| The Royal College of Midwives has devoted an | | | | mentioned that there is a "'lag time' between |
| entire chapter to maintaining nutrition during labor. | | | | scientific discovery and the first application of |
| Their Midwifery Practice Guideline purports to give | | | | discoveries to medical practice." Additionally, |
| "evidence-based guidelines for midwifery-led care | | | | Varmus indicates there is a "delay between |
| in labour," and lists some strong statements | | | | medical progress and its application more generally |
| regarding the practice of NPO during labor. | | | | to public welfare." This lag between supported |
| The Guideline further discusses the importance of | | | | belief and practice is a "culturally patterned |
| maintaining a woman's psychological health during | | | | behavior [that] continues to be practiced long |
| labor and delivery. Many experts point out that | | | | after the reasons for doing so have disappeared." |
| NPO is a restriction that exists only in hospitals. | | | | Despite marked improvements in obstetric care, |
| Perhaps the most important evidence provided by | | | | anesthetic agents, and anesthesia administration, |
| this document is that a woman's body may be | | | | women are still prohibited from eating and drinking |
| the best indicator of whether or not eating and | | | | in labor. |
| drinking during labor is warranted. The desire to | | | | In order to end the debate and effect decisive |
| eat appears to be most common in early labor. | | | | and cohesive practices regarding eating and |
| Assuming that the human body functions | | | | drinking during labor, extensive studies regarding |
| independent of medical thought, a woman's body | | | | the safety of doing so must be conducted. |
| may be indicating a desire for nutrition at the | | | | However, as one expert points out "Death or |
| point during labor in which it may be most | | | | significant morbidity from pulmonary aspiration is |
| important; just as the hard work is beginning. The | | | | so rare that the use of randomised controlled |
| psychological interpretation of a laboring woman | | | | trials to examine this outcome is impossible". Still, |
| indicates that the withholding of food and liquids | | | | productive studies can be conducted that |
| during labor may increase maternal apprehension | | | | precisely define how NPO affects the laboring |
| because the practice is decidedly authoritarian. At | | | | woman physiologically and psychologically. Such |
| a time when a woman should feel in control, | | | | studies can also address how NPO affects the |
| control is taken from her. Other studies indicate | | | | fetus during and after delivery. Although whether |
| that NPO during labor results in increased stress | | | | withholding food and liquids from the laboring |
| for the laboring woman and an increased | | | | mother truly influences the risk of aspiration under |
| perception of pain. | | | | general anesthesia may never be known, the |
| In his December 2001 speech at the Nobel | | | | other ways that this practice effects mother, |
| Foundation's Centennial Symposia in Stockholm, | | | | child, and birth outcomes, can eventually be |
| Harold Varmus, the President and Chief Executive | | | | determined. |
| Officer of Memorial Sloan-Kettering Cancer Center | | | | |