Nutrition in Pregnancy + Beyond: Labor + Delivery

During my first pregnancy, I ate a big slice of angel food cake topped with whipped cream and strawberries...for breakfast...on the morning I was induced.  Twelve hours after my "last meal" and still in labor, I wished I had at least tossed a little protein onto my delicious (but not so nutritious) dessert-for-breakfast (a peanut butter drizzle, perhaps?).  I think my logic at the time went something like "well, I'm nearly 42 weeks pregnant, and there's leftover birthday cake in the house!"  That's it.  No further justification needed.  Hours later as I drank water and enviously watched my husband eat solid foods, I made a mental note to avoid pre-labor birthday cake if I ever became pregnant again (coincidentally, my due date with #2 falls very close to my birthday, so there's a very real chance there will be birthday cake in the house!).  Of course circumstances surrounding planned versus spontaneous labor + delivery vary, but here are some healthy eating tips for the periods preceding the birth of your baby.  

The final weeks:  As your due date approaches (max capacity alert!), eating habits can shift in a few different directions.  You might feel so ravenous, exhausted, and ready to deliver that you find comfort in food and opt for less healthy bites.  Or maybe you see that delivery is near and try extra hard to prep your body for what's to come by consuming healthy eats.  Or you might feel so pregnant that you end up eating fewer calories overall and even dropping a couple pounds.  Depending on the day, my feelings towards food have encompassed a bit of each aforementioned situation.  Sometimes I want fried chicken and ice cream, sometimes I crave a crunchy + veggie-filled salad, and sometimes I feel like there's simply no more room for food (healthy or not!).  While it's ok for your weight to stabilize in the last couple weeks of pregnancy, ideally you'll continue eating a well-balanced, healthy diet to continue to provide your baby with much-needed nutrients and to provide you with a much-needed energy boost (at a time when energy is likely waning).  Opting for multiple snack-sized meals throughout the day can help combat that "no vacancy" feeling, allowing room for at least a couple nutrient-dense options.  

Early labor:  If you're going to be induced or think you recognize signs of early labor, skip the cake + whipped cream breakfast and opt for easily digestible yet slightly more nutrient dense foods.  During labor, gastric emptying is delayed (read: it takes longer for food to leave your stomach), so it's important to minimize foods high in fiber and fat, which already delay gastric emptying (sans labor).  Stick to small portions of lower fiber options with a touch of protein and/or healthy fats.  Think toast with a thin spread of avocado or a banana topped with 1-2 teaspoons of smooth peanut butter.  Be sure to include fluids in your plan too, sipping on water throughout the day.  If you're looking for more flavor in your fluids, try a glass of coconut water, which provides easily digestible carbs and electrolytes.  Or let the blender do the hard work (and give your stomach a break!), and try hydrating + fueling up with a smoothie.  Combine unsweetened almond milk, frozen banana, and powdered peanut butter or coconut water, frozen mango + plain Greek yogurt for a balanced snack or light meal.  Whatever you decide to eat, remember to keep portions small and meals light (or you'll risk seeing that food again later!).  And if a scheduled Cesarean section is in your future, refer to your doctor for more detailed instructions as the procedure usually requires a lengthier fasting period before arriving for surgery.

Active labor:  If you're delivering in a hospital, you'll likely encounter rules surrounding food + drink intake during active labor.  Ask your doctor about the rules ahead of time so you can manage expectations and engage in open dialogue regarding the reasons behind the rules.  Most likely, the rules relate to the delayed gastric emptying I mentioned earlier.  When combined with general anesthesia, the risk of the stomach contents (solids + liquids) finding their way into the lungs increases (and while you may not have plans for general anesthesia, emergency c-sections aren't exactly planned and a small percentage of these require general anesthesia).  Related to those risks, the American Congress of Obstetricians and Gynecologists (ACOG) set forth guidelines for oral intake during labor (updated in 2015) that recommend avoiding solids.  Clear liquids get the green light for up to 2 hours prior to anesthesia.  Not so intuitively, the approved liquids don't actually need to be clear.  They can include water, pulp-free fruit juices, coffee, sports drinks, and carbonated drinks.  If laboring at home or in a less restrictive hospital, solids might end up on the approved list.  A recent meta-analysis including 10 randomized trials and nearly 4,000 women revealed a shorter labor duration (by an average of 16 minutes) for those who could eat more freely during labor compared to those who could only consume water and/or ice chips.  Of note, the study focused on women with low-risk singleton pregnancies and did not show an increase in vomiting among those with fewer eating restrictions.  Among the ten trials, approved foods ranged from carbohydrate drinks to complete food freedom.  

Final thoughts: To be entirely honest, the thought of eating before or during labor didn't even cross my mind amid all the hospital preparations with baby #1 (that's probably obvious from the description of my induction-day breakfast!).  It's not a time to get too caught up in what you're eating or drinking, but that doesn't mean you need to discount it completely.  Get input from your doctor, keep a few of the suggested snacks on hand, and please, save the cake for after delivery!