Two new studies on giving birth could give doctors and patients a little less to worry about in the delivery room. One debunks the conventional wisdom that people shouldn’t eat or drink while they’re in labor; the other confirms that new guidelines on delaying elective induced labor will not increase stillbirths.
At the American Society of Anesthesiologists’ annual conference last month, a Canadian research team presented data culled from 385 studies from the past 25 years that show that women in labor burn calories and use energy at rates comparable to marathon runners. But unlike marathoners, who get pats on the back, protein bars, and bananas at checkpoints along their routes, people giving birth are usually denied all but ice chips. Doctors have long believed that women would aspirate their food if they chose to eat during labor, especially if they were managing pain with anesthesia or painkillers.
But researchers found only one U.S. case of aspiration during labor between 2005 and 2013, and that patient had complications related to pre-eclampsia, a pregnancy disorder. It seems that the conventional wisdom of labor fasting was a holdover from the days before epidurals and spinal blocks, when women would give birth under anesthesia that required a face mask or a windpipe tube. Now, the anesthesiologists say that it’s fine for healthy people to eat a light meal during the birth process.
Many people lose their appetites during the strenuous physical pressures of labor, but others could benefit from a little calorie replenishment. The study notes that a lack of proper nourishment could prolong labor in two ways: Without food, bodies burn fat, making the blood of the baby and the person birthing it more acidic, reducing uterine contractions. Fasting can cause emotional stress, too, diverting blood away from the uterus and placenta. Then there’s the extreme physical exertion, which is much harder to keep up for hours on end without caloric intake.
So, pregnant people can now opt to eat while they give birth. But when should they schedule their labor? Doctors once thought that babies born between 37 weeks and 39 weeks after conception—just shy of the accepted 40-week gestation period—were just as healthy as full-term babies. Some patients with perfectly healthy pregnancies elected to induce labor during this period because they wanted caesarean sections, because the security of a planned date can be comforting, because they were expecting a particularly large baby, or because the last weeks of pregnancy can be uncomfortable.
But in 2011, the National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development issued a recommendation that all elective labor inductions be held until at least 39 weeks; infants delivered in the two weeks earlier ran a higher risk of respiratory problems, low blood sugar, and infections. Still, a number of doctors worried that fewer preterm births would lead to more stillbirths later in pregnancy, just because spending more time in the womb would make it more likely for a fetus to terminate there. A 2006 study showed that women aged 40 and up are more likely to give birth to stillborn children with each additional two-week period of pregnancy between 37 and 41 weeks.
On Monday, the NIH released a new study that challenges those beliefs. Researchers analyzed U.S. infant birth and death statistics between 2006 and 2012 (the year with the most recent data since the new recommendation) and found no difference in the proportion of births that were stillborn 34 to 36 weeks, 37 weeks, and 38 weeks. The key to their finding seems to lie in the data-crunching: Rather than comparing the number of stillbirths at each week of gestation with the number of total births that week, the researchers compared the number of stillbirths with the total number of people pregnant during that week. They claim that this method is a more accurate measure of stillbirth risk among pregnant people.
With the highest infant mortality rate of the world’s 27 wealthy nations and a maternal death rate on the rise, the U.S. has considerable room for improvement in pre- and post-natal health care. More food options for people in labor and better data on stillbirths are incremental developments, but they’re two much-needed steps in the right direction.
