Nancy C.

Sharts-Hopko, PhD, RN, FAAN

Oral Intake During Labor:

A Review of the Evidence Abstract
The purpose of this article is to review evidence and practices within and beyond the United
States related to the practice of maternal fasting during labor. Fasting in labor became stan-
dard policy in the United States after findings of a 1946 study suggested that pulmonary
aspiration during general anesthesia was an avoidable risk. Today general anesthesia is rarely
used in childbirth and its associated maternal mortality usually results from difficulty in intuba-
tion. Healthcare professionals have debated the risks and benefits of restricting oral intake
during labor for decades, and practice varies internationally. Research from the United States,
Australia, and Europe suggests that oral intake may be beneficial, and adverse events associ-
ated with oral intake such as vomiting and prolongation of labor do not seem to be associated
with alterations in maternal or infant outcomes. The World Health Organization recommends
that healthcare providers should not interfere in women’s eating and drinking during labor
when no risk factors are evident. Nurses in intrapartum settings are encouraged to work in
multidisciplinary teams to revise policies that are unnecessarily restrictive regarding oral intake
during labor among low-risk women.
Key words: Aspiration risk; Labor; Oral intake.

July/August 2010 MCN 197

Copyright © 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
 Pulmonary aspiration among women
experiencing cesarean birth is so rare
that a randomized clinical trial to see if
oral intake is related to maternal mortality
is not even feasible.

or decades obstetricians, midwives, and anesthesiolo- anesthesia providers is high. In this context the question

F gists have debated the need for women in labor to be

restricted to nil per os (NPO). Competing concerns
include
• risk of gastric aspiration if women require general an-
esthesia
has persisted as to whether routine oral intake restriction
is warranted by the scientific evidence.

Practices Within and Outside the

• energy needs of the laboring woman
• the effect of ketosis on the laboring woman and fetus
• hyponatremia due to excess intake of hypotonic fluids
• maternal stress associated with NPO status and the
limitation on movement and discomfort imposed by
an intravenous line
• the impact of oral intake on maternal vomiting, the
duration of labor, and fetal outcomes.
The purpose of this review of literature is to assess cur-
rent evidence about the safety of women’s oral intake during
labor and generate recommendations for nursing practice.
Cesarean births account for over 31% of all births in
the United States (Centers for Disease Control and Pre-
vention, 2007), but general anesthesia is only used in the
10% of cesarean births that are characterized as urgent
(McDonald & Yornell, 2006, p. 442). Anesthesia-related
deaths occur in 1.6 per million live births; most of these
reflect difficulty in intubation (Chang et al., 2003).
Origin of the NPO Policy
Even after the move of childbearing into hospitals in
the 1920s, birth was still a common threat to life. The
twilight sleep movement of the 1930s was embraced by
educated, influential women. Twilight sleep entailed the
use of morphine and scopolamine to reduce pain and
memory of birth. General anesthesia was commonplace
even for vaginal births, although it was not necessarily
administered by specialists.
In 1946, Curtis Mendelson audited records of 44,016
women, in which 66 women experienced pulmonary aspi-
ration, of whom 40 aspirated liquid and 5 aspirated food.
Although only two of the women died, Mendelson’s rec-
ommendation that women fast throughout labor led to
the rapid adoption of NPO policies in the United States
and investigation of gastric aspiration during childbirth
in the United Kingdom (O’Sullivan & Scrutton, 2003),
with subsequent conformity to U.S. policies. Currently
in the United States and other developed nations, general
anesthesia is rarely used in childbirth and the skill level of
198 volume 35 | number 4
United States
Recommendations by various professional organiza-
tions are summarized in Table 1. Obstetrical anesthesia
guidelines from the American Society of Anesthesiolo-
gists Task Force on Obstetric Anesthesia (2007) include
restriction of oral intake to small amounts of clear liquids
for women at low risk up to 2 hours before anesthesia;
further restriction for women with identified risk factors
for aspiration include morbid obesity, diabetes, a difficult
airway or a nonreassuring fetal heart rate pattern; and
the avoidance of solid foods. Women who will undergo
elective cesarean birth are advised to fast from solids for
6 to 8 hours, and before surgical procedures aspiration
prophylaxis to reduce acidity of gastric contents is rec-
ommended. Recently the American Congress of Obstetri-
cians and Gynecologists (2009) recommended intake of
clear liquids.
The American College of Nurse-Midwives (ACNM
[2008]) recommends that women at low risk for pulmo-
nary aspiration be permitted self-determined intake ac-
cording to guidelines established by the practice setting.
They urge midwives to participate in research to confirm
the safety of ad lib nutrition for laboring women.
The World Health Organization (WHO) recommends
that because the energy demands of labor are so great
and because replenishment ensures maternal and fetal
well-being, healthcare providers should not interfere
with women’s desire for oral intake during labor (WHO,
1997). The Society of Obstetricians and Gynecologists
of Canada recommends that healthcare personnel offer
a woman in active labor a light or liquid diet (Society of
Obstetricians and Gynecologists of Canada, 1998).
Recently the Cochrane Collaboration, which main-
tains a set of databases providing systematic reviews of
the scientific evidence related to various healthcare prac-
tices, published a review on restricting oral fluid and food
intake during labor. The authors concluded that there is
no evidence in support of restriction in women at low
risk of complications (Singata, Tranmer & Gyte, 2010).
July/August 2010

Copyright © 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Table 1.
Recommendations of Selected Professional Organizations on Restriction
of Oral Intake During Labor
Organization Recommendation

Self-determination regarding oral intake encouraged for women at low

American College of Nurse-Midwives
risk for pulmonary aspiration
American Congress of Obstetricians and
Clear liquids for women at low risk for pulmonary aspiration
Gynecologists

American Society of Anesthesiologists Task Small amounts of clear liquids up to 2 hours before anesthesia for
Force on Obstetric Anesthesia women with no complications

Society of Obstetricians and Gynecologists Light or liquid diet as preferred by women at low risk for pulmonary
of Canada aspiration

Noninterference with laboring women’s desire for food or liquid intake

World Health Organization
without cause

Parsons (2001, 2004) has published two studies re- Ketosis

lated to practices in that country related to oral intake
in labor. In a survey of 109 Australian maternity units,
81.7% of hospitals did not have a policy for oral intake
in labor, and the remaining 18.3% reported policies that
varied from permitting ice only to allowing women free-
dom to eat and drink whatever they desired. A total of
60.5% of the hospitals reported that they leave food and
fluid requirements to the women’s own discretion as long
as they demonstrate no risk for using general anesthesia.
In a subsequent study Parsons surveyed Australian 89
midwives to determine their views and practices related
to oral intake in labor for women with low-risk pregnan-
cies. The midwives were divided on this issue, and their
own practices tended to reflect accepted practice in the
hospital in which they were employed.
ACNM (2008), based on an in-depth review of litera-
ture on oral intake during labor, reported that American
hospitals tend to limit oral intake during the latent phase
of labor to clear liquids, and during the active phase to
sips of water or ice chips. Fewer than 10% of hospitals
had policies permitting food intake during the latent
phase, and none permitted food intake during the active
phase. A survey of British obstetrical units found that
96% of units permitted oral intake, with 32.8% allow-
ing both fluids and food. The ACNM review found that
in a survey of Dutch obstetricians and midwives, 73% of
obstetricians and 67% of midwives left the decision to
eat or drink to the woman.
Effects of Oral Intake During Labor
Energy Needs in Labor
No published research on the energy requirements or nu-
tritional needs of laboring women was found in this re-
view. Eighteen years ago a team of investigators at Walter
Reed Army Medical Center (Eliasson, Phillips, Stajduhar,
Carome, & Cowsar, 1992) observed that the metabolic
demands of labor are similar to those of continuous mod-
erate aerobic exercise. Believing this analogy to be apt,
ACNM considers it relevant that The American College
of Sports Medicine endorses ingestion of carbohydrate
drinks during exercise to delay fatigue (Casa, Clarkson,
& Roberts, 2005).
July/August 2010
Pregnant women are prone to ketosis because of the met-
abolic demands of fetal growth and hormone changes
(Dumoulin & Foulkes, 1984). Although prolonged labor
increases ketone production (Kubli, Scrutton, Seed, &
O’Sullivan, 2002), which can be exacerbated by fasting,
ketosis has not yet been linked to birth outcome.
Hyponatriemia
Hyponatremia can complicate labor when laboring
women consume hypotonic fluids. Johansson, Lindow,
Kapadia, and Norman (2002) published case reports of
four neonates and one mother in Sweden who experi-
enced seizures or other central nervous system (CNS)
symptoms associated with maternal oral intake of be-
tween 4 and 10 L of water or water and fruit juice during
labor. Pregnant women have increased extracellular fluid
volume, and the activation of water-sparing systems dur-
ing labor reduces the woman’s ability to compensate for
an acute water surplus. Both the mother and the fetus can
experience rapid decrease in serum sodium.
Recently, in a study of this topic, 287 laboring women
in Sweden were permitted to have oral fluids during labor
(Moen, Brudin, Rundgren, & Irestedt, 2009). Hypona-
tremia was found in 16 of 61 women who received more
than 2,500 mL of fluid during labor, and two-thirds of
fluids were orally ingested. Hyponatremia was associated
with prolongation of the second stage of labor, instru-
mental birth, and emergency cesarean birth for failure
to progress. These investigators recommended that oral
intake be limited, intake be documented, and hypotonic
fluids not be administered intravenously.
Maternal Stress
Penny Simpkin (1986) assessed 159 women’s evaluation
of the stressfulness of childbirth using the Childbirth
Events Stress Survey within 10 days to 2 months of birth.
She found that 27% of the respondents considered re-
striction of food intake to be moderately or very stressful
and 57% of the women reported restriction of oral fluids
to be moderately or very stressful.
Armstrong and Johnston (2000) surveyed 149 Scottish
postpartum women within 36 hours of birth to ascertain
MCN 199

Copyright © 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
what proportion of them would have liked to have eaten
during labor. Of the respondents, 30% indicated that
they would have liked to eat during labor and 25% said
that it would have made a significant difference to their
overall satisfaction with their birth experience. Some
women reported that they had secretly eaten in early
labor; when compared to women who did not eat, no
differences were found in duration of labor, age, parity,
choice of analgesia, or mode of birth.
Vomiting
O’Reilly, Hoyer, and Walsh (1993) examined vomiting in
relation to oral intake among 106 low-risk women labor-
ing in a Michigan birthing center. The women were able
to choose the types and amounts of oral intake through-
out labor. Nurses completed a survey instrument to re-
cord women’s patterns of oral intake and emesis during
all stages of labor. Earlier in labor 103 of the women
chose oral intake, decreasing to 50 women during the
pushing phase. In the immediate postpartum phase, 104
women consumed food and/or fluids. Of women who ate
or drank during labor, 20 women vomited and 8 of those
women vomited more than once. Vomiting was associ-
ated more with food than fluid intake but no association
was found with quantity of food ingested. None of the
women who vomited experienced poor outcomes and the
length of labor did not differ between women who vom-
ited versus those who did not.
Scrutton, Metcalfe, Lowy, Seed, and O’Sullivan (1999)
undertook a randomized trial to determine effects of a
light, low-residue diet (N = 48) or water only (N = 46) dur-
ing labor on women’s metabolic profile, labor outcomes,
and residual gastric volume. In the light-diet group, food
consumption decreased as labor advanced. By the end of
labor the water-only group demonstrated greater ketosis,
as well as lower levels of plasma glucose and insulin. Gas-
tric volume was greater in the eating group within 1 hour
of birth. The eating group was twice as likely to vomit
around the time of birth, and the volumes vomited were
significantly greater than in the water group. The groups
did not differ in duration of labor, use of oxytocin, mode
of birth, Apgar scores, or umbilical blood gases.
Parsons Bidewell, and Nagy (2006) studied the effect
of eating in early labor on maternal and infant outcomes
in a prospective comparative trial of 176 low-risk nul-
liparous Australian women. Food was consumed by 82
women, whereas 94 consumed clear fluids only. Food in-
take during the latent phase of the first stage of labor was
associated with longer labor. No differences were found
in rate of medical interventions, adverse birth outcomes,
or vomiting.
Obstetric Outcomes
Scheepers, Thans, de Johng, Essed, and Kanhai (2002a)
implemented a double-blind, placebo-controlled study in
the Netherlands with 100 low-risk women. The partici-
pants received either 200 mL of a carbohydrate solution
or an identically flavored solution containing aspartame.
Women needing intravenous fluid received normal saline
200 volume 35 | number 4
Copyright © 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
and no other oral ingestion was permitted. No statistically
significant differences in quality of labor or birth outcomes
were demonstrated. In particular, fetal acid–base balance
did not differ between the two groups. Scheepers, Thans,
de Jong, Essed, Le Cessie, and Kanhai (2002) addition-
ally undertook a randomized study among 201 Dutch
women of the effect of at-will ingestion of carbohydrate
solution (N = 102) versus placebo (N = 99) on duration
of labor, need for augmentation, use of pain medication,
and incidence of surgical or instrumental births. The
groups had a higher incidence of high-risk pregnancies,
labor induction, and postterm pregnancies than was usu-
al in the Netherlands, but the two groups did not differ.
Fetal weights, Apgar scores, and acid–base balance were
similar in the two groups. Length of labor did not differ
between the groups, but surprisingly, the number of ce-
sarean births was significantly higher in the carbohydrate
group. More women in the carbohydrate group received
narcotic-based analgesia, which delays gastric emptying.
The authors concluded that further research is needed.
Kubli et al. (2002) evaluated the effect of isotonic sport
drinks versus water only during labor in a randomized
prospective study of 60 London women. At the end of the
first stage of labor, women in the water-only group evi-
denced more ketosis and decreased serum glucose levels.
Gastric volume was similar in the two groups after birth,
as were incidence and volume of vomiting. There were no
differences in maternal or infant outcomes, and the au-
thors concluded that ingestion of isotonic sport drinks
reduces maternal ketosis in labor with no adverse effects.
Parsons et al. (2006) studied labor duration and out-
comes among the women referenced above. Corroborat-
ing the finding of Scheepers Thans, de Jong, Essed, Le
Cessie, and Kanhai (2002), food intake during the latent
phase of labor was associated with a longer mean dura-
tion of labor of 2.35 hours. No other differences were
noted between the food and fluid groups. In a subsequent
analysis, Parsons, Bidewell, and Griffiths (2007) com-
pared birth outcomes among 82 women who chose to eat
food during early labor only, 10 who ate during estab-
lished labor only, 31 who ate during both early and es-
tablished labor, and 94 who chose to consume clear fluids
only during early and established labor. Eating during the
early phase of the first stage of labor was associated with
labor averaging 2.16 hours longer; eating during both
early and established phases of labor was associated with
a mean of 3.5 hours longer labor. Incidences of vomiting,
medical interventions, and adverse birth outcomes were
unaffected by food intake.
Tranmer, Hodnett, Hannah, and Stevens (2005) un-
dertook a randomized clinical trial in Canada to deter-
mine if unrestricted oral carbohydrate intake during labor
would reduce the incidence of dystocia in low-risk nullipa-
rous women. Women in the intervention group (N = 163)
received guidelines about food and fluid intake during la-
bor and were encouraged to eat and drink as they pleased
during labor. Women were free to consume what they
desired, and they were instructed to bring their own se-
lection of desired food and drinks to the hospital. Women
July/August 2010
Table 2.
Summary of Selected Findings of Effect of Oral Intake on Labor
or Maternal–Infant Outcomes.
References Setting Type of study Findings

27% of respondents considered food restric-

Simpkin (1986) United States Survey of 159 postpartum women tions moderately or very stressful; 57% found
liquid restrictions moderately or very stressful

103 women had oral intake early in labor; 50

had oral intake during pushing phase; 104
Quantitative study of vomiting
O’Reilly et al. had oral intake in immediate postpartum. 20
United States among 106 low-risk laboring
(1993) women vomited, more after food than fluid
women
with no impact on birth outcomes or length
of labor

Randomized trial comparing ef- Water-only group demonstrated greater

Scrutton et al. fects of low-residue diet versus ketosis, lower levels of plasma glucose and
United States
(1999) water only among 94 laboring insulin; eating group vomited more; out-
women comes did not differ

30% would have liked to eat during labor;

25% reported that it impacted overall sat-
Armstrong and Survey of 149 women within 36
Scotland isfaction with birth experience; no differ-
Johnston (2000) hours of birth
ences in outcomes between women who ate
secretly and women who abstained

Most institution have no written policy,

Parsons
Australia Survey of 129 maternity units 18.3% restrict oral intake; in practice over
(2001)
60% allow women self-determination

Johansson et al. Case studies of 4 neonates, 1 CNS symptoms were associated with excess
Sweden
(2002) mother water intake

Scheepers, Double-blind, placebo-controlled

Thans, de Jong, study of 100 low-risk laboring No differences in quality of labor or birth
Netherlands
Essed, and Kan- women comparing effects of pla- outcomes
hai (2002) cebo or carbohydrate drink

Randomized study of 201 labor-

Scheepers
ing women comparing effects of
Thans, de The groups did not differ in any outcomes
placebo or carbohydrate drink
Jong, Essed, Netherlands except that the carbohydrate drink group
on length of labor, augmenta-
Le Cessie, and had a higher incidence of cesarean birth
tion, pain medication, surgical or
Kanhai (2002)
instrumental births

Comparison of effect of ingestion

The water group had more ketosis and
Kubli et al. of sports drink versus water on ke-
England decreased serum glucose levels; no other
(2002) tosis, serum glucose, and related
differences observed
factors among 60 women

Parsons (2004) Australia Survey of 89 midwives Practices tended to reflect institutional policy

Randomized clinical trial examin-

Tranmer et al. ing effect of carbohydrate intake No difference between groups on any
Canada
(2005) on dystocia among 328 laboring outcomes
women

Study of effect of oral intake on Labor lasted longer among women who
Parsons et al.
Australia length of labor among 176 low-risk consumed food; no differences in vomiting
(2006)
laboring women or birth outcomes were observed
(Continued...)

July/August 2010 MCN 201

Copyright © 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Table 2.
Summary of Selected Findings of Effect of Oral Intake on Labor
or Maternal–Infant Outcomes. (Continued...)
References Setting Type of study Findings

Birth outcomes among 82 women Eating was associated with longer labor;
Parsons et al.
Australia choosing whether or not to eat vomiting and other outcomes did not differ
(2007)
and/or drink during labor among groups

Few U.S. hospitals permit food intake in

United States, latent phase and none in active phase; 96%
American Col- Review of practice policies in hos-
England and of British units permit oral intake with 32.8%
lege of Nurse- pitals in the United States, Britain,
Wales, Nether- permitting both food and liquid; 73% of
Midwives (2008) and Netherlands
lands Dutch obstetricians and 67% of midwives left
decision to mother

Hyponatremia was found in 26% who

Moen et al. Assessment of serum sodium lev- received over 2500 ml in labor and was as-
Sweden
(2009) els among 287 laboring women sociated with fluid volume. Adverse effects
on labor were identified.

Randomized controlled trial com-

O’Sullivan et al. paring eating and water only on
England No differences were observed
(2009) outcomes among 2,426 laboring
women

in the usual care comparison group (N = 165) received no
prelabor information on oral intake and were restricted
to ice chips and water. The incidence of dystocia was not
significantly different in the two groups, and no other
maternal or infant outcomes demonstrated a difference.
Although the authors concluded only that oral carbohy-
drate intake did not reduce the occurrence of dystocia,
it also did not contribute to an increased incidence of
adverse outcomes in this sample.
In the most recent investigation of the effect of food
intake versus water only on labor, O’Sullivan, Liu, Hart,
Seed, and Shennan (2009) studied 2,426 nulliparous,
nondiabetic women at term in a prospective randomized
controlled trial. The rate of spontaneous vaginal birth
was similar in both groups and no significant differences
were observed in duration of labor, cesarean birth rate,
the incidence of vomiting, or neonatal outcomes.
Conclusions and Recommendations
The scientific evidence that was reviewed supports the
recommendation of the WHO that the preferences of
low-risk women dictate their oral intake during labor.
Studies have demonstrated that women would like re-
strictions to be eased. Although excess water intake can
lead to maternal and fetal hyponatremia, in general ad-
verse effects were not observed as a result of oral intake
of carbohydrates. The study by Scheepers Thans, de Jong,
Essed, Le Cessie, and Kanhai (2002) of the effect of oral
carbohydrate intake on birth outcomes demonstrated a
higher incidence of cesarean birth in the treatment group;
however, other differences between the groups make it
difficult to attribute that outcome to the experimental in-
tervention in the face of contradictory evidence provided
by other studies. Food ingestion may prolong labor, but
no adverse maternal or infant outcomes were associated
with that effect. Likewise, women who ingest food in la-
bor may experience more vomiting, but with no associated
202 volume 35 | number 4
adverse birth outcomes. Oral intake of carbohydrates
does reduce the occurrence of maternal ketosis, with no
detected adverse effect on fetal well-being.
The research on food intake has been inconsistent in
terms of foods that were permitted. However, it is known
that foods high in fats slow gastric emptying and may
be a poor choice during labor. Larger scale, multicenter,
quantitative studies that examine women’s satisfaction as
well as birth outcomes associated with ingestion of food,
clear liquids, and water or ice only are needed to provide
definitive guidance. Although the evidence is not defini-
tive, the following recommendations are warranted:
• The ACNM (2008) classifies women as being at in-
creased risk for pulmonary aspiration if they have
comorbidities such as debilitating or chronic disease,
hypertension or preeclampsia, a neurologic disorder,
gastritis or ulcers or a history of either, previous ab-
dominal surgery, esophageal disease, obesity, the occur-
rence of an obstetrical emergency, or factors associated
with difficult intubation.
• The ACNM recommendations include the reaffirmation
that pregnancy and birth are normal life processes; the
need to assess risk for aspiration associated with anesthe-
sia and to discuss the small risk of pulmonary aspiration
with women; promotion of self-determination among
women with low risk; evaluation of all women who
are at increased risk for operative birth; communication
with anesthesia services in a timely manner; development
of institutional guidelines for identification of risk and
restriction of oral intake; assessment of anesthesia service
practice patterns in particular healthcare settings; and as
noted earlier, continuous participation in research to
identify best practices related to oral intake during labor.
• Nurses who work in intrapartum settings need to ad-
vocate for the establishment of multidisciplinary work-
ing groups to review policies that restrict oral intake
among low-risk women and advocate their relaxation.
July/August 2010

Copyright © 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
 Newlin and Champion (1997) described the process by
which a team including a research midwife, an anes-
thetist, and an obstetrician formulated such a policy in
Nottingham, United Kingdom, and developed an audit
process to ensure that safety was maintained.
• When policies about oral intake during low-risk labor
are relaxed, women need to be advised about the types
of foods that are appropriate in advance of labor so
that they can prepare and plan. They need to be advised
that excess water intake is undesirable, whereas intake
of liquids containing carbohydrates may safely confer
positive effects on their well-being. Women should be
informed of potential risks associated with eating and
drinking in labor that the literature has identified, in-
cluding vomiting and prolongation of labor, although
adverse effects on birth outcomes have not been ob-
served. When risk factors are identified, women need
to receive an explanation for restriction of oral intake.
• The implementation of any changes in oral intake poli-
cies should be accompanied by a plan for evaluating
patient outcomes, including women’s satisfaction, inci-
dence of vomiting and electrolyte imbalance, duration
of labor, type of birth, and maternal and infant out-
comes. The establishment of a protocol for monitoring
outcomes should allay concerns about the potential
compromise of maternal—infant safety. ✜
Nancy C. Sharts-Hopko is a professor and Director,
Doctoral Program, Villanova University College of
Nursing, Villanova, PA. She can be reached via e-mail at
Nancy.sharts-hopko@villanova.edu
The author has disclosed that there are no financial
relationships related to this article.
References
American College of Nurse-Midwives. (2008). Providing oral nutrition
to women in labor. Clinical Bulletin Number 10. Journal of Mid-
wifery & Women’s Health, 53(3), 276- 283.
American Congress of Obstetricians and Gynecologists. (2009). Recom-
mendations relax on liquid intake during labor. Retrieved October 20,
2009, from www.acog.org/from_home/ publications/press_releases/
nr08-21-09-2.cfm
American Society of Anesthesiologists Task Force on Obstetric An-
esthesia. (2007). Practice guidelines for obstetric anesthesia: An
updated report by the American Society of Anesthesiologists Task
Force on Obstetric Anesthesia. Anesthesiology, 106(4), 843-863.
Armstrong, T. S. H., & Johnston, I. G. (2000). Which women want food
during labour? Results of an audit in a Scottish DGH. Health Bul-
letin, 58(2), 141-144.
Casa, D. J., Clarkson, P. M., & Roberts, W. O. (2005). American College
of Sports Medicine roundtable on hydration and physical activity:
Consensus statements. Current Sports Medicine Reports, 4, 115-127.
Centers for Disease Control and Prevention. (2007). Births: Final data
for 2005. National Vital Statistics Report, 56(6), December 5, 2007.
Retrieved July 29, 2009, from www.cdc.gov/nchs/data/nvsr/nvsr56/
nvsr56_06.pdf
Chang, J., Elam-Evans, L. D., Bert, C. J., Herndon, J., Flowers, L., Seed,
K. A., et al. (2003). Pregnancy-related mortality surveillance—United
States, 1991-1999. National Center for Chronic Disease Prevention
and Health Promotion. Morbidity & Mortality Weekly Reports, 52, 1-8.
Dumoulin, J., & Foulkes, J. (1984). Ketonuria during labor. British Jour-
nal of Obstetrics & Gynecology, 91, 97-98.
For 15 additional continuing nursing education articles on topics related to
obstetrics topics, go to nursingcenter.com/ce.
July/August 2010
Copyright © 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Eliasson, A. H., Phillips, Y. Y., Stajduhar, K. C., Carome, M. A., & Cowsar,
J. D. (1992). Oxygen consumption and ventilation during normal
labor. Chest, 102, 467-471.
Johansson, S., Lindow, S., Kapadia, H., & Norman, M. (2002). Perinatal
water intoxication due to excessive oral intake during labour. Acta
Paediatrica, 91, 811-814.
Kubli, M., Scrutton, M. J., Seed, P. T., & O’Sullivan, G. (2002). An evalu-
ation of isotonic “sport drinks” during labor. Obstetric Anesthesia,
94, 404-408.
McDonald, J. S., & Yornell, R. W. (2006). Obstetric analgesia and an-
esthesia.
In A. DeCherney, L. Nathan, & T. M. Goodwin (Eds.), Current diagnosis
and treatment obstetrics and gynecology (10th ed., chap. 29, pp.
441-460). New York: McGraw-Hill Medical.
Mendelson, C. L. (1946). The aspiration of stomach contents into the
lungs during obstetric anesthesia. American Journal of Obstetrics
& Gynecology, 52, 191-206.
Moen, V., Brudin, L., Rundgren, M., & Irestedt, L. (2009). Hyponatre-
mia complicating labour—Rare or unrecognized? A prospective
observational study. British Journal of Obstetrics & Gynecology,
116, 552-561.
Newlin, C., & Champion, P. (1997). Oral intake in labour: Nottingham’s
policy formulated and audited. British Journal of Midwifery, 5(7),
418-422.
O’Reilly, S. A., Hoyer, P. J. P., & Walsh, E. (1993). Low-risk mothers:
Oral intake and emesis in labor. Journal of Nurse Midwifery, 38(4),
228-235.
O’Sullivan, G., Liu, B., Hart, D., Seed, P., & Shennan, A. (2009) Effect
of food intake during labour on obstetric outcome: Randomized
controlled trial. British Medical Journal, 338, b784. doi:10.1136/bmj.
b784.
O’Sullivan, G., & Scrutton, M. (2003). NPO during labor: Is there any
scientific validation? Anesthesiology Clinics of North America,
21(1), 87-98.
Parsons, M. (2001). Policy or tradition: Oral intake in labour. Australian
Journal of Midwifery, 14(3), 6-12.
Parsons, M. (2004). A midwifery practice dichotomy on oral intake in
labour. Midwifery, 20, 72-81.
Parsons, M., Bidewell, J., & Nagy, S. (2006). Natural eating behavior in
latent labor and its effect on outcomes in active labor. Journal of
Midwifery & Women’s Health, 51, e1-e6.
Parsons, M., Bidewell, J., & Griffiths, R. (2007). A comparative study
of the effect of food consumption on labour and birth outcomes in
Australia. Midwifery, 23(2), 131-138.
Scheepers, H. C. J., Thans, M. C. J., de Jong, P. A., Essed, G. G. M., &
Kanhai, H. H. H. (2002). The effects of oral carbohydrate adminis-
tration on fetal acid base balance. Journal of Perinatal Medicine,
30(5), 400-404.
Scheepers, H. C. J., Thans, M. C. J., de Jong, P. A., Essed, G. G. M., Le
Cessie, S., & Kanhai, H. H. H. (2002). A double-blind, randomized,
placebo controlled study on the influence of carbohydrate solution
intake during labour. British Journal of Obstetrics & Gynecology,
109, 178-181.
Scrutton, M. J. L., Metcalfe, G. A., Lowy, C., Seed, P. T., & O’Sullivan, G.
(1999). Eating in labour. A randomized controlled trial assessing the
risks and benefits. Anaesthesia, 54, 329-334.
Simpkin, P. (1986). Stress, pain and catecholamines in labor: Part 2.
Stress associated with childbirth events: A pilot survey of new
mothers. Birth, 13, 234-240.
Singata, M., Tranmer, J. & Gyte, G.M.L. (2010). Restricting oral fluid
and food intake during labour. Cochrane Database of Systematic
Reviews (1), CD003930. doi:10.1002/14651858.CD003930.pub 2
Accessed May 15, 2010.
Society of Obstetricians and Gynecologists of Canada. (1998).
Healthy beginnings: Guidelines for care during pregnancy and
childbirth. SOGC Policy Statement, Clinical Practice Guidelines
(p. 85). Toronto, Ontario: Society of Obstetricians and Gynecolo-
gists of Canada.
Tranmer, J. E., Hodnett, E. D., Hannah, M. E., & Stevens, B. J. (2005).
The effect of unrestricted oral carbohydrate intake on labor prog-
ress. Journal of Obstetric, Gynecologic and Neonatal Nursing, 34,
319-328.
World Health Organization. (1997). Care in normal birth: A practical
guide. Report of a Technical Working Group. Geneva: Author.
MCN 203