Eating or drinking during labor: Is it time to change the rules?

Abstract

M OST PRACTICING anesthetists have never . managed or even observed acid pulmonary aspiration (Mendelson's Syndrome) 1 in a parturient. In the most recent Report on the Confidential Enquiries into Maternal Deaths in the United Kingdom (1994-1996), 2 no mother died as a consequence of pulmonary aspiration. In the last four Confidential Enquiries (1985 to 1996), 3 in which 12-year period there were approximately 9 million births, four mothers died from pulmonary aspiration. However, in two of these mothers there were other complicating factors. Three of the mothers had received parenteral opioids during labor; in the fourth case the use of opioids was not recorded. This is in sharp contrast to the very first Confidential Enquiry (1952-1954), 4 which reported 29 maternal deaths from aspiration (Fig 1). This remarkable improvement can in part be attributed to the greater use of regional anaesthesia, the introduction of the H 2 antagonists, the improved training of obstetric anesthetists, and the policy of fasting women during labor. It could therefore be argued that gastric aspiration is no longer an important clinical issue in obstetric anesthesia and that in the very rare event of a mother aspirating, it is likely that treatment in a modern intensive care unit will ensure her complete recovery. It is not surprising then that midwives, obstetricians, and even mothers themselves are demanding that the unpopular policy of starving women during labor be reviewed.