06 December 2009

Thought This Was Interesting


Policies restricting food and liquid intake [during labor] date from an era when laboring women were routinely given general anesthesia and risked aspirating food into the lungs. Modern anesthetic techniques have virtually eliminated this risk, which is further reduced by the fact that only a tiny minority of laboring women, even among those who deliver via cesarean section, actually receive general anesthesia. ...

Elizabeth Allemann, MD [said,] “Women deserve to be fully informed about what the evidence actually shows, and it’s time that the medical profession abandoned policies based on the outdated and paternalistic idea that patients should play no role whatsoever in the decision-making process.” -The Big Push For Midwives press release

Read more...


The commentary above comes in response to a recent statement from the American College of Obstetricians and Gynecologists, which uses phrases like "may be allowed to quench their thirst" and "women are not allowed to eat." Part of the Big Push's objection is to the paternalistic nature of such language: this is not words used by people who see themselves as a hired consultant, adviser, and emergency safety net. This is something said by people who think they have a right to order women around. The other objection is that this recommendation is not supported by research.

I'm currently reading The Thinking Woman's Guide to a Better Birth by Henci Goer, and she has a lot to say about how the "nothing by mouth" rules stack up next to the research. Chapter 4 is all about this topic, but I'll pull out some of the highlights.


In the 1940's, back in the days when general anesthetics were administered through opaque masks, doctors began forbidding food to patients undergoing surgery because they realized that vomiting and inhaling food particles into the lungs (aspiration) was a grave and often fatal complication to surgery. Since laboring women during this time were usually heavily drugged and often had general anesthesia even for vaginal births, doctors extended the policy to childbirth. On on grounds whatever, and despite knowing that clear liquids empty rapidly from the stomach, the ban included drinking too. Thus, nothing by mouth... became standard practice before surgery and during labor.

Today, changes in anesthetic and obstetric practice have made aspiration a vanishingly rare event. Less than 2 per 1,000,000 pregnant women in the United States between 1988 and 1990 died of
any anesthesia-related complication - not just aspiration - during delivery. ... Nonetheless [nothing by mouth] in labor remains the norm at many hospitals. ...

To begin with, eating and drinking in labor are safe. In three large U.S. studies totaling seventy-eight thousand women in labor who ate and drank freely, there was not one case of aspiration. The anesthesia-related maternal mortality rate in England and Wales, where oral intake in labor is usual, is identical to the rate in the United States, where it is not. ...

Why then the strenuous objections to oral intake and the insistence on routine IVs? What we have, once again, is an obstetric belief system that defines childbirth as a medical-surgical event. Eating and drinking do not fit this model. IVs do. ...



In addition to being a direction that arose in circumstances that no longer exist, Goer goes on to point out that forbidding food and drink during labor not only makes the process of labor unnecessarily unpleasant, it may pose some risks to the baby as well:


Hunger and thirst cause considerable discomfort. ... In addition, during pregnancy, starvation causes a faster, sharper drop-off in blood sugar levels, and an earlier switch to metabolizing body fat. Vigorous exercise - in this case, labor - accelerates this process. This is a problem when women fast in labor because metabolizing fat produces ketones. In animal studies, ketones have been shown to cross into fetal circulation, making the fetal blood more acidic (acidosis). Acidosis is a symptom of fetal distress... (Pages 75-79)


Really makes that statement from the ACOG sound a lot less generous, doesn't it?

2 comments:

Lisa said...

I got around this by doing my research and ignoring the policy. I was there in labor, what were they going to do, throw me out?

Ritsumei said...

I actually got to eat lunch, at the hospital, with the doctor's blessing. Puked later, but I'm not sorry. I ate when I needed to. I would have been seriously tempted to check out (I wasn't very far along) and eat, and come back later, had they been difficult about it. But since I'd talked it over with my dr ahead of time, I told the nurse it was in my dr-approved birth plan. She called him, he said, "Yep, that's right," and I got my lunch. (OK, I have no idea exactly what he said, but I still got lunch.)

LinkWithin

Blog Widget by LinkWithin