundred women will be randomly assigned a clear liquid diet – this is our control group and will give information about our current practice – and 100 women will be randomly assigned a special diet – this is our experimental group,” said Brogan. 

At mealtime, participants in active labor – those with a cervical dilation of 6 centimeters or more – will receive either clear liquids such as broth, jello, juice and popsicles or a low-fat, low-residue diet which includes a meat, starch, vegetable and beverage.

Brogan said that although L&D is interested in safe, patient-centered, evidence-based and current practices, this study carries some risks the same as with normal labor.

“It is likely that (participants) will experience increased nausea, vomiting and or a larger bowel movement due to eating,” said Brogan.  “It is less likely they will experience a longer labor or a likelihood rate of cesarean delivery.” 

Additionally, participants could be at risk of pulmonary aspiration, which may lead to coughing, difficulty breathing and, in some instances, choking, said Brogan. 

To participate in the study, volunteers must be TRICARE beneficiaries ages 18 and older who plan to deliver at the David Grant USAF Medical Center.  Also, they must be at 37 weeks gestation or greater with only one baby developing in the uterus.

Women in the high-risk category will not be accepted. This includes those with a pre-pregnant body mass index over 40, diabetes, hypertension, allergies to foods offered in the study, women who previously had a C-section or a past history or current diagnosis of hyperemesis gravidarum – severe nausea and vomiting that causes weight loss and dehydration – or a difficult airway as determined by the anesthesia provider.

Women who deliver at DGMC still have the option not to participate in the study, said Brogan.

For more information or to volunteer for the study, call Toni McNeary-Garvin at 707-423-7733 or Delicia Echevarria Valentin at 707-423-7188.