At the water's edge: where obstetrics and anesthesia meet

Conflict exists between satisfying the parturient's desire for oral intake and traditional restrictive standards of obstetric and anesthesia departments. Surveys of institutions providing obstetric services reveal greatly varying oral intake policy. There is neither evidence of benefit in withholding fluids nor evidence of risk in allowing them. Prolonged fasting has potential liabilities. Maternal mortality is rare, and anesthesia-related causes are not among the common etiologies. Aspiration is not a significant factor in the modern era. Higher risk for anesthesia morbidity is associated with general anesthesia, particularly difficult intubation. Instead of implicating oral intake as a risk factor for pulmonary aspiration, the literature consistently emphasizes the critical role of properly trained and dedicated obstetric anesthesia personnel. Unless parturients are not candidates for regional anesthesia, a nonparticulate diet should be allowed. Liberal use of regional anesthesia as well as antacid prophylaxis is recommended.