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Women shouldn't have to suffer pangs of hunger while they are enduring labour pains, according to a new study that overturns a standard bit of medical advice.

For decades, some physicians have urged pregnant women not to eat once they go into labour. Doctors feared that if a woman required a general anesthetic for an emergency cesarean section she could aspirate the undigested contents of her stomach. In other words, in an unconscious state, there is a risk the woman might choke to death on her own vomit.

But in recent years, medical practices have changed. Now, C-sections are often performed under a local anesthetic and the woman remains awake, lessening the chances of pulmonary aspiration.

What's more, midwives are once again playing a greater role in the delivery process and they adhere to the notion that some nourishing food can help women cope better with a prolonged labour.

Even so, the handful of small studies that have explored the issue yielded contradictory results, with some showing benefit and others suggesting harm.

To remove the uncertainty, British researchers conducted a large trial involving 2,426 women having their first child. Half of them were told to eat a small amount of food such as bread, biscuits, fruits, non-fat yogurt, isotonic drinks and fruit juice. The others were advised to drink only water and chew on ice chips.

The results, published in the British Medical Journal, revealed that the rate of vomiting was almost identical in both groups - about 35 per cent.

In fact, there were a lot of other similarities. The length of labour was roughly equal (averaging about 10 hours) and the rate of complications was about the same, with about 30 per cent of women from both groups requiring C-sections.

"So, over all, we basically found eating wasn't a bad thing," said senior researcher Andrew Shennan, a professor of obstetrics at King's College London.

"If you are a low-risk normal woman having a straightforward labour, having a light diet is probably not unreasonable with today's [labour] practices," Dr. Shennan said in an interview. He added that the study participants who were given the option to eat "felt more in control and certainly liked it."

In high-risk cases, however, it still makes sense to refrain from eating, he said. If the birth dictates a C-section, and a localized nerve block fails, the woman will require a general anesthetic - and that's still best done on an empty stomach.

Maggots to the rescue?

It may sound like a throwback to the Middle Ages, but in recent years there has been renewed interest in using maggots to help treat stubborn wounds.

Advocates believe that maggots, which remove dead flesh while leaving healthy tissue alone, speed healing and reduce the risk of infection.

However, the first randomized controlled trial to investigate the practice in leg ulcers found no big advantage in using maggots over regular medical therapy.

The maggots - larvae of blow flies - remove dead flesh slightly faster than the standard procedure of spreading hydrogel on the wound. (The deep-cleaning lasts several days.) But there was no significant difference in the time it took for the wounds to heal - 236 days for patients treated with maggots compared with 246 days for those getting hydrogel.

"Larval therapy does not seem to speed the healing of these wounds," the principal investigator of the study, Nicky Cullum of England's University of York, said in an e-mail.

And there is one downside to maggots. The maggots produced twice as much pain before removal than hydrogel, according to the findings published in the British Medical Journal.

Prof. Cullum isn't sure why maggots cause more pain. But she speculated "it's likely to be a response to the secretions from the larvae," which use enzymes and digestive juices to break down the dead flesh. Or, it's possible the pain results from "the direct physical stimulation of the nerve endings by the larvae," she added.

So, will this study be the death knell for the somewhat creepy procedure? Not necessarily, Prof. Cullum says. "We have only investigated them in a specific patient group, namely people with leg ulcers." More research would be needed to study the merits of maggots in other patients.

Lead law goes too far?

U.S. public libraries and second-hand book stores have been caught in the public backlash against lead-contaminated products.

Last year, the U.S. Congress passed a bill to limit public exposure to the hazardous metal following the public uproar over lead-tainted toys imported from China.

The legislation, which took effect last month, also contained a ban on the distribution of children's books printed before 1985. Those books might have been printed with leaded ink that could end up in children's mouths, according to U.S. regulators. (Books published since the mid-1980s are supposed to be lead-free.)

Now, U.S. libraries and booksellers are worried that they will have to junk their older children's books. Even some medical experts believe U.S. lawmakers have been too zealous in their crackdown.

"I think this is just absurd," Ellen Silbergeld of Johns Hopkins University told The Washington Post.

"On the scale of concerns to have about lead, this is very clearly not a high priority," said Prof. Silbergeld, a leading scholar on lead poisoning. She added that contaminated toys and trinkets should be the main cause for concern.

ptaylor@globeandmail.com