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If you've given birth to date, then in addition to labor and delivery pains you likely experienced hunger and thirst pangs as well.
Many pregnant women may now be releasing a big sigh of relief, as the American Society of Anesthesiologists released new guidance last week reversing their long-held position of requiring women in labor to fast. They are now saying instead that "most healthy women can skip the fasting and, in fact, would benefit from eating a light meal during labor." New research presented at the Anesthesiology 2015 annual meeting in late October supports this recommendation.

The logic behind requiring women in labor to fast was thus: if the labor changed course, and a c-section was needed, a patient who had eaten recently was at risk of aspirating her own vomit if given general anesthesia.

It was a policy predicated on a lot of if/then scenarios, and applied incredibly widely (to pretty much everyone giving birth in a hospital setting) despite a relatively low risk and changes in practice that mean most c-section anesthesia is provided in a similar fashion to an epidural (through a spinal block) and not through a mask over the nose and mouth, where the potential aspiration risk came in.

Anyone steeped in maternal health policy will understand that these kind of standards based on worst case scenarios are not unusual, but it's refreshing to finally see a change in policy on this front. A major impetus for the change is the recognition that the risk of aspiration no longer exists:
Researchers said aspiration today is almost nonexistent, especially in healthy patients. In the United States, there was only one case of aspiration associated with labor and delivery between 2005 and 2013, involving a complicated case of a woman who was obese and had pre-eclampsia, according to the American Society of Anesthesiology's Closed Claims Project database. Researchers also noted that no cases of death due to aspiration were reported in the United Kingdom between 2000 and 2005, compared to 1.5 cases per 1,000 during the 1940s.
One major reason many advocates have been pushing back on this practice for decades is that - as anyone who has given birth or supported someone doing it can attest - labor and birth are incredibly challenging. Even the press release from the anesthesiologists compares labor to running a marathon. Fasting while doing so is unbelievably challenging, and as they point out, has real consequences on the progression of labor.
Without adequate nutrition, women's bodies will begin to use fat as an energy source, increasing acidity of the blood in the mother and infant, potentially reducing uterine contractions and leading to longer labor and lower health scores in newborns. Additionally, the studies suggest that fasting can cause emotional stress, potentially moving blood away from the uterus and placenta, lengthening labor and contributing to distress of the fetus.
Midwives, especially those working outside of hospital settings, have long taken a different approach, allowing women to drink and eat as they saw fit during their labors. Even women giving birth in hospitals have been known to delay arrival at the hospital so that they could drink and eat as needed during early labor.

We are beyond thrilled that the recommendations have finally caught up to the common sense approach taken by the midwifery community. It may take some time for standards of practice to change, but these recommendations should help speed the process along. But before you start planning to eat a cheeseburger and fries during labor, note that the recommendations say "a light meal," which could include "fruit, light soups, toast, light sandwiches (no large slices of meat), juice and water.