Nếu đây là tiêu đề cần dịch sang tiếng Anh theo văn phong y khoa, bản dịch phù hợp là: What Should You Eat During Labor to Ensure the Safety of Both Mother and Baby? Expert Advice
Labor is an energy-intensive process, and maintaining adequate nutrition is important. However, physiological changes in the maternal body, together with the use of obstetric analgesia such as epidural anesthesia, may pose various risks, particularly the risk of aspiration. This article focuses on risk factors and important recommendations for aspiration prevention to ensure maximum maternal safety.
1. Physiological Changes and Risks During Labor
During labor, the maternal body undergoes numerous physiological changes that affect the digestive system and increase the risk of complications.
1.1. Physiological Changes Affecting Digestion
Hormonal changes, particularly involving progesterone, and pressure from uterine contractions may slow gastric emptying and reduce intestinal motility [1]. As a result, food remains in the stomach longer, increasing gastric volume and the risk of reflux.
1.2. Increased Risk of Nausea and Vomiting
Nausea and vomiting are common symptoms during labor and may be caused by pain, stress, or the side effects of certain medications, such as uterotonic agents and analgesics, particularly opioid analgesics used with epidural anesthesia [1].
1.3. Risk of Aspiration During Emergency General Anesthesia
When an emergency cesarean section requires general anesthesia, the risk of aspiration is particularly high if the mother has food in her stomach. Aspiration occurs when gastric contents or food reflux from the stomach into the respiratory tract.
- Airway obstruction caused by solid food: Solid food particles may obstruct the airway, leading to acute respiratory failure [1].
- Aspiration pneumonia: Highly acidic gastric contents entering the lungs can cause severe injury to lung tissue, resulting in aspiration pneumonia or acute respiratory distress syndrome (ARDS) [1, 2]. Although the incidence of aspiration has decreased with modern anesthetic techniques, it remains a serious complication that requires preventive measures [2].
2. High-Risk Patients
Certain laboring women have a higher risk of complications related to eating and drinking during labor, including [1]:
2.1. Patients with Gastrointestinal or Metabolic Risk Factors
These conditions may delay digestion or increase the risk of reflux:
- A history of severe or poorly controlled gastroesophageal reflux disease.
- Gastrointestinal abnormalities (e.g., hiatal hernia, esophageal or intestinal obstruction).
- Delayed gastric emptying (e.g., gastroparesis, poorly controlled diabetes).
2.2. Patients at High Risk for Difficult Endotracheal Intubation
Difficult endotracheal intubation during anesthesia may prolong airway exposure to gastric contents and increase the risk of aspiration. Risk factors include a history of difficult intubation or severe obesity (BMI ≥40 kg/m²) [1].
2.3. Patients with Specific Health Conditions or Obstetric Complications
These conditions may increase the likelihood of requiring urgent medical intervention, including emergency cesarean delivery:
- Preeclampsia.
- Placental abruption.
- Multiple pregnancy.
- Non-reassuring fetal status.
- Factors associated with an increased risk of cesarean delivery (e.g., macrosomia, abnormal fetal presentation, fetal abnormalities).
3. Recommendations for Eating and Drinking During Labor
Based on recommendations from the American Society of Anesthesiologists (ASA) and the American College of Obstetricians and Gynecologists (ACOG), the following recommendations are intended to ensure maternal safety and prevent aspiration [1, 2]:
3.1. Medical Consultation
All decisions regarding eating and drinking during labor should be discussed with and approved by the healthcare team. Laboring women should clearly inform the medical team about what they have eaten or drunk before arriving at the hospital [1].
3.2. Prioritize Clear Liquids
The American Society of Anesthesiologists (ASA) and the American College of Obstetricians and Gynecologists (ACOG) jointly recommend that laboring women may consume clear liquids during labor to help meet their needs for hydration and energy [1, 2].
- Safe and easily digestible options include plain water, carbonated beverages, pulp-free fruit juice, black coffee, tea without milk or cream, and isotonic sports drinks [1].
- This helps maintain energy, reduce thirst and discomfort, and prevent ketosis associated with prolonged fasting [1, 2].
3.3. Avoid Solid Foods and High-Fat Foods
The ASA and ACOG recommend avoiding solid foods and liquids containing particulate matter during active labor [1, 2]. Solid foods, particularly high-fat foods, delay gastric emptying and increase the risk of aspiration if general anesthesia becomes necessary [1].
3.4. Do Not Withhold Epidural Analgesia Because of Oral Intake
The ASA recommends that epidural analgesia or other forms of anesthesia should not be withheld solely because of the patient's oral intake status [1]. Strategies should be implemented to reduce the need for general anesthesia in emergency situations, particularly in patients who have not appropriately fasted [1].
3.5. Intravenous Fluids When Necessary
When intravenous fluids are required, the type of fluid and infusion rate should be determined according to the patient's individual clinical needs and the anticipated duration of labor [2]. Recent studies have shown that continuous infusion of 5% dextrose in normal saline does not increase the risk of neonatal hypoglycemia [2].
4. Frequently Asked Questions (FAQ)
If I have received epidural anesthesia, what can I eat or drink?
You should prioritize clear liquids such as plain water, pulp-free fruit juice, black coffee, tea without milk or cream, and sports drinks to provide energy and electrolytes [1, 2]. Avoid solid foods and high-fat foods.
Is aspiration still a major concern in modern obstetric care?
Although the incidence of aspiration has decreased significantly with modern anesthetic techniques, major aspiration events can still occur and may result in significant morbidity and mortality [1, 2]. Therefore, aspiration remains an important concern, particularly when general anesthesia is required.
Is complete fasting beneficial during labor?
Complete fasting is not recommended because it may have undesirable consequences, including maternal stress and increased ketone levels [1, 2]. Consumption of clear liquids is encouraged to maintain energy and comfort [1, 2].
5. References
- [1] ASA Committee on Obstetric Anesthesia (2022). Statement on Oral Intake During Labor. American Society of Anesthesiologists. https://www.asahq.org/standards-and-practice-parameters/statement-on-oral-intake-during-labor.
[2] American College of Obstetricians and Gynecologists (2019). Approaches to Limit Intervention During Labor and Birth. Committee Opinion, No. 766.
The information provided above is for reference purposes only and does not constitute a recommendation. Please consult a physician for detailed medical advice.