“The concern with oral intake in labor is that it risks death from aspiration should general anesthesia be required. We quantified that risk using cesarean data from U.S. studies. The primary (first) cesarean rate in 2006, the latest year for which we had this statistic, was 24%, of which all but a few percent would have been during labor. In the Netherlands, where women are freely permitted oral intake, the mortality rate from aspiration during cesarean surgery is 0.9 per 100,000. Using 24% as a proxy rate for intrapartum cesareans, multiplying it by the percentage of cesareans done under general anesthesia in the U.S. (15%), and multiplying that result by 0.9 per 100,000, the likelihood that a fed woman having an intrapartum cesarean under general anesthesia will die of pulmonary aspiration is 3.2 per 10 million. To put this number into perspective, in 2003 she would have been twice as likely to die of aspiration during cesarean surgery than to be killed by a lightning strike (1.6 per 10 million), but she would have been 8 times more likely to die in a plane crash (26 per 10 million) and nearly 200 times more likely (543 per 10 million) to die in a car crash. She would also be nearly 900 times more likely to die of an elective repeat cesarean (2800 per 10 million).”

Passage from chapter 11, Routine IVs Versus Oral Intake in Labor: “Water, Water Everywhere, Nor Any Drop to Drink”
image credit: Nancy Rae