This blog is a must read for ALL pregnant women. For those who have had babies before you will know that the last thing you feel like doing whilst in the throws of labour is eating. Especially because of the crazy influx of hormones, combined with any opiate medications you may need, will make you feel incredibly sick. However, I cannot stress enough how important this is! Your body is working the hardest it has ever worked, the equivalent of running a marathon. Now I’m no long distance runner, nor can I confess to ever having run a marathon (or half for that matter) but in order for your body to accomplish this immense task, you need to take on calories, as on average you will burn 2500 with such a race.
Generally, the recommended daily calorie intake is 2000kcal for women. So how then can a woman labour successfully and make enough progress to achieve full dilatation AND have enough left in the tank to push a baby out (which requires immense physical effort), if all she has eaten is a yoghurt beforehand? We must also factor in the time women will spend in the latent phase of labour, which can be two or three days of in-cordinate, period type pains- which are all making changes to the cervix by the way (known as cervical effacement). The latent phase needs energy too, for that uterus to keep contracting, so if you have not eaten well during this time, coupled with the fact you’re most likely running on little sleep, how is your body going to manage the ‘main event’ of active labour?
A quick note about cervical effacement.
I’m going to avoid using any medical jargon in explaining this and try and put it simply.
-When you haven’t had a baby before you will have a long, thick and closed cervix. About 4cm in length.
-During a sweep or induction of labour your midwife may refer to your cervix as long and closed, or quite posterior (meaning it is far back behind baby’s head and therefore difficult to reach.)
-Cervical effacement is also known as the ripening, or softening of the cervix.
-Before the cervix can even start to open (dilate) it must first shorten in length, become softer and thinner.
-This is what all those mild period pains are helping to achieve in the latent phase (4cm or less dilated).
-When you have had a baby before your cervix is known as a ‘multips os’ and a benefit of this is that the cervix is partially effaced. It’s already short and thin and therefore it will start to dilate sooner than with your first baby, as many of the stages of effacement have effectively been skipped.
Since carbohydrates are our primary source of energy, we can maximise our consumption to make sure there is plenty of fuel for the fire. I cannot stress the importance of this prior to labour. There is quite a bit of research on carbohydrate intake vs. performance, and it does indicate that the more grams of carbohydrates you ingest, the better you will perform. Now this research is very relevant to athletes etc. but still should be applied to women who are ready to pop! When the body does not have carbohydrates readily available it will go into a state of ketosis. We test women’s urine for this, amongst other things in pregnancy, but we pay particular attention to ketones present in wee during labour. This is because it highlights that the woman has low glucose availability for the muscles to use, so ketosis is occurring instead, which is not a good thing. We would therefore offer her food and drinks high in energy, isotonic sports drinks for example, to try and reduce the ketosis. What is best though is to avoid this state altogether.
I would like to share an example from my midwifery practice that stresses all of the above. In December 2020 I admitted a young lady to the labour ward shortly after lunch had been served. I will use the pseudonym Kim for this case. As Kim was in the latent phase of labour I thought I would offer her some lunch whilst it was still available. She declined, so I then asked when did she last have something to eat. I was honestly gobsmacked when she told me, “18:00 yesterday”, it was currently 13:00. So she’d had no breakfast and I think the dinner the night before wasn’t what I would deem a substantial meal, one slice of toast or something to that effect. I explained to her the importance of eating and drinking well in labour and all of the above, she still did not wish to have lunch but I managed to convince her to at least have some snacks and brought some fruit bags and biscuits to her room. I told her mum to encourage her to eat as much as possible. Kim was 2cm dilated on admission and this was her first baby- so a fair way to go still.
I then handed over care to another midwife and informed the midwife that she needed a lot of encouragement with eating and I had seen Kim’s partner outside the ward, so also told him to go to the shops and buy some isotonic drinks for her to have. At dinner time I popped back in to ask Kim if she wanted a meal, she declined and was not in active labour at this point, so could have stomached something in my opinion. I managed to at least get her to order a side and she opted for mashed potatoes and I also put a yoghurt on her tray, in case she would eat some more. To my knowledge, I think the potato was left. Imagine not being pregnant and going 24 hours just on some toast- I’d be starving, without throwing an endurance race like childbirth into the mix. I left that shift knowing her labour would become quite medicalised and most likely end in assisted delivery. I was sad that I wasn’t caring for her, as I would have tried my damn hardest to gently coerce her into eating (and I would have sent her home at 2cm to establish but that’s a debate for a different time)!
I was on the postnatal ward the next day and in the afternoon I saw her being pushed on a bed to be admitted, having had a caesarean section. I went to say hello and congratulate her and asked her what had happened. I also had a read through her notes and to summarise she did not progress past 5cm dilated. She had a Category 2* c-section at 09:36 and at 00:05 she had 4+ of ketones in her urine. Four pluses is a lot and hard to rectify with someone who is not eating and has not eaten a proper meal for over 24 hours.
*Categories of caesarean section:
|1||Immediate threat to the life of the woman or fetus|
|2||Maternal or fetal compromise that is not immediately life-threatening|
|3||No maternal or fetal compromise but needs early delivery|
|4||Elective – delivery timed to suit woman or staff|
Labour is hard and I’m certain that’s why it’s called labour! Even what someone would define as a lovely, beautiful birth has still been incredibly tough on the woman’s body, you get hot in labour and sweat a lot, because your body is facing a tough, physical challenge. When I helped Verity to birth Ada, my niece, she was born after 22 hours. From the first contraction with her waters breaking, to delivery that’s a long time. One of my most important roles as her birth partner, in my opinion, was to keep her well hydrated and fed. Of course the emotional and mental support was also pivotal to her having a low intervention, non-medicalised and what myself and her consider a wonderful home birth but would she have continued to progress over such a length of time without any energy? Experience tells me not.
To finish I will give a few recommendations of snacks good for labour below but with my sister this is a summary: