From Mendelson to modern labour wards: rethinking fasting in labour.

Abstract

Concerns about the risk of pulmonary aspiration of gastric contents has long shaped obstetric anaesthesia, embedding a culture of caution that continues to influence labour ward practice. However, aspiration is now rare in contemporary obstetric care. In this context, data from the French National Perinatal Survey reveal that restrictions on eating and drinking during labour remain common, inconsistently applied, and unequally distributed. Women who are socially disadvantaged, of migrant origin, or without support are more likely to be fasted, suggesting that practice reflects institutional culture and structural inequity as much as clinical risk. At the same time, labour is physiologically demanding, and prolonged fasting can contribute to fatigue, dehydration, and impaired progress. The persistence of restrictive policies raises a critical question: are we preventing harm, or perpetuating outdated practice? Given the uncertainty surrounding gastric physiology in labour and the realities of obstetric care, a more pragmatic, individualised approach to oral intake is warranted, one that balances safety with equity and maternal wellbeing.