FEEDING IN LABOR

Historically, women have long been encouraged to eat and drink in labo ur. The purpose was twofold; first to ensure adequate nutritional inta ke for the mother to sustain herself during what could be a long and d ifficult labour, and second to expedite labour by encouraging strong u terine contractions. Ancient (and not so ancient) literature contains numerous accounts and suggestions as to what to administer to augment labour ranging from herbal teas to gunpowder (Broach and Newton, 1988) . The policy of encouraging women to maintain their oral intake throug hout labour continued until the late 1940s when it was appreciated tha t labouring women were particularly at risk from the dangers of aspira tion if general anaesthesia were employed, fasting in labour and then became established practice. Anaesthetists came to regard the stomach of the mother with awe and dread and saw strict abstension from any or al intake in labour as a vital weapon in their battle against aspirati on pneumonitis. Certainly the last 40 years has seen a marked fall in anaesthetic related mortality, but the precise contribution of starvat ion in labour to this reduction remains unclear. We have now come full circle and the traditional policy of starvation in labour is under sc rutiny. In the most recent survey on practice of oral intake in labour in maternity units in the United Kingdom in 1989, 96% of units alread y allow mothers some form of oral intake (Michael et al, 1991). This a rticle examines the origins of the traditional nil by mouth policy and attempts a systematic review of the evidence both in support and agai nst it. In the light of current knowledge, the authors review the bala nce of risk between liberalization of feeding in labour and the danger of aspiration pneumonitis. Points to be considered when devising a fe eding policy are discussed.