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Meta-Analysis
. 2013 Aug 22;2013(8):CD003930.
doi: 10.1002/14651858.CD003930.pub3.

Restricting oral fluid and food intake during labour

Mandisa Singata  1 , Joan Tranmer, Gillian M L Gyte
Affiliations
Meta-Analysis

Restricting oral fluid and food intake during labour

Mandisa Singata et al. Cochrane Database Syst Rev. .

Abstract

Background: Restricting fluids and foods during labour is common practice across many birth settings with some women only being allowed sips of water or ice chips. Restriction of oral intake may be unpleasant for some women, and may adversely influence their experience of labour.

Objectives: To determine the benefits and harms of oral fluid or food restriction during labour.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2013) and reference lists of retrieved studies.

Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs of restricting fluids and food for women in labour compared with women free to eat and drink.

Data collection and analysis: Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction.

Main results: We identified 19 studies of which we included five, involving 3130 women. We excluded eight studies, one awaits classification and five are ongoing studies. All the included studies looked at women in active labour and at low risk of potentially requiring a general anaesthetic. One study looked at complete restriction versus giving women the freedom to eat and drink at will; two studies looked at water only versus giving women specific fluids and foods and two studies looked at water only versus giving women carbohydrate drinks.When comparing any restriction of fluids and food versus women given some nutrition in labour, the meta-analysis was dominated by one study undertaken in a highly medicalised environment. There were no statistically significant differences identified in: caesarean section (average risk ratio (RR) 0.89, 95% confidence interval (CI) 0.63 to 1.25, five studies, 3103 women), operative vaginal births (average RR 0.98, 95% CI 0.88 to 1.10, five studies, 3103 women) and Apgar scores less than seven at five minutes (average RR 1.43, 95% CI 0.77 to 2.68, four studies, 2902 infants), nor in any of the other outcomes assessed. Women's views were not assessed. The pooled data were insufficient to assess the incidence of Mendelson's syndrome, an extremely rare outcome. Other comparisons showed similar findings, except one study did report a significant increase in caesarean sections for women taking carbohydrate drinks in labour compared with water only, but these results should be interpreted with caution as the sample size was small.

Authors' conclusions: Since the evidence shows no benefits or harms, there is no justification for the restriction of fluids and food in labour for women at low risk of complications. No studies looked specifically at women at increased risk of complications, hence there is no evidence to support restrictions in this group of women. Conflicting evidence on carbohydrate solutions means further studies are needed and it is critical in any future studies to assess women's views.

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Conflict of interest statement

One of the review authors (J Tranmer) is principal author of one of the trials that was considered for inclusion. She did not participate in the decisions regarding data from this trial, which were considered by the other two review authors.

Figures

1
1
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 Any restriction of oral fluid and food versus some fluid and food, Outcome 1 Caesarean section (primary outcome).
1.2
1.2. Analysis
Comparison 1 Any restriction of oral fluid and food versus some fluid and food, Outcome 2 Operative vaginal birth (primary outcome).
1.4
1.4. Analysis
Comparison 1 Any restriction of oral fluid and food versus some fluid and food, Outcome 4 Apgar < 7 at 5 min (primary outcome).
1.6
1.6. Analysis
Comparison 1 Any restriction of oral fluid and food versus some fluid and food, Outcome 6 Maternal ketoacidosis.
1.10
1.10. Analysis
Comparison 1 Any restriction of oral fluid and food versus some fluid and food, Outcome 10 Duration of labour (hours).
1.12
1.12. Analysis
Comparison 1 Any restriction of oral fluid and food versus some fluid and food, Outcome 12 Maternal nausea.
1.13
1.13. Analysis
Comparison 1 Any restriction of oral fluid and food versus some fluid and food, Outcome 13 Maternal vomiting.
1.14
1.14. Analysis
Comparison 1 Any restriction of oral fluid and food versus some fluid and food, Outcome 14 Augmentation of labour.
1.15
1.15. Analysis
Comparison 1 Any restriction of oral fluid and food versus some fluid and food, Outcome 15 Narcotic pain relief.
1.16
1.16. Analysis
Comparison 1 Any restriction of oral fluid and food versus some fluid and food, Outcome 16 Epidural analgesia.
1.18
1.18. Analysis
Comparison 1 Any restriction of oral fluid and food versus some fluid and food, Outcome 18 Regurgitation during general anaesthesia.
1.19
1.19. Analysis
Comparison 1 Any restriction of oral fluid and food versus some fluid and food, Outcome 19 Mendelson's syndrome.
1.34
1.34. Analysis
Comparison 1 Any restriction of oral fluid and food versus some fluid and food, Outcome 34 Infant admission to intensive care.
2.1
2.1. Analysis
Comparison 2 Complete restriction of oral fluid and food (other than ice chips) versus freedom to eat and drink, Outcome 1 Caesarean section (primary outcome).
2.2
2.2. Analysis
Comparison 2 Complete restriction of oral fluid and food (other than ice chips) versus freedom to eat and drink, Outcome 2 Operative vaginal birth (primary outcome).
2.4
2.4. Analysis
Comparison 2 Complete restriction of oral fluid and food (other than ice chips) versus freedom to eat and drink, Outcome 4 Apgar < 7 at 5 min (primary outcome).
2.6
2.6. Analysis
Comparison 2 Complete restriction of oral fluid and food (other than ice chips) versus freedom to eat and drink, Outcome 6 Maternal ketoacidosis.
2.10
2.10. Analysis
Comparison 2 Complete restriction of oral fluid and food (other than ice chips) versus freedom to eat and drink, Outcome 10 Duration of labour (hours).
2.12
2.12. Analysis
Comparison 2 Complete restriction of oral fluid and food (other than ice chips) versus freedom to eat and drink, Outcome 12 Maternal nausea.
2.14
2.14. Analysis
Comparison 2 Complete restriction of oral fluid and food (other than ice chips) versus freedom to eat and drink, Outcome 14 Augmentation of labour.
2.16
2.16. Analysis
Comparison 2 Complete restriction of oral fluid and food (other than ice chips) versus freedom to eat and drink, Outcome 16 Epidural analgesia.
2.19
2.19. Analysis
Comparison 2 Complete restriction of oral fluid and food (other than ice chips) versus freedom to eat and drink, Outcome 19 Mendelson's syndrome.
7.1
7.1. Analysis
Comparison 7 Water only versus specific oral fluid and food, Outcome 1 Caesarean section (primary outcome).
7.2
7.2. Analysis
Comparison 7 Water only versus specific oral fluid and food, Outcome 2 Operative vaginal birth (primary outcome).
7.4
7.4. Analysis
Comparison 7 Water only versus specific oral fluid and food, Outcome 4 Apgar < 7 at 5 min (primary outcome).
7.10
7.10. Analysis
Comparison 7 Water only versus specific oral fluid and food, Outcome 10 Duration of labour (hours).
7.13
7.13. Analysis
Comparison 7 Water only versus specific oral fluid and food, Outcome 13 Maternal vomiting.
7.14
7.14. Analysis
Comparison 7 Water only versus specific oral fluid and food, Outcome 14 Augmentation of labour.
7.15
7.15. Analysis
Comparison 7 Water only versus specific oral fluid and food, Outcome 15 Narcotic pain relief.
7.16
7.16. Analysis
Comparison 7 Water only versus specific oral fluid and food, Outcome 16 Epidural analgesia.
7.18
7.18. Analysis
Comparison 7 Water only versus specific oral fluid and food, Outcome 18 Regurgitation during general anaesthesia.
7.19
7.19. Analysis
Comparison 7 Water only versus specific oral fluid and food, Outcome 19 Mendelson's syndrome.
7.34
7.34. Analysis
Comparison 7 Water only versus specific oral fluid and food, Outcome 34 Infant admission to intensive care.
10.1
10.1. Analysis
Comparison 10 Water only versus oral carbohydrate based fluids, Outcome 1 Caesarean section (primary outcome).
10.2
10.2. Analysis
Comparison 10 Water only versus oral carbohydrate based fluids, Outcome 2 Operative vaginal birth (primary outcome).
10.4
10.4. Analysis
Comparison 10 Water only versus oral carbohydrate based fluids, Outcome 4 Apgar < 7 at 5 min (primary outcome).
10.10
10.10. Analysis
Comparison 10 Water only versus oral carbohydrate based fluids, Outcome 10 Duration of labour (hours).
10.13
10.13. Analysis
Comparison 10 Water only versus oral carbohydrate based fluids, Outcome 13 Maternal vomiting.
10.14
10.14. Analysis
Comparison 10 Water only versus oral carbohydrate based fluids, Outcome 14 Augmentation of labour.
10.15
10.15. Analysis
Comparison 10 Water only versus oral carbohydrate based fluids, Outcome 15 Narcotic pain relief.
10.16
10.16. Analysis
Comparison 10 Water only versus oral carbohydrate based fluids, Outcome 16 Epidural analgesia.
See this image and copyright information in PMC

Update of

References

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References to other published versions of this review

Singata 2010
    1. Singata M, Tranmer J, Gyte GML. Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews 2010, Issue 1. [DOI: 10.1002/14651858.CD003930.pub2] - DOI - PMC - PubMed

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