We would like to extend our gratitude to our expert clinician reviewers for their feedback on the 2017 version of this article: Claudia Breglia, LM, CPM, attends births at home and The Natural Birth and Women’s Center in Canoga Park, CA; Rebecca Bull, MD, practices Family Medicine with Obstetrics in Madison WI since 1989; Saraswathi Vedam, RM, FACNM, MSN, Sci D(hc), Associate Professor at the University of British Columbia; Shannon J. Voogt, MD, Board-Certified in Family Medicine; and Kathy Watkins, RN, BSN, MSN, CNM, practices full scope midwifery providing locum relief to hospitals, and birth centers.

The report recommends that when general anesthesia is administered in a suspected full stomach situation, the person should ideally be fully awake and able to protect their airway when it comes time for the tube to be removed (a procedure known as extubation). Attempts to reduce stomach contents with a tube inserted into the stomach through the mouth (orogastric tube) should have also taken place, but did not.

Someday we may have evidence on the best foods to fuel labor. But regardless of any research that may come out, here at EBB we believe that food choices should ultimately be left up to the birthing person’s preferences and desires. We urge nurses, doctors, and midwives to address their own implicit biases about food and question their assumptions about what makes something healthy or unhealthy to eat during pregnancy or labor. As Maya Feller, MS, RD, CDN says, “Looking down on another culture’s food demonizes one of the major pillars that makes that culture who they are.”

The Royal College of Anaesthetists and the Difficult Airway Society conducted a study to estimate how often major airway events (also called “near deaths”) occurred during general anesthesia in the U.K. (Cook  et al. 2011). Out of approximately 720,000 births that took place during 2008-2009, only one case of aspiration was documented. And the aspiration wasn’t considered the primary cause of the person’s airway problems. Instead, the main complication was because they had difficulty placing a tube in this person’s airway. We don’t know what the oral intake was during labor, only that the individual transferred from a midwifery unit for a long pushing stage and had a Cesarean with regional anesthesia…but then needed general anesthesia during the surgery. The birth resulted in a live infant and the birthing parent made a full recovery within a week.

In their position statement, the ASA noted that aspiration has become so rare that randomized trials and even large databases have been unable to calculate an incidence:

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The uterus is mostly made of muscle tissue. Muscles use fuel as they work and require enough nutrition to meet their energy needs.

The researchers combined 385 research studies of hospital births published in 1990 or later. They also reviewed the American Society of Anesthesiology’s (ASA) Closed Claims Project database. In all, they found only one case of aspiration in the U.S. between 2005 and 2013, in a woman who was plus size and had pre-eclampsia. They concluded that fasting is not necessary in low-risk laboring people. In fact, fasting can lead to ketosis, making stomach juices more dangerously acidic if there were an aspiration.

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The authors of the Cochrane review note that most laboring people seem to naturally limit their intake as labor gets stronger. They concluded that if you’re low risk, you should be able to choose whether you would like to eat and drink during labor (Singata et al. 2013). No trial has examined eating during labor in people who are at higher risk of needing Cesareans with general anesthesia.

“There is insufficient evidence to draw conclusions about the relationship between fasting times for clear liquids or solids and the risk of aspiration during delivery.”

We have heard many doctors say that everyone going into labor is assumed to be at risk of aspiration (because it is not possible to predict who will end up needing a Cesarean surgery under general anesthesia), so everyone should be NPO during labor. However, the studies above show that aspiration death is extremely rare during childbirth. The few published deaths that we found were completely preventable—standard airway protection was not provided. Overall, a small percentage of Cesareans require general anesthesia today, and when they do, failed airway management is rare.

In a news release about research on eating and drinking in labor, one researcher in the field said laboring people’s energy/calorie needs are similar to those of marathon runners. Online advice for marathon runners is to aim for roughly 3 grams of carbohydrates per kilogram of your body weight before the race. So, larger people and smaller people might have different carbohydrate requirements to meet energy needs during labor.

In an interview we did with the authors of this study, they said that the anesthesiology profession has made great progress since the 1940s. Even though Cesarean rates have risen as high as 32% of all U.S. deliveries, widely increased use of regional anesthesia during surgery, such as a spinal or an epidural, has resulted in far fewer anesthesia-related pregnancy deaths. When a general anesthetic is used, doctors now use new strategies to reduce the volume of stomach contents, make stomach juices less acidic (by administering medications), and keep the person’s airway safe. These advances were not available back in Dr. Mendelson’s time (Personal communication, M. Bautista, 2015).

Even if glucose levels are well controlled throughout pregnancy, glycemic control over the 18 hours or so before birth has a significant impact on the newborn (AACE, 2022). When the birthing person has hyperglycemia (high blood sugar) during labor, the baby compensates by secreting more of the hormone insulin, which can result in fetal hyperinsulinemia. Then after the umbilical cord is clamped, the source of incoming glucose is cut off and the newborn can experience hypoglycemia (low blood sugar).

In many hospitals, patients are told not to eat or drink during labor. The medical term for this is “NPO,” which comes from the Latin nil per os, meaning nothing by mouth. In a survey of people who gave birth in U.S. hospitals, 60% reported not drinking during labor, and 80% said that they did not eat (Declercq et al. 2014). However, when people are free to eat and drink as desired during labor, as is typical in U.S. freestanding birth centers, very few of them (5%) choose to not eat or drink (Rooks et al. 1989).

One aspect of fatphobia is when health care providers lack experience or confidence in treating people with diverse size. Thus, the limited evidence we found seems to suggest that the perception of aspiration risk with higher BMI is rooted in fatphobia and not any documented increase in risk.

A larger, more recent review found that the people laboring under less-restrictive eating and drinking policies had shorter labors by about 16 minutes and no other differences in health outcomes (Ciardulli et al. 2017). Only one of the trials in the review considered parental satisfaction and found that more of the eating group participants reported satisfaction with their nourishment during labor compared to those given sips of water only (97% versus 55%) (Goodall & Wallymahmed, 2006).

Let’s jump ahead to 1997, when researchers conducted the first large U.S. study to look at pregnancy- related deaths due to anesthesia between the years 1979 to 1990. General anesthesia was used in 41% of the sample in the earlier years, and 16% of the sample in the later years. The risk of death because of aspiration during Cesarean was 1 death for every 1.4 million births (Hawkins et al. 1997).

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Similarly, a study in Michigan between 1985 and 2003 reported eight anesthesia-related deaths among pregnant people. Five of the eight deaths involved general anesthesia; none of the participants in this study died from aspiration (Mhyre et al. 2007).

In 2015, several researchers at the annual meeting of anesthesiologists in the U.S. reported their research findings that most healthy people would benefit from a light meal in labor (Harty et al. 2015). To read a news release about this study, click here.

We also hear that many hospitals who have lessened their restrictions still ban food for patients with epidurals during labor. Is there evidence to back up these eating bans?

In high-risk situations, the informed consent discussion might look a bit different. People should know there is no evidence from randomized trials that could be applied to a higher-risk situation (and having a high BMI should not mean that you are automatically “high risk”). However, regardless of risk status, people should not have food and drink withheld against their will.

ACOG has a practice bulletin on pregestational diabetes with a section on glucose management during labor (ACOG, 2018). They recommend:

Some people may argue that the reason there are fewer deaths from aspiration today is because people are not allowed to eat or drink during labor. However, in the United Kingdom, clinical guidelines were updated in 2007 to recommend that drinks and a light meal be offered to low-risk people in labor. So, it may be helpful to look at aspiration deaths in the United Kingdom since 2007, after they began to encourage eating and drinking during labor.

Here at EBB, in our communications with pregnant people with pregestational or gestational diabetes, many of them have voiced their struggles when staff forbid them from using nutrition to manage blood sugar during labor. Here are some examples of situations we have heard about:

In the absence of evidence, the ASA decided to base their guidelines on expert opinion. They conducted an official survey of 357 members, and 77% believed that clear liquids were okay in low-risk laboring people, while 91% said that solid foods should be avoided in all laboring people. So these opinions became the basis of ASA practice guidelines and ACOG’s (Withdrawn) 2009 Committee Opinion No. 441 “Oral Intake During Labor”. Note that it is not evidence-based practice to allow opinions to restrict people’s human rights simply because they think that there is “insufficient evidence.” Insufficient is a vague and subjective term, and as we’ve shown in this Evidence Based Birth® Signature Article, there is a wide range of evidence showing that birthing people can safely eat and drink during labor.

Aspiration is when a person vomits stomach contents into their mouth while under anesthesia. If the contents of the stomach are aspirated back down the airway—going down the “wrong tube”— then this can lead to infection and breathing problems, called aspiration pneumonitis. Due to the possible risk of aspiration, general surgery patients are often asked to fast for at least eight hours before scheduled procedures (however, as we will discuss later, some fasting policies for general surgery are being rejected due to new evidence).

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So far, we do not have evidence on specific foods or drinks to recommend for consumption during labor. Some foods specifically mentioned in studies (Ciardulli et al. 2017; Karimi et al. 2020; Huang et al. 2020) include:

Because of NPO and clear liquids only policies in hospitals, some of the diabetic parents we talk to must bring their own food and drinks with them to the hospital.

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We could not find any research showing that plus-size people are more likely to experience aspiration during childbirth. So, we looked at a couple of possible sources for this belief, related to intubation and epidural placement.

Importantly, stomach emptying slows down once labor starts, so fasting for 8, 12, or even 24 hours after contractions begin may not guarantee an empty stomach at the time of birth. This means that withholding food is not effective in creating an empty stomach situation.

Table 1:Singata et al. 2013 Meta-Analysis on Eating or Drinking During LaborIn 2017, another review described the benefits and harms of food and drink during labor (Ciardulli et al.  2017). The researchers included all five studies from the Cochrane review and added five more, for a total of 3,982 participants. The authors found that less restrictive eating and drinking policies led to shorter labors by about 16 minutes. There were no differences in any other health outcomes.

Overall, the Cochrane review of five randomized trials with low-risk participants did not find any evidence for harm or benefit from eating and drinking during labor (Singata et al. 2013). Maybe we would have seen benefits if any of the trials had looked at patient satisfaction—but none of them did.

Mendelson concluded that aspirations are preventable and recommended using IV fluids instead of oral fluids. He also recommended switching to local anesthesia when possible, instead of general anesthesia. His advice caught on, and “Nothing by Mouth” became the norm in hospitals across the U.S. and even around the world. The NPO practice has persisted, becoming a part of hospital culture, even though the modern population is nothing like the people who gave birth back in Dr. Mendelson’s time, who were exposed to general anesthesia all the time, and without airway protection.

Neither ACOG nor ASA recommends restricting low-risk people to ice chips or sips of water during labor. Providers that continue to enforce NPO policies are not in line with their professional organization’s guidelines. In a recent statement, ACOG’s Committee on Obstetric Practice reaffirms their recommendation to allow people without complications free access to moderate amounts of clear liquids (“Committee Opinion No. 766: Approaches to Limit Intervention During Labor and Birth,” 2019, Reaffirmed 2021). They continue to advise against consuming solid foods while in labor; however, they note that the evidence for this recommendation has been questioned and is under review. To access these guidelines, click here.

The person in this case had a known placenta previa and was hospitalized for monitoring, but was not in labor. After consuming a full meal in the hospital, the patient began bleeding due to the previa and had an emergency Cesarean with general anesthesia. Vomiting occurred while the tube was being removed in the recovery room, and the patient died a few days later from the resulting aspiration pneumonitis.

Some people have (inaccurately) taken this publication to mean that the American Society of Anesthesiologists supports eating during labor, since the publication was presented at the ASA Annual Meeting. However, the ASA continues to deny that patients should have the right to eat during labor, as we’ll discuss in a few sections down.

North America’s Society for Obstetric Anesthesia and Perinatology developed a registry of obstetric anesthesia complications between 2004 and 2009 (D’Angelo et al. 2014). Thirty U.S. hospitals provided information on more than 307,000 people giving birth. Most of the birthing people (257,000) had regional (epidural, spinal or combined spinal-epidural) or general anesthesia. General anesthesia accounted for 5.6% of Cesareans in this study. Out of 5,000 pregnant people who received general anesthesia, there were zero cases of aspiration. We don’t know how many ate or drank during labor.

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New versions of a tool called a laryngoscope were developed in the late 1940s, allowing doctors to view a patient’s vocal cords so that they could place a tube in the trachea (intubation) and keep an open and protected airway during general anesthesia (Robinson & Toledo, 2012). The design, technique, and popularity of laryngoscopes and intubation continued to improve over the second half of the 20th century.

In 2009, when ACOG revised its recommendations to allow clear liquids during labor, it was part of a wider trend in the anesthesia community to relax rules on fasting before all surgeries. In a meta- analysis of randomized trials, researchers compared fasting times of two to four hours versus more than four hours and found that the patients who fasted longer were at greater risk of aspiration from larger and more acidic stomach contents (“Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report” 2017). Healthy patients undergoing elective surgeries are now advised to consume clear liquids up until two hours before the procedure, instead of “NPO after midnight.”

Fatphobia, also known as being anti-fat, is defined as bias, blame, and stigma against larger people that is rooted in thinner people feeling like they have superior morals. There is also a long history of fatphobia being related to racism and white supremacy—to learn more, visit this NPR podcast episode here.

In the U.S., some “cultural foods” may be perceived as unhealthy for laboring people due to their foods being perceived as “strong-smelling,” “spicy,” or “heavy/greasy.” Most dieticians, nurses, doctors, and midwives in the U.S. are white (U.S. DHHS 2017; Serbin & Donnelly, 2016), and we’ve seen health care workers make disgusted facial expressions or remarks when they see a patient eating “ethnic” food. We have also witnessed labor and delivery staff make judgmental and classist statements about people who would like to eat fast food during labor.

The issue of eating and drinking during labor should be reframed as one of bodily autonomy and human rights. All laboring people, whether they have an epidural or not, or have diabetes or not, have the right to choose whether they would like to eat and drink during labor.

Here at EBB, we were curious if a higher BMI is related to a true increase in risk of aspiration, or if there is a perception of higher risk due to fatphobia among health care workers (Lee & Pause, 2016).

Likewise, a recent article inspired by the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely® campaign, entitled “Things We Do for No Reason™: NPO After Midnight,” concluded that NPO after midnight provides little value to surgical patients in general (Black et al. 2021). When patients have scheduled procedures requiring sedation or general anesthesia, requiring NPO after midnight “represents a low-value and arbitrary practice that leaves patients fasting longer than necessary.”

The United Kingdom reviews every pregnancy-related death in regular “Confidential Enquiries into Maternal Deaths Reports.” Between 2000 and 2008 (spanning three reports), one person died from aspiration out of more than six million births (Cantwell et al. 2011).

Ultimately, people have the human right to decide if they would like to eat or drink during labor, or not. Hospital policy is not binding on patients, including birthing people, and hospitals do not have the legal authority to prevent a laboring person from eating and drinking if they so choose.

There were no cases of aspiration in any of the trials; however, the study sizes were not large enough to determine how often this rare outcome truly occurs.

In the mid 1900s, when anesthesia methods were crude and unsafe, “Nothing by Mouth” policies came about to prevent the dangerous consequences of aspiration with general anesthesia. Now that the safety of anesthesia has greatly improved, hospital policies and physician guidelines need to be rewritten to be in line with current evidence. We’ve started to see some movement in that direction. Several countries have started encouraging people to eat and drink as desired during labor, and in the U.S., obstetric practice guidelines were updated in 2009 to allow clear liquids.

Other organizations recommend that low-risk people avoid solid food during labor but be free to drink clear liquids, such as water, sports drinks, black coffee, tea, and soda:

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Only one of the trials considered satisfaction and found that more of the eating group participants reported satisfaction with their nourishment during labor compared to those given sips of water only (97% versus 55%).

Recall that the large Hawkins et al. 1997 study (of around 45 million births) looked at birth and death certificates and found the risk of aspiration death during delivery to be 0.7 per million people. That estimate is from a sample in the 1980s, before general anesthetic use decreased from 41% of all Cesareans to less than 6% now (nearly all involving emergent situations) (D’Angelo et al. 2014), and before pregnancy-related deaths fell an additional 60% (Hawkins et al. 2011). SSo, the risk of aspiration during surgery under general anesthesia is likely even lower today than in 1997, the last time we have exact numbers published about aspiration death in the U.S. population. As it says in a recent Anesthesiology editorial, “The actual incidence of the complication is so low, we cannot accurately describe it” (Palmer and Jiang, 2022).

Before these advances, in 1946, Dr. Curtis Mendelson published the landmark study responsible for “Nothing by Mouth” policies. He described how giving general anesthesia during birth could lead to the inhalation of stomach contents, which in rare cases could lead to severe lung disease or death. The pathology of this illness, named “Mendelson’s syndrome,” was replicated in animal studies (Mendelson,  1946).

Interestingly, in a 2016 position statement update, the American Association of Anesthesiologists reviewed much of the same evidence and decided that because there isn’t evidence of harm or benefit, hospitals should limit solid food during labor. Patient satisfaction was not factored into their opinion.

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Although Canadian guidelines recommend the option of food and drink, researchers surveyed 118 hospital maternity centers in Canada, and found that most low-risk people are not allowed to eat or drink during active labor (Chackowicz et al. 2016). In early labor, 98% of low-risk laboring people were free to consume fluids and solids. However, in active labor, 60% of people without epidurals and 83% of those with epidurals were restricted to ice chips and clear fluids. The authors concluded with their hope that this study will spark revisions of current hospital policy to be in line with Canadian professional guidelines and best practices and meet “psychological and physiological requirements in labor.”

More recently, a 2-year national descriptive study from the U.K. examined aspiration during pregnancy and the immediate postpartum period between 2013 and 2015 (Knight et al. 2016). They found nine confirmed cases of aspiration out of nearly 1.5 million pregnancies, giving an estimated rate of only 6 aspiration events per million pregnancies. Seven of the cases occurred with general anesthesia, representing 2.2 cases per every 10,000 uses of general anesthetics. The other instances of aspiration occurred when pregnant people were semi-conscious for other reasons. One person died from aspiration during this period (described earlier).

AJOG MFM (Maternal-Fetal Medicine), a companion title to the American Journal of Obstetrics and Gynecology, published a recent review of evidence based labor management guidelines (Alhafez and  Berghella, 2020). The authors made a strong recommendation that fluid or solid food should not be restricted: “Given that the aspiration risk in uncomplicated women is 1/1,000,000, there is no evidence to support restriction of oral intake.”

A follow-up study looked at anesthesia and pregnancy-related deaths in the U.S. between 1991 and 2002 (Hawkins et al. 2011). During this time, general anesthesia was used in approximately 14% of births. They found that anesthesia-related deaths fell 60% over time. The authors calculated that there were 6.5 deaths per million uses of general anesthetics from the later years in the sample (1997-2002). The number of these deaths directly caused by aspiration was not studied because it was too difficult to distinguish them from the other deaths related to airway problems, such as intubation problems, inadequate ventilation, or respiratory failure (Personal correspondence, Hawkins, 2016).

The researchers who presented at the 2015 ASA meeting concluded that “Nothing by Mouth” is an outdated restriction that should not be applied to low-risk people giving birth today. Their findings were echoed in a 2016 opinion paper published by Sperling et al. in the American Journal of Obstetrics and Gynecology.

The main reason that some hospitals have a “Nothing by Mouth” policy is to ensure that laboring people have an empty stomach should they need emergency surgery with general anesthesia. But is this effective?

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The authors write that aspiration in pregnancy and immediately postpartum in the U.K. is extremely rare: “Reassuringly, there does not appear to be a substantial number of cases associated with oral intake in labor following the change in policy [to no longer restrict oral intake among low-risk people in labor.]”

The research is limited, but fasting as soon as contractions begin may still not guarantee an empty stomach during birth (Carp et al. 1992). Fasting could even be harmful; it could cause stomach juices to become more dangerously acidic if an aspiration were to occur (Harty et al. 2015).

Here at Evidence Based Birth®, we urge the American Society of Anesthesiologists and the American College of Obstetricians and Gynecologists to revisit their current guidelines and adjust them according to the evidence and ethics. Any revisions in guidelines should also consider parental satisfaction. There is abundant research showing that people often complain about their distress in being forced to fast during labor (Manizheh & Leila, 2009).

In 2014, researchers looked at 57 million hospital births in the U.S. between 1998 and 2011 to better understand cardiac arrest in people giving birth (Mhyre et al. 2014). Cardiac arrest is an emergency that happens when the heart suddenly stops beating. The researchers found that cardiac arrest happened in 1 in 12,000 birthing people and that aspiration pneumonitis possibly contributed to 346 out of 4,843 (7%) of these cardiac arrests. This means that about 6 cardiac arrests per million births may have been related to aspiration.

Labor has a glucose lowering effect, just like exercise (AACE, 2022). For this reason, people with gestational diabetes who usually require insulin should stop the insulin at the start of labor. There is no mention of eating/drinking, but the AACE recommends, “sufficient glucose should be infused to keep the woman from becoming ketotic from the pronged period of starvation.”

The reviewers mentioned a few circumstances that can increase risk of aspiration – eclampsia, pre- eclampsia, having a body mass index (BMI) of 30 and above, and the use of intravenous (IV) opioids (such as morphine) to manage labor pain (which may further delay stomach emptying). They ended by saying that more research focusing on high-risk birth is needed, but people with these risk factors could possibly benefit from fasting during labor.

The authors of the third study (Bouvet et al. 2022) think that the significantly lower pain scores seen in the epidural group may have improved stomach emptying. The authors concluded that epidural use “should be taken into consideration when allowing women in labor to consume a light meal.” In other words, they see people with epidurals as good candidates for eating during labor (in contrast to many doctors, who withhold food from laboring people with epidurals).

When Dr. Mendelson looked at 44,016 patients who gave birth from 1932 to 1945, he found that aspiration occurred in 66 of them (0.15% or 1 in 667). All the people who experienced aspiration had a mixture of gas, ether, and oxygen given to them through a mask during the delivery. It is not clear if any of them had airway protection. General anesthesia wasn’t limited to Cesarean deliveries; it was also used to control the patient during vaginal births. More than half of the people in the study had a longer anesthesia time and greater anesthesia depth than usual. Most of the aspirations were from liquids, and only a few were from solids. There were two deaths in the study; both patients had general anesthesia without airway protection, aspirated solid food, and died of suffocation on the delivery table.

Having a Body Mass Index (BMI) of greater than 30-40 is sometimes mentioned in the research as making someone at high risk for aspiration.

In 1989, researchers looked at 11,814 low-risk people who gave birth in 84 freestanding U.S. birth centers from 1985 to 1987 (Rooks et al. 1989). There were no aspirations, even though 95% of the study participants drank or ate while in labor. Only 4.4% of those planning a home birth transferred to the hospital for a Cesarean; it’s not clear how many of the Cesareans were performed under general anesthesia. This sample population was at especially low-risk of aspiration because of the low rate of surgical births.

In the 1940s, when aspiration was recognized as a major problem during birth, anesthesiologists were using very primitive tools to keep a person’s airway open when under general anesthesia, and some doctors didn’t use any airway tools at all.

A second maternal death from anesthesia-related aspiration occurred almost 10 years later, between 2013 and 2015 (Knight et al. 2017). In this case, a pregnant woman with small bowel obstruction (blockage in the small intestine) aspirated during a combined Cesarean and general surgical procedure. The health care workers did not place a nasogastric tube in the patient with the general anesthesia. The authors say that this tube should have been placed to empty the stomach, as this is standard practice during surgery with conditions such as bowel obstruction.

Very little research has been published on nutritional needs during labor, but research in sports nutrition has found that ingesting carbohydrates during exercise improves performance and protects against fatigue and ketosis (Rodriguez et al. 2009). Ketosis means that there are raised levels of ketones that can be measured in blood and urine. During times of starvation or carbohydrate restriction, the body burns fat for energy, resulting in the release of ketones. It’s not clear whether ketosis during labor is normal and harmless or if it requires an intervention like IV fluids or food and drink (Toohill et al. 2008).

In the guidelines below, “high-risk” means a BMI of 40 or greater, diabetes, having a medical complication that makes an urgent Cesarean more likely, and/or the possibility of having difficulty managing an airway during anesthesia. In contrast, low-risk would mean the absence of these factors.

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We commonly hear doulas recommend consuming honey sticks and coconut water during labor. In addition, doulas on our Team here at Evidence Based Birth® suggest laboring people consider eating foods that are affordable and culturally grounded for you. Some examples from Team EBB include:

Updated by Rebecca Dekker PhD, RN on May 3, 2022. Originally published in 2013. © Evidence Based Birth®, All Rights Reserved. Please read our Disclaimer and Terms of Use. For a printer-friendly PDF, become a Professional Member to access our complete library.

However, we would caution against saying people should or shouldn’t eat in labor based on whether they have an epidural. These studies are small, and there are serious ethical concerns with restricting food based on whether people choose to have an epidural for pain management or not. People who have an epidural may have longer labors and wish to eat to sustain their energy. And people who do not have an epidural (especially those who prefer to avoid unnecessary interventions) may also feel very strongly about their right to eat during labor.

In a Cochrane review, researchers combined evidence from five trials involving a total of 3,103 participants who were randomly assigned to eat/drink or not during labor (Singata et al. 2013). Everyone was in active labor and at low risk of needing a Cesarean. A few of the trials reached opposite conclusions on outcomes like Cesareans, vomiting, and labor duration. Unfortunately, none of the researchers looked at satisfaction with childbirth. They concluded that there is no proven harm or benefit in restricting low-risk people from consuming food and drink during labor.

We did not find any evidence or guidelines on eating or drinking during labor for people with pregestational (pre-existing) diabetes or gestational diabetes. However, there are some guidelines on glycemic (i.e. blood sugar) control during childbirth.

The UpToDate article on “Intrapartum and postpartum glycemic control” for people with pregestational diabetes or gestational diabetes seems to assume that people will not be allowed to have oral intake during labor. They recommend eating 50% of normal caloric intake during the cervical ripening period of a medical labor induction (as it can take 12-24 hours to complete cervical ripening before labor contractions are started).