Tuesday, August 25, 2009

Sweet of them

ACOG, my very favorite organization, has released a new policy statement on "oral intake during labor" (committee opinion #441). You'll be very happy to know that women will now be allowed to drink clear fluids while laboring.


Amazingly, this is actually a relaxation of the previous ACOG guidelines, which restricted women to ice chips only.

How did we so completely lose the concept of a woman's bodily autonomy?

Thanks to Dr. Fischbein for bringing this to my attention. He has a good article in response, a portion of which I'll quote here:
Policies restricting food and liquid intake 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.

"The women I care for eat when they are hungry and drink when they are thirsty, all without asking for ACOG's permission first," said Elizabeth Allemann, MD. "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about what the evidence actually shows, and it's time that the medical profession abandoned policies based on the outdated and paternalistic idea that patients should play no role whatsoever in the decision-making process."


Becks said...

Ug. I remember when they were inducing me (the 1st time), and I had eaten dinner about 2 hours before. I have diabetes, and am prone to major blood sugar swings. My blood sugar totally crashed - I felt horrible. I was shaking and crying (low blood sugar makes me emotional an paranoid), and they wouldn't even give me a piece of hard candy or a box of juice so I could come down a little more easily. AND (!) the induction failed. And so did the second one. GAR.

On the other hand, between the inductions my doctor let me eat, and I had some applesauce. Which I totally threw up into my oxygen mask during my emergency c-section. Lovely! (TMI?) So I get why they may not want women to eat.

I'm thankful that hospitals exist, and I really did receive excellent care, but it was really frustrating that they were SO adamant about following the no-liquids, no-food rule that I had to suffer a extremely uncomfortable blood sugar crash, and I wasn't even allowed to have a sip of juice, a glucose tablet, a piece of hard candy, NOTHING.

Ok, on the OTHER other hand, no all laboring women act rationally, or know what is best for them. Around the time I was begging for a piece of candy or a sip of juice, I was also threatening to rip out my IV and try to escape. Because a 36 week pregnant woman with advanced preeclampsia is going to get reeaally far ;)

Trace said...

This is very interesting. And great news, hopefully hospitals will follow suit and change policies! Key information being "Modern anesthetic techniques have virtually eliminated this risk."

Ma Torg said...

Reading about stuff like this always makes me thankful for my homebirths.

Jennifer said...

Makes me an even bigger fan of homebirthing. Thanks for your blog- I really enjoy it! :)

(Jennifer in Iowa)

Faith Alterton said...

Hi Emily, well ... from the short rotation in Labor and Delivery in nursing school, I'd say the no food/drink is probably unnecessary for most people. But, like Becks wrote, if you DO happen to vomit while sedated or in a C-section it's pretty easy to inhale nastiness and can end up with a lot of complications and pneumonia afterwards.

That being said, I usually eat a good meal before going in for a delivery and am not above snacking on the sly even in L & D. :) Though not all hospitals have policies forbidding food during labor. Our last delivery was a sixteen hour induction and they ordered in all the meals for me so long as we weren't in transition.