Reply to Why just clear liquids during labor

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[quote=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

[quote=Anonymous][quote=Anonymous][quote=Anonymous]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.  [/quote]

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.[/quote]

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  I hear they are totally out-of-date at that fogey old institution.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?  [/quote][/quote]

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