Saturday, February 6, 2010

Pregnancy Pudding

I love to eat (clearly). And, I love working with pregnant women and delivering babies. Unfortunately, these two passions do not coincide. Sure, pregnant women love to pack on the pounds and devour thousands of calories of delicious treats everyday. But, the second they go into labor, they are banned from consuming anything but clear liquids in almost every labor and delivery suite in America.


The story goes back to 1946 when Mendelson wrote a ground-breaking paper showing that pregnant women are at high risk of aspirating their stomach contents into their lungs if they required emergency surgery and intubation (when a breathing tube is placed in the airway for safety during anesthesia) 1. Since the time that Mendelson’s groundbreaking paper was published, the fear of aspiration has permeated the minds of all OB/GYNs and anesthesiologists, banning food from the labor suite. Aspiration is an absolutely devastating outcome which can cause significant morbidity and can be fatal. Aspiration rarely occurs in the modern day L&D ward, but it should be prevented at all costs.

Can prohibiting oral intake actually prevent aspiration? This has never been proven, and is extremely difficult to study based on the rare occurrences of aspiration. In order to study this properly, there is a need for a very high study volume to detect a difference in aspiration rates for those that eat versus those that don’t. Even so, there is limited data on the effects of labor outcomes for fasting versus eating women.

Recently, an article was written in the NY Times discussing an analysis by the Cochrane Review2. The Cochrane Review is a database of meta-analyses of randomized control trials of high quality, and is an excellent, unbiased source of information. This particular review compiled 5 studies looking at studies of eating or consuming sports drinks during labor. They concluded that “there is no justification for the restriction of fluids and food in labor for women at low risk of complications.”

The analysis is complemented by a study recently published in the British Medical Journal3. This study was a randomized trial of 2426 low-risk, non diabetic subjects randomized to clear liquids or a low residue diet. The low residue diet group did not have a statistically significant difference in Cesarean rate, APGAR scores, or vomiting, and thus seemingly did not greatly affect birth outcomes. 
I do NOT make any recommendations to eat during labor. The American College of Obstetrician Gynecologists recently published guidelines recommend to not change any rules4. Thus, we will continue to fast. Even so, this is an area that needs more well designed, strongly powered studies, especially since many women are so miserable during labor and simply want something to eat. Anesthesiology has advanced incredibly since 1946 and has many new techniques and medicines to prevent aspiration. Beyond this, less than 1% of people require intubation for emergency surgery because epidural and spinal anesthesia are used for C-sections the majority of the time. 

Hopefully, for my sake and the sake of everyone around me, by the time I get pregnant and have babies, the rules will have changed and I can gobble it up. (I didn’t eat during my triathlon, and pooped out in the run coming in 5th from last!) In preparation, I will make some pregnancy pudding, because what could be better to eat during labor than homemade chocolate peanut butter pudding (maybe toast, but I can dream)? It’s filling, delicious, and easy on the stomach, with carbohydrates and proteins to give you energy for the long push. Most homemade puddings have raw eggs in them (not good for the pregnant ladies), but you can make a great pudding with just milk and cornstarch (and peanut butter and chocolate). And if you’re not gestating currently, feel free to partake as well.

Recipe adopted from Bon App├ętit January 2009:

Chocolate peanut butter pregnancy pudding
½ cup sugar
5 teaspoons cornstarch
1/8 teaspoon salt
2 ¼ cups whole milk (honestly, you can do it with skim or 1% and I eliminated the heavy whipping cream from the recipe and replaced it with milk. This is not meant to give you massive indigestion)
1/2 cup creamy peanut butter
4 oz (about 2/3 cups) semi-sweet chocolate chips
1 tsp vanilla
Whisk first 3 ingredients in large saucepan to blend.

Gradually whisk in milk. Whisk over medium heat until mixture comes to boil.
Then boil until thick, whisking constantly about 30 seconds (this step can sometimes take longer, but you’ll be able to see it thickening).
Whisk in peanut butter; boil until thick again, whisking often, about 1 minute.
Remove from heat, add chocolate chips and stir until melted, add vanilla.

Cover and chill at least a few hours ahead of time.

1. Mendelson CL. The aspiration of stomach contents into the lungs
during obstetric anesthesia. Am J Obstet Gynecol 1946;52:191-206.
2. Singata M et al. Restricting oral fluid and food intake during labour. Cochrane Database Syst Rev 2010; 1:CD003930.
3. O'Sullivan, G., et al. Effect of food intake during labour on obstetric outcome: randomised controlled trial. BMJ: British Medical Journal 2009; 338:784.
3. ACOG Committee Opinion No. 441: Oral intake during labor. Obstetrics and Gynecology 2009. 114(3): 714.


  1. OhmyGod, yummy! This is on my list for after Lent :) And it totally cracks me up this is your pregnancy pudding! Anyway, I'm sure you know, at least ACOG -- which I pronounce agggh-oggh like a well, gag (sorry)-- has said laboring women and _even women planning c/sections_ may have moderate amounts clear liquid. And you know, last I heard vodka and cranberry was a clear liquid.... :)

  2. Haha...isn't that what epidurals are for? Let's not endorse drinking during pregnancy, for the sake of our patients...however I fully endorse it, in moderation of course, when loaded up on contraceptives!