Food and liquids with particulate matter should be withheld during active labor and delivery. Gastric emptying time is remarkably prolonged once labor is established and analgesics are administered. As a consequence, ingested food and most medications remain in the stomach and are not absorbed. Instead, they may be vomited and aspirated (Chap. 25, p. 499). According to the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (2017), oral intake of moderate amounts of clear liquids is reasonable for women with uncomplicated labor. Modest amounts of clear liquids such as water, clear tea, black cofee, carbonated beverages, Popsicles, and pulp-free fruit juices are allowed in uncomplicated laboring women. In those with appreciable risks for aspiration or those with significant risks for cesarean delivery, further restriction may be instituted. For example, for those with planned cesarean delivery, liquids are halted 2 hours before and solids are stopped 6 to 8 hours prior to surgery (American College of Obstetricians and Gynecologists, 2016b).
Although an intravenous (IV) infusion system is often routinely established early in labor, real need for this in the normal pregnant woman is limited, at least until analgesia is administered. However, venous access is advantageous during the immediate puerperium to administer oxytocin prophylactically and at times therapeutically when uterine atony persists. Moreover, with longer labors, the administration of glucose, sodium, and water to the otherwise fasting woman at the rate of 60 to 120 mLlhr prevents dehydration and acidosis. Shrivastava and associates (2009) noted shorter labors in nulliparas delivering vaginally who were provided an intravenous normal saline with dextrose solution compared with those given saline solution only. In another study, 195 women in labor received lactated Ringer or isotonic sodium chloride solution at a rate of either 125 or 250 mLlhr. The mean volume of total IV luid was 2008 mL in the 125 mL/hr group and 2487 mL in the 250 mL/hr group (Garite, 2000). Labor lasted more than 12 hours in signiicantly more of the women given a 125 mLlhr infusion compared with those given 250 mLlhr-26 versus 13 percent, respectively. In yet another study, 31i1 nulliparas with uncomplicated pregnancies in spontaneous labor at term received one of three IV infusions (Edwards, 2014). Group 1 was given 125 mLlhr of lactated Ringer solution with 5 percent dextrose (D5LR), Group 2 received 250 mLihour of the same solution (D5LR), and Group 3 was administered 25 mL/hr of D5LR. Groups 1 and 2 were allowed ice chips, Popsicles, and hard candy, and Group 3 also received Gatorade. Oral intake was limited in Groups 1 and 2 but was ad libitum in Group 3. The authors concluded that any of the regimens studied was safe but none was superior for labor performance.
In bed, the laboring woman may assume the position she finds most comfortable, and often this will be lateral recumbency. Lying supine is typically avoided to avert aortocaval compression and its potential to lower uterine perfusion (Chap. 4, p. 62). However, the normal laboring woman need not be conined to bed early in labor. A comfortable chair may be beneicial psychologically and perhaps physiologically. Others encourage ambulation.