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[quote=Anonymous][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]

Y[b]es, 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  I hear they are totally out-of-date at that fogey old institution.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?[/b]

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]

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 [i]personally[/i] 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.[/quote]

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