Fasting or restricting oral intake during labor is a common historical practice intended to reduce the risk of pulmonary aspiration. Early reports such as Mendelson’s case series contributed to routine fasting, but advances in obstetric anesthesia and the low current frequency of general anesthesia have reduced the incidence of aspiration. Contemporary studies report general anesthesia in fewer than 1.5% of women in labor and aspiration rates estimated between roughly 1 in 900 and 1 in 10,000 when general anesthesia is used.
Restricting oral intake during labor has been associated with reduced maternal comfort, lower satisfaction, diminished sense of control, and increased anxiety. It may also result in inadequate energy reserves, potentially prolonging labor and increasing the likelihood of operative vaginal delivery. Given changes in obstetric practice, anesthesia safety, and a greater emphasis on maternal experience, there is ongoing debate about optimal oral intake management during labor.
Clinical guidance varies internationally: the American Society of Anesthesiologists 2016 guidance permits moderate amounts of clear liquids while avoiding solids, whereas the World Health Organization and other regional guidelines (for example, the 2022 Queensland guideline) support allowing low-risk women to eat and drink according to preference. Multiple intervention types have been studied—fasting, ice chips, sports drinks, carbohydrate-containing or isotonic beverages, high-energy liquid diets, and individualized regimens—but head-to-head comparisons among many strategies remain limited.
A network meta-analysis (NMA) can integrate direct and indirect comparisons across three or more interventions to estimate relative effects within a single framework. No prior NMA has comprehensively compared the range of oral intake strategies used during labor. This protocol therefore proposes a systematic review and NMA to synthesize available RCT evidence and identify which oral intake approaches are most effective or safe for mothers and newborns.
This protocol was prepared following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and will report the final review according to the PRISMA extension for Network Meta-Analyses (PRISMA-NMA). The review protocol is registered in PROSPERO (CRD42025630953). At the time of publication the review had not begun; data collection was scheduled to start in January 2026 with an anticipated completion within one year.
Only randomized controlled trials (RCTs) will be eligible, irrespective of language or publication date. Full-text published studies only will be included. Conference abstracts, unpublished studies, and ongoing trials lacking full data will be excluded.
Eligible participants are women with a singleton cephalic pregnancy at or beyond 37 weeks of gestation who are admitted for planned vaginal birth.
Any structured oral intake intervention during labor is eligible. Interventions will be categorized by degree of restriction and by type of intake. Examples include:
Interventions reported in the primary studies will be grouped into predefined categories for analyses.
Selected outcomes reflect maternal and neonatal safety, labor progress, metabolic effects, and childbirth experience. Outcomes will be grouped as primary and secondary, and outcome definitions/time points will be extracted as reported in the original trials.
Maternal primary outcomes:
Neonatal primary outcomes:
These primary outcomes were chosen because they directly reflect safety and effectiveness of oral intake management during labor.
Secondary maternal outcomes include:
Secondary neonatal outcomes include:
Excluded study designs are non-randomized studies (cohort, case-control, cross-sectional), case reports, editorials, letters, conference abstracts, animal studies, reviews, and prior meta-analyses. Duplicate publications and studies with insufficient data or for which missing data cannot be obtained after contacting authors will be excluded.
A comprehensive search will be performed in the following electronic sources from database inception to January 2026, without language restrictions: Web of Science, PubMed, Embase, Ovid, Cochrane Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, the Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNKI), Wanfang Database, and the VIP Database. The strategy will combine Medical Subject Headings (MeSH) and relevant free-text keywords related to oral intake during labor, maternal and neonatal outcomes, and randomized trials. The detailed PubMed strategy is provided in the protocol’s supplementary material.
All records retrieved will be managed and duplicates removed using EndNote 20. Two independent reviewers will screen titles and abstracts for eligibility; where abstracts lack detail the full-text will be reviewed. Excluded studies and reasons for exclusion will be documented. Disagreements will be resolved by a third reviewer. The study selection process will be summarized in a PRISMA flow diagram.
Data extraction will be completed independently by two reviewers using a standardized data extraction form developed and pilot-tested by the review team on a sample of included studies. Extracted items will include participant characteristics, intervention details, outcome definitions and time points, and results for prespecified outcomes.
When appropriate, meta-analyses will be conducted using RevMan 5.4. The protocol anticipates performing network meta-analysis methods to synthesize direct and indirect evidence across multiple oral intake strategies. Where statistical pooling is not appropriate, subgroup analyses or descriptive syntheses will be performed. Risk-of-bias assessment and other standard methodological procedures will be applied in accordance with PRISMA-NMA guidance.
The review will not involve individual patient-level data and therefore does not require ethical approval. Results will be disseminated through submission to a peer-reviewed journal and presentations at relevant academic conferences. The authors reported no specific funding for the work and declared no competing interests.
This protocol is registered in PROSPERO under CRD42025630953.