Sperling et al present their case for liberalizing oral intake during labor in healthy parturients. They suggest that this should be permitted given the low rate of general anesthesia for cesarean delivery and because of the results of the recent systematic review of 3130 deliveries that showed no harm associated with liberalization of oral intake during active labor.

We would like to suggest an alternative interpretation of the available data. As the authors point out, well-designed randomized studies of different types of oral intake during labor have failed to show a difference in important outcomes such as the need for cesarean or operative vaginal delivery, duration of labor, and neonatal outcomes. Despite being potentially unpleasant for the patient, limiting oral intake to clear liquids appears to impact neither the patient’s ability to tolerate labor and delivery, nor their chance of achieving a spontaneous vaginal delivery. However, gastric emptying is known to be delayed in the setting of labor and in the presence of epidural or intrathecal opioids, placing parturients at potentially increased risk for aspiration. While certainly rare, when aspiration does occur, it can result in significant maternal morbidity and even death. In a contemporary sample of delivery admissions in the United States in the setting of limited oral intake, aspiration was associated with 7% of all maternal cardiac arrests.

Given that restricting oral intake during labor does not appear to impact obstetrical outcomes and may prevent a rare but potentially catastrophic event, we believe that current practices should remain the same and oral intake should continue to be restricted.