Just Say “No” to a Routine IV and No Oral Intake

by | Oct 1, 2026 | Labor & Birth, Policies & Practices

Jump to Your Takeaway »

Jump to “What Do Professional Guidelines Recommend?” »

Routinely starting an IV and prohibiting oral intake remain fairly common practices in the United States despite no evidence supporting them and evidence against them.22 For those reasons, I thought the topic would make a good addition to my “Just Say ‘No’” series of articles.

Accordingly, this article will:

  • Explain the theory behind routine IVs and prohibiting oral intake,
  • Assess whether the policies are justified, and
  • Present evidence of their harms.

Following that, I’ll get to the “What can you do about it?” section of my article. I’ll quote guidelines from authoritative bodies to reassure you that declining a routine IV and choosing to drink and eat in labor are reasonable and to use as leverage should you meet with resistance to that plan. I’ll then wrap up with “Your Takeaway,” which will provide suggestions for developing your birth plan and tips on minimizing an IV’s adverse effects in case you have one. If you want to bypass the evidence analysis, feel free to jump to this section of the article.

Before we get started, though, a caveat: An IV is part of the packages of having an epidural and inducing labor, and both procedures make it more likely you won’t be allowed oral intake. If you decide you want to avoid an IV and eat and drink in labor, you also want to plan on letting labor start on its own unless there’s a medical reason to induce and for an unmedicated birth—which doesn’t mean you can’t change your mind in labor. If those aren’t your plans, jump to “Minimizing an IV’s Adverse Effects.”

What’s the Theory Behind Routine IVs and Prohibiting Oral Intake?

Prohibiting oral intake and routine IVs are relics of the 1940s, when patients labored under heavy doses of opioids and scopolamine (twilight sleep) and were delivered under inhalation anesthesia administered by face mask. Curtis Mendelson, published a paper at the time describing what came to be called “Mendelson’s syndrome”:24laboring patients vomiting under general anesthesia, inhaling the vomitus into their lungs (aspiration), and developing a type of pneumonia that sometimes led to death. Fear of Mendelson’s syndrome led to prohibiting oral intake to ensure an empty stomach, and mandating an empty stomach led to providing hydration and calories via a routine IV.

Are Routine IVs and Prohibiting Oral Intake Still Justified Today?

Let’s start with prohibiting oral intake.

To begin with, unlike in Mendelson’s day, general anesthesia for delivery is rare. Only 6 percent of cesarean deliveries are done under them in the United States.8 That means prohibiting oral intake subjects laboring women and birthing people to a restriction that affects very few of them. If that restriction were harmless, the policy might be justified even so, but as we’ll see later, it isn’t.

More importantly, thanks to improvements in the administration of general anesthesia, aspiration has become a non-issue. In evidence of this, a study reported an aspiration incidence of 1 in 11,345 cases of cesarean under general anesthesia and no deaths.4

You might think the rarity of aspiration events merely testifies to the success of prohibiting oral intake, but here’s evidence that’s not the reason: Anyone laboring at home or a birth center will be eating and drinking at will. Some percentage of them will be transferred to the hospital, and some percentage of transfers will end in a cesarean. However, studies of community birth report that among 586,000 labors at home or in birth centers, not one labor-related maternal death has occurred from any cause, let alone aspiration.7, 18, 20, 25 In other words, your odds of dying because you ate and drank in labor is effectively zero.

What about routine IVs?

There are two rationales for routine IVs: The first, as we saw, is to provide hydration and calories, but once you allow drinking and eating, that rationale disappears. The second is to have an IV in place as a precaution against the possibility of needing emergency surgery, but that same logic applies to athletes, team sports players, and drivers entering the freeway. Until we require IVs for those situations, we shouldn’t be requiring them for labor.

Do Routine IVs and Prohibiting Oral Intake Have Harms?

So far we’ve seen that neither policy prevents harms nor offers benefits when drinking and eating are allowed. That brings us to harms.

One harm of both is subtle but real: They reinforce the perception that birth is a medical crisis. Feeling endangered can slow or stop labor, a throwback protective mechanism that allowed our mammalian ancestors to give birth when less vulnerable to attack. You can see this at work today: It isn’t uncommon for contractions to fade during the bustle and disturbance of moving into the hospital and pick up once settled in.

Prohibiting Oral Intake

Deprivation of oral intake can increase stress in labor.22, 23 Experiencing emotional or physical distress can contribute to a negative birth experience. A negative birth experience can have long-term impact on maternal mental health, including developing childbirth-related posttraumatic stress disorder (PTSD).3, 9

Routine IVs

To begin with, an IV interferes with mobility, which can hinder labor progress,14 possibly leading to IV oxytocin to speed up progress and to a cesarean if that fails to work. The IV may also cause pain at the insertion site, which increases stress.22, 23 Increased stress, as I said above, can contribute to a negative birth experience, which can have long-term impact on maternal mental health.3, 9

The major problem, though, is the potential for fluid overload. When too much fluid enters the bloodstream, the excess fluid can collect in the lungs and other tissues, not just in the mother but the baby too. This can cause:

  • Increased birth weight:6, 11, 16, 19 This artificial increase is a problem because breastfeeding adequacy is determined by how fast babies regain their birth weight.
  • Breast tissue swelling (edema):13 Excess fluid in the breast tissue makes it difficult and painful to breastfeed. Difficulty with breastfeeding can lead to early cessation.

Excess fluid can also dilute the blood and imbalance blood electrolytes causing:

  • Anemia:5, 12Anemia increases risk of postpartum hemorrhage.21
  • Low blood sodium (hyponatremia): In severe cases, this can cause feeding difficulties and seizures in babies and headaches, nausea, impaired consciousness, and seizures in adults.10, 16

By itself, the IV flow rate shouldn’t cause a problem, provided IV fluid input is carefully monitored, which it may not be.10 One study of vaginal births reported an average amount of 2 liters administered over the course of labor rising to nearly 3 liters when IV fluid given postpartum was included. That’s equivalent to drinking 1, increasing to 1 ½, large bottles of soda over the course of perhaps a few hours and almost certainly less than a day.13 Amounts ranged as high as more than 3 liters in labor and nearly 4 ½ liters when IV fluids after the birth were included. Another study reported that 1 in 7 participants received 2 ½ liters or more of IV fluid during labor alone.11 However, even when flow rate is monitored, risk of fluid overload increases with an epidural or cesarean delivery because it is usual to deliver a bolus (a large amount of fluid, usually 500 mL or 2 cups, given in a short amount of time) as a preliminary to those procedures. Furthermore, oxytocin (Pitocin or Syntocinon), used in most labors either to start or strengthen labor,22 increases the potential for fluid overload because it increases water retention.10, 16

What Do Professional Guidelines Recommend?

You may meet with resistance if you plan to decline a routine IV and to drink and eat in labor. It may help to point out that these authoritative bodies support oral intake. None of them recommend routine IVs, and while it lags behind data-based practice, even the American College of Obstetricians and Gynecologists supports clear, calorie-containing oral fluids.

Promote self-determination of appropriate oral intake in healthy women experiencing normal labors. … [M]idwives and physicians should discuss the potential benefits of oral intake during labor with women.

The use of epidural analgesia for intrapartum pain management in an otherwise normal labor should not preclude oral intake.

American College of Nurse-Midwives (2016)1

For women at low risk, oral fluid and food intake during labour is recommended.

World Health Organization (2018)26

Inform the woman that she can drink during labour when she is thirsty, but there is no benefit to drinking more than normal. Isotonic drinks may be more beneficial than water.

Inform the woman that she can eat a light diet in established labour unless she has received opioids or she develops risk factors that make a caesarean birth more likely.

National Institute for Health and Care Excellence (UK) (2023)17

Women who are at low risk of requiring general anesthesia should have the choice to eat or drink as desired or tolerated in labour.

Society of Obstetricians and Gynaecologists of Canada (2016)15

Women in spontaneously progressing labor may not require routine continuous infusion of intravenous fluids. … Oral hydration can be encouraged to meet hydration and caloric needs. … Current guidance supports oral intake of moderate amounts of clear liquids by women in labor who do not have complications. However, particulate-containing fluids and solid food should be avoided. These restrictions have recently been questioned, citing the low incidence of aspiration with current obstetric anesthesia technique. This information may inform ongoing review of recommendations regarding oral intake in labor.

American College of Obstetricians and Gynecologists (2019)2

Your Takeaway

In this section I’ll cover “Developing Your Birth Plan” and “Minimizing an IV’s Adverse Effects.” To repeat what I said in the introduction, if you decide you want to avoid an IV and eat and drink in labor, you also want to plan on letting labor start on its own unless there’s a medical reason to induce and for an unmedicated birth—which doesn’t mean you can’t change your mind in labor. If those aren’t your plans, jump to “Minimizing an IV’s Adverse Effects.”

Developing Your Birth Plan

Once you’re clear on what you want, your next step is to find out where your care provider sits. There are three possibilities:

  1. Your care provider only starts an IV when needed for a specific purpose, and absent a reason not to, you are free to drink and eat as you please. If you are planning to birth at home or at a freestanding, i.e., not part of a hospital, birth center, no IV and drinking and eating freely are already guaranteed. If you are planning hospital birth, and your care provider is fine with these policies, you can’t stop there. Doctors and midwives in private practice work in groups and rotate call, and some of you may be birthing in hospitals where you get whoever is on call. That means your care provider in labor may not agree with those policies. You need to follow up by asking how you can ensure that your care provider in labor will abide by this care provider’s policies.
  2. Your care provider insists on a routine IV and strongly opposes oral intake beyond sips of water and ice chips. If your care provider takes this position, I recommend changing care providers and/or planned place of birth if possible. This stance signals a medical management approach, and that approach is problematic in more ways than this one.

But what if making a change isn’t feasible?

If there’s no health reason not to, I recommend holding off on hospital admission until active labor. That will allow you to do as you please while at home and is a good thing to do anyway as early hospital admission increases the probability of cesarean. Stay home until you are having regular contractions for at least an hour that occur no more than 5 minutes apart counting from the beginning of one to the beginning of the next, that last about a minute—a.k.a., the “5-1-1” rule—and that are strong enough that you can’t walk or talk while you’re having one. Ask to be checked when you arrive at the hospital and decline hospital admission unless you are at least 4 centimeters dilated and have a strong, regular contraction pattern. If you’re feeling that things might be picking up, hang around the hospital or somewhere close by for an hour or so and then go back and get rechecked. If there hasn’t been a change, again, go home.

Once admitted, it is your right to decline having an IV and refraining from eating or drinking. If you do, though, I recommend that you discuss with your care providers under what circumstances you would change your mind. This may help avoid them pigeonholing you as a “difficult patient.”

  1. Your care provider falls between those two poles. Once you know their policy, consider whether it’s acceptable to you. If it isn’t, explore further with them to see if you can negotiate an agreement that is. If you succeed, as with case #1, ask how you can ensure that whoever attends you in labor will abide by it. If you can’t, see #2 above.

Minimizing an IV’s Adverse Effects

There’s a fair chance that you will end up with an IV even if that wasn’t your plan. If you do, here are some ways to minimize its adverse effects:

  • If you are planning a VBAC, your care providers will likely require a routine IV. Decline this in favor of a saline lock. A saline lock is the business end of an IV. An IV line can be plugged in at any time, but you aren’t tethered to an IV pole.
  • Don’t allow having an IV to deter you from being mobile or changing positions.
  • If you are allowed liquids in addition to the IV, limit your intake to minimize the chance of fluid overload.
  • Especially if you’ve had an epidural, IV oxytocin, or a cesarean and are breastfeeding, request that the baseline used for calculating time to regain birth weight be the baby’s weight 24 hours after birth.19 This will give the baby’s kidneys a chance to eliminate the excess water weight.
  • If breast engorgement causes trouble with latch and pain while breastfeeding, get help and have patience with yourself and your baby.

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References

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