We appreciate the interest of McQuaid-Hanson et al in our article. Restriction of oral intake in labor has been a tradition since Mendelson’s famous 1946 report despite limited evidence to support its practice. Interestingly, liberalization of oral intake from nothing by mouth to clear liquids was met with similar hesitation as McQuaid-Hanson et al describes. At that time, similar concerns were present about the conflict between “satisfying the parturient’s desire for oral intake and traditional restrictive standards.” As we noted in our article, although nationwide statistics come from an obstetric milieu where oral intake is limited or prohibited during labor, the best estimate of its safety is evident by the absence of harm noted in the randomized controlled trials.

While we agree that gastric emptying may be delayed, this physiologic change does not correlate with adverse clinical outcomes (including aspiration or mortality). In contrast, patient satisfaction and autonomy remain important, often overlooked outcomes with up to 57% of women finding restriction of food intake to be moderately or very stressful. The authors reference their excellent work on cardiac arrest during hospitalization for delivery, noting 7% of all cardiac arrests had an association with aspiration. The data, however, give no context to the circumstances in which aspiration took place (eg, critical illness, difficult intubation for respiratory failure) or whether it was the proximate etiology for cardiac arrest. Furthermore, this rate also emphasizes the extreme rarity given approximately 6 cardiac arrest events per 100,000 hospitalizations for delivery were associated with aspiration.

While we appreciate and understand the alternative viewpoint on this subject, we continue to believe that women are competent to make an informed decision surrounding their desire to eat solid food during labor. If low-risk patients understand the risks, benefits, and alternatives and appropriate consent is obtained, eating solids in labor should not be restricted. We also believe strongly that continued collaboration of anesthesiologists, obstetricians, midwives, and pediatricians is paramount to optimizing perinatal outcomes. Finally, we believe that, in places where these practices are implemented, outcomes should be monitored prospectively to confirm the safety of this intervention.