Why just clear liquids during labor

[Anonymous]

Anonymous wrote:

Anonymous wrote:I wasn't hungry once active labor hit. I felt like I was going to hurl during almost all of active labor. Really, how much digesting is going to take place when your body is doing the very difficult work of labor?

Who are these women doing all of early labor in a hospital? That kind of time line seems more likely to guarantee a section than food vs popsicle.

Puked during transition pp above. I was induced so I spent the whole glorious time in hospital. I would guess some others too.

Yes, another induction here. Food was the last thing on my mind during my 17-hour induction, and I too vomited during transition and was glad it was only liquids.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I'm married to an anesthesiologist and the no-foods rule is not a joke. It can be extremely dangerous to perform surgery on someone with a full-stomach (and that's defined as having anything other than water for the last 8 hours). Pregnant women are especially prone to vomiting, and the risk of aspiration (vomit entering the lungs) is high and can be extremely dangerous, even fatal.

Tell your husband to look at the research on this. the risk of aspiration is the same regardless of whether or not the patient has eaten.

Yes, you're right. My husband trained at Johns Hopkins. I hear they are totally out-of-date at that fogey old institution. Why on earth would they recommend a medical precaution that a DCUM says is antiquated?

Snark aside, I'll do my best to defend the practice to the best of my non-medically-trained understanding. It's a question of risk-calculus. Often times a surgery will be delayed if a patient has eaten. However, if a patient has a full stomach requires emergency surgery, such as after a trauma, it is significantly more risky to delay surgery than to wait for the food to digest. Anesthesiologists must perform a different assessment of the airway and the method of induction for a full-stomach patient, and sometimes that may method be contraindicated by other characteristics of the patient. Pregnant patients are more likely to vomit and to aspirate than non-pregnant patients. When you weigh the risks, forgoing a plate of spaghetti while laboring is certainly less burdensome than the risk of developing a severe lung infection or death in the event you aspirate on the table, no?

[Anonymous]

With respect, those are the risks to weigh. On the other side is the risk if a c-section because the woman is too weak to labor after 24 hours.

[Anonymous]

I guess an important question for me is who decides whether something is "too risky". If a mom is informed of the likelihood and severity of aspiration during a cesarean with general anesthesia, and she decides she's willing to eat anyway, then is it acceptable for the hospital to forbid her to do so? I understand that medical professionals want to minimize risk as much as possible as far as their own liability goes, but a woman's calculus of risk and benefit may be different. And it really, really seems like a lot of studies are saying that forbidding food and drink does not improve outcomes -- so while I understand the rationale that you are giving, you still haven't explained why the research shows no benefit:

"The restrictions date back almost seven decades, said Joan Tranmer, an associate professor of nursing at Queen’s University in Kingston, Ontario, an author of the new review, published last week by the Cochrane Collaboration.

“We thought it was time to question this, now that we’re in the 2000s,” said Dr. Tranmer, who said she had seen all too many women in labor complaining of thirst and dry mouth resort to sucking wet washcloths.

“With improved anesthetic techniques, we don’t do general anesthesia a lot anymore,” she said. “And even when they have to administer general anesthesia, they’ve improved the techniques, and the risk is very, very low.

“So we turned the question around and asked: Is there any benefit to restricting oral food and fluid during labor? And we found no benefit and no harm.”"

http://www.nytimes.com/2010/01/26/health/26child.html

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I'm married to an anesthesiologist and the no-foods rule is not a joke. It can be extremely dangerous to perform surgery on someone with a full-stomach (and that's defined as having anything other than water for the last 8 hours). Pregnant women are especially prone to vomiting, and the risk of aspiration (vomit entering the lungs) is high and can be extremely dangerous, even fatal.

Tell your husband to look at the research on this. the risk of aspiration is the same regardless of whether or not the patient has eaten.

Yes, you're right. My husband trained at Johns Hopkins. I hear they are totally out-of-date at that fogey old institution. Why on earth would they recommend a medical precaution that a DCUM says is antiquated?

Snark aside, I'll do my best to defend the practice to the best of my non-medically-trained understanding. It's a question of risk-calculus. Often times a surgery will be delayed if a patient has eaten. However, if a patient has a full stomach requires emergency surgery, such as after a trauma, it is significantly more risky to delay surgery than to wait for the food to digest. Anesthesiologists must perform a different assessment of the airway and the method of induction for a full-stomach patient, and sometimes that may method be contraindicated by other characteristics of the patient. Pregnant patients are more likely to vomit and to aspirate than non-pregnant patients. When you weigh the risks, forgoing a plate of spaghetti while laboring is certainly less burdensome than the risk of developing a severe lung infection or death in the event you aspirate on the table, no?

[Anonymous]

Is anyone else getting the "+EBag, Emergency sickness containment pouch" advertisement on the side? Apparently, they sell take-along barf bags. Hilarious!

[Anonymous]

Anonymous wrote:Is anyone else getting the "+EBag, Emergency sickness containment pouch" advertisement on the side? Apparently, they sell take-along barf bags. Hilarious!

Yep! I saw that. Haha.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I'm married to an anesthesiologist and the no-foods rule is not a joke. It can be extremely dangerous to perform surgery on someone with a full-stomach (and that's defined as having anything other than water for the last 8 hours). Pregnant women are especially prone to vomiting, and the risk of aspiration (vomit entering the lungs) is high and can be extremely dangerous, even fatal.

Tell your husband to look at the research on this. the risk of aspiration is the same regardless of whether or not the patient has eaten.

Yes, you're right. My husband trained at Johns Hopkins. I hear they are totally out-of-date at that fogey old institution. Why on earth would they recommend a medical precaution that a DCUM says is antiquated?

Snark aside, I'll do my best to defend the practice to the best of my non-medically-trained understanding. It's a question of risk-calculus. Often times a surgery will be delayed if a patient has eaten. However, if a patient has a full stomach requires emergency surgery, such as after a trauma, it is significantly more risky to delay surgery than to wait for the food to digest. Anesthesiologists must perform a different assessment of the airway and the method of induction for a full-stomach patient, and sometimes that may method be contraindicated by other characteristics of the patient. Pregnant patients are more likely to vomit and to aspirate than non-pregnant patients. When you weigh the risks, forgoing a plate of spaghetti while laboring is certainly less burdensome than the risk of developing a severe lung infection or death in the event you aspirate on the table, no?

You ask these things sort of rhetorically, but I do think it's not quite that simple - first of all a lot of institutions train students based on protocols and standards of care. They aren't necessarily reviewing the research and updating recommendations as they go along. Go ahead, ask your husband if he has personally researched this issue and reviewed the latest evidence. Chances are he hasn't. I would never accept the doctors opinion simply because that's what he learned in school and therefore "he knows best". Training in school - even at a great school - does not always equal knowledge of best practices.

The other issue is regarding why an institution would recommend something that is "out of date." Well, there are many reasons. Again, institutions are indeed "old fogeys" who often have a very delayed reaction to updated evidence. We have a huge problem in maternity care that much of it is not evidence-based. So many of our protocols are based on what protects the doctor and the hospital from a liability perspective -- ie, the most restrictive and most interventive protocols are seen as the highest level care, and therefore the safest for the OB, even if they may cause serious problems in the natural, normal, biological process of birthing.

The other huge issue, as a PP pointed out, is that it ultimately should be the woman's right to choose. This goes not only for this particular issue, but a host of other issues which may unfold during labor and delivery. Since birth is a normal biological event, it should be up to the woman to make decisions for when she is willing to intervene, as she is the only one who understands her deepest preferences. The OB should be a collaborator - not a dictator! - on this, making recommendations depending on the severity of the situation. Whenever it is possible, the OB should be laying out risks and benefits and allowing the woman a fair shot at deciding for herself. We can debate all day about what the recommendation ought to be, but at the end of the day when we are talking about risks in the millions - as in, "the risk of aspiration is 1 in one million" - then it is ludicrous to say that the doctor/hospital should be forcing any particular course of action on every laboring woman.

[Anonymous]

Doctors who don't follow the standards of care are opening themselves up to lawsuits. Being informed about risks vs benefits does not eliminate their risk of a lawsuit.

[Anonymous]

Most ACOG recommendations aren't based on scientific evidence. And there's scientific evidence to prove it. http://pushformidwives.org/2011/08/15/acog-study/

Not eating or drinking in labor is like trying to run a race without any food and drink. It's ridiculous to say that one will experience labor while prepping for the extremely rare chance that one will need GA for surgery. It's part of our cultural distortion of birth.

Try to imagine a life where you attended the birth of a sibling when you between the ages of 6-12 (old enough to really remember). And then as a teenager who had minor roles to play when relatives were in labor. You were present for more labors, seeing women supporting women in labor and joining in on that. So when it was your turn to experience labor you were comfortable with the idea of getting sweaty, swaying your hips around, moaning, resting your head on loved one's shoulders, working with the pain, knowing it wasn't harming you, it WAS you. If someone said to you "No eating or drinking that during labor" you would respond "What are you talking about? I'm having a baby here. Get real." So that's my scientific answer to someone who tells me not to eat or drink in labor - I'm having a baby here. Get real. LOL!

[Anonymous]

Anonymous wrote:Most ACOG recommendations aren't based on scientific evidence. And there's scientific evidence to prove it. http://pushformidwives.org/2011/08/15/acog-study/

Not eating or drinking in labor is like trying to run a race without any food and drink. It's ridiculous to say that one will experience labor while prepping for the extremely rare chance that one will need GA for surgery. It's part of our cultural distortion of birth.

Try to imagine a life where you attended the birth of a sibling when you between the ages of 6-12 (old enough to really remember). And then as a teenager who had minor roles to play when relatives were in labor. You were present for more labors, seeing women supporting women in labor and joining in on that. So when it was your turn to experience labor you were comfortable with the idea of getting sweaty, swaying your hips around, moaning, resting your head on loved one's shoulders, working with the pain, knowing it wasn't harming you, it WAS you. If someone said to you "No eating or drinking that during labor" you would respond "What are you talking about? I'm having a baby here. Get real." So that's my scientific answer to someone who tells me not to eat or drink in labor - I'm having a baby here. Get real. LOL!

That may be so, but they're still opening themselves up to lawsuits.

And, who has a meal in the middle of a race?

[Anonymous]

Anonymous wrote:And, who has a meal in the middle of a race?

Well, my first was a 36 hour labor... In early labor, I had a burger, fries, and a milkshake. Throughout labor, I had water, Gatorade, and chocolate (the only food that sounded good to me- included M&Ms, Kudos bars, a Snickers). When it came time to push, my midwife suggest some Coca Cola and more M&Ms. That, my friend, was my meal in the middle of the race and I can tell you from personal experience... it made all the difference.

[Anonymous]

And, who has a meal in the middle of a race

Seriously? Who tried to do a distance event without refueling? You might not sit down and dine, but people who are participating in endurance events *do* eat.

[Anonymous]

Anonymous wrote:Most ACOG recommendations aren't based on scientific evidence. And there's scientific evidence to prove it. http://pushformidwives.org/2011/08/15/acog-study/

Not eating or drinking in labor is like trying to run a race without any food and drink. It's ridiculous to say that one will experience labor while prepping for the extremely rare chance that one will need GA for surgery. It's part of our cultural distortion of birth.

Try to imagine a life where you attended the birth of a sibling when you between the ages of 6-12 (old enough to really remember). And then as a teenager who had minor roles to play when relatives were in labor. You were present for more labors, seeing women supporting women in labor and joining in on that. So when it was your turn to experience labor you were comfortable with the idea of getting sweaty, swaying your hips around, moaning, resting your head on loved one's shoulders, working with the pain, knowing it wasn't harming you, it WAS you. If someone said to you "No eating or drinking that during labor" you would respond "What are you talking about? I'm having a baby here. Get real." So that's my scientific answer to someone who tells me not to eat or drink in labor - I'm having a baby here. Get real. LOL!

I can totally see why women don't like being told what they're allowed to drink, but the fact remains that if you get to the hospital early enough to still be hungry or want to eat, you should probably go home anyway. I ate lots during labor, but once I was in full-on sway-moan-rest my head mode, I was past that point. **That said, once I got the epidural at the hospital, I really wanted a smoothie, and despite the only-clear-liquids rule the OB and nurses said nothing about my husband holding the straw up to my lips between pushes. I have a feeling some of these rules are on their way to being relaxed right off the books in the more progressive hospitals.

[Anonymous]

Anonymous wrote:Doctors who don't follow the standards of care are opening themselves up to lawsuits. Being informed about risks vs benefits does not eliminate their risk of a lawsuit.

And so the big question is -- why do we put up with sub-standard or potentially harmful care just to accommodate an OBs fear of a possible law suit? Ladies, these are OUR bodies and OUR babies. You have the right to informed consent - AND to informed refusal. I challenge all of you to simply say "thank you nurse/doctor for the information. You may write in my chart that I have declined. Thank you." and take a big bite of your snickers/pineapple/pasta/whatever you want.

[Anonymous]

Anonymous wrote:Any idea what the MCA midwives do?

They advise only clear liquids, but also won't wag their fingers at you. Angel was very sympathetic when the red jello my husband snuck me came up in between pushes.