Eating during labor

[chaucer]

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Anybody else see this?

http://well.blogs.nytimes.com/2010/01/25/going-into-labor-its-okay-to-snack/

Some of the comments are ridiculous. I enjoyed "That’s the nice thing about homebirth, the anesthesiologists aren’t the ones in charge of the labor."

 

[proman]

I think it's awesome that Craig Palmer, who was the anesthesiologist quoted in the story, is posting comments too.

 

[nap$ter]

i shouldn'ta eaten before i read some of those comments, cuz i vomited in my mouth a little bit... and aspirated chunks.

 

[Planktonmd]

I think a good juicy burger is worth the risk of aspiration pneumonia.

 

[seinfeld]

I tend to allow for clear liquids with epidural in place, unless they are obese or look like a difficult airway. Full diet i dont agree with. From a biological perspective i cant see wanting to eat being a big part of active labor.

 

[urge]

As long as they take full responsibility for aspirating their cheetos...

On a practical note, those ones that want to eat all the way thru are probably 350lbs, high risk for regional failure, high risk for aspiration, and high risk for difficult airway.

What the heck, the world is overpopulated. Eat away!

 

[Noyac]

We allow liquids during labor.

I like the comment by the woman who claims to be hypoglycemic. I have never met a man that claimed to be hypoglycemic. Just like I've never seen fibromyalgia in a man. THis lady probably weights a ton but I could be wrong.

Hypoglycemic Give me a f*cking break.

 

[Bertelman]

i shouldn'ta eaten before i read some of those comments, cuz i vomited in my mouth a little bit... and aspirated chunks.

👍

 

[Stitch]

This article and its comments are symptomatic of the problem with American culture and its attitude towards health care in general. Care is so good here that complications are generally rare, so patients have come to believe that they never happen while those of us who see those complications are accused of being 'too old fashioned.' Notice the resentment towards medical providers and hospitals in those comments. Moreover, Americans have been conditioned by politicians and lawyers to believe that when complications do happen, they are the fault of the medical provider. 😡

Add to this administrators who feel that making the patient 'happy' is more important than keeping a patient safe and you've a recipe for disaster. Personally I feel that people (women/infants) will need to start dying again before anyone will appreciate what we give to patients as standard of care. So have your home births and eat all you want. It's fine with me if they do, but please don't come to the hospital and expect me to fix it. I'd rather not have my name on the chart.

 

[2ndyear]

I will allow them to eat during labor when the OB's quit doing 'emergency' C-sections based on tiny dips in FHR late in labor, 'variables', not enough variability, fetal tachycardia, maternal fever, prolonged induction, maternal intolerance of labor, all breech, all multiple gestations (these are not only real, but just from this week for me!). Until then the IV provides hydration and humans can go 2 weeks without food.

Problem with OB is you can't put everything in little boxes. Sure, some healthy low risk patients have a low risk of c section. But then why do we have a 30% c section rate in the US? Find me a subgroup with a 98% rate of vaginal birth and they can eat if everything is going well. I can already tell you who it is, the multip who is not being induced, not augmented, and not VBACing. Maybe a compromise could be Pit=No food.

 

[hoyden]

I will allow them to eat during labor when the OB's quit doing 'emergency' C-sections based on tiny dips in FHR late in labor, 'variables', not enough variability, fetal tachycardia, maternal fever, prolonged induction, maternal intolerance of labor, all breech, all multiple gestations (these are not only real, but just from this week for me!). Until then the IV provides hydration and humans can go 2 weeks without food.

Problem with OB is you can't put everything in little boxes. Sure, some healthy low risk patients have a low risk of c section. But then why do we have a 30% c section rate in the US? Find me a subgroup with a 98% rate of vaginal birth and they can eat if everything is going well. I can already tell you who it is, the multip who is not being induced, not augmented, and not VBACing. Maybe a compromise could be Pit=No food.

Because the prevalence of obesity is approximately the same

 

[SleepIsGood]

We allow liquids during labor.

I like the comment by the woman who claims to be hypoglycemic. I have never met a man that claimed to be hypoglycemic. Just like I've never seen fibromyalgia in a man. THis lady probably weights a ton but I could be wrong.

Hypoglycemic Give me a f*cking break.

isnt that what D5W is for? Titrate then with insulin if needed.

 

[Licoricestick]

This article and its comments are symptomatic of the problem with American culture and its attitude towards health care in general. Care is so good here that complications are generally rare, so patients have come to believe that they never happen while those of us who see those complications are accused of being 'too old fashioned.' Notice the resentment towards medical providers and hospitals in those comments. Moreover, Americans have been conditioned by politicians and lawyers to believe that when complications do happen, they are the fault of the medical provider. 😡

Add to this administrators who feel that making the patient 'happy' is more important than keeping a patient safe and you've a recipe for disaster. Personally I feel that people (women/infants) will need to start dying again before anyone will appreciate what we give to patients as standard of care. So have your home births and eat all you want. It's fine with me if they do, but please don't come to the hospital and expect me to fix it. I'd rather not have my name on the chart.

This is not a problem limited to the US. I've been reflecting on the (never ending) home birth debate in Australia recently. I am sick of women complaining "why can't I have my baby the way I want to have it?" when they really don't want to hear the responses. They think none of it is going to happen to them, but if it does - it's someone else's responsibility.

Sadly, it appears to me that many of the changes to obstetric (and by extension obstetric anaesthetic) practice in the last couple of decades have been driven by women suing doctors over adverse outcomes. Defensive medicine is always going to be the outcome.

My other favourite is "Being pregnant isn't an illness". Whilst I agree that this is strictly true - it still has a mortality rate (8.4/100000 women giving birth in Aus), something that almost none of my currently getting pregnant friends have even stopped to think about because pregnancy is "natural" and natural things are all good. 😱

 

[smq123]

Maybe a compromise could be Pit=No food.

That's not a compromise.

I think a good compromise would be "I'll let you eat if you promise to sign a waiver first, that says that you won't sue the OB, the anesthesiologist, the nurse, the CNM, the pediatrician, the hospital janitor, NOBODY, if you have a bad outcome that results from your 'hypoglycemia' that prevents you from going 2-3 hours without a snack." 🙄

(Well, maybe not NOBODY - you can sue your doula if you want.)

My other favourite is "Being pregnant isn't an illness". Whilst I agree that this is strictly true - it still has a mortality rate (8.4/100000 women giving birth in Aus), something that almost none of my currently getting pregnant friends have even stopped to think about because pregnancy is "natural" and natural things are all good. 😱

Lay people don't get it. They just don't, because they don't see that many bad outcomes. Bad things happen in pregnancy, but they rarely see it or hear about it. They never hear about the full term IUFDs ("I was at home and I just rolled onto my side and the baby stopped moving! How could this happen?"), or the placental abruptions where the baby never stood a chance, or the triple tight nuchal cords and the baby comes out limp and blue. AFEs, post-partum hemorrhage, PEs....these are things that most expectant mothers who want to "experience their labor" 🙄 just aren't willing to admit exist.

After all, what do most family members ask about? "How much did the baby weigh, was it a boy or a girl, does it have all 10 fingers and toes?" How about, did it aspirate thick meconium? Did it breath spontaneously? Any problems getting the placenta out?

The problem is, most lay people aren't willing to acknowledge the reality that, yes, bad things happen in pregnancy. I don't know if it's fear or ignorance or what, but they just don't.

 

[Noyac]

(Well, maybe not NOBODY - you can sue your doula if you want.)

I'd take the CNM out of the "No Sue" clause as well. They are the ones preaching this crap. WE had a local midwife write an article about all this crap in the paper. One of the most ridiculous things she said was that a mother should deliver her baby in the same place that she conceived the baby. 😱 Does this mean if you have sex in the back of a car and get pregnant, you need to deliver there? How about in the bathroom of a bar? You get the point.

 

[Stitch]

I am sick of women complaining "why can't I have my baby the way I want to have it?" when they really don't want to hear the responses. They think none of it is going to happen to them, but if it does - it's someone else's responsibility.

Sadly, it appears to me that many of the changes to obstetric (and by extension obstetric anaesthetic) practice in the last couple of decades have been driven by women suing doctors over adverse outcomes. Defensive medicine is always going to be the outcome.

Interesting point, and you're right: defensive medicine will be the outcome (which trial lawyers insist doesn't exist). I'm coming at it from a pediatrics perspective, but the attitude affects all of us. While I don't deal with the actual delivery, I see more and more moms refusing GBS antibiotic prophylaxis because "I've never seen anyone get GBS." Doesn't matter I've seen plenty of devastating and permanent damage from GBS. Likewise they refuse vitamin K, then don't understand why we won't circ the kid.

When this happens, I print out a large, bolded paper from MS Word that says "I understand my baby could die by refusing _____ and accept all responsibility" and have them sign it. Don't know if it will ever hold up legally, but hopefully I won't have to find out.

One of my partners (and I moonlight in a community nursery as a hospitalist) had a home birth come in by EMS. Midwife had refused to call 911 despite the kid being blue and in distress. Kid comes in floppy and looking bad, has a bad outcome. Who gets sued? The pediatrician for 'ineffective and inappropriate resuscitation.' Oh, and I'm liable for 18 years just for being in the room of a delivery.

(Well, maybe not NOBODY - you can sue your doula if you want.)

I was talking to one of the (very good) midwives who delivers only at a hospital and only with an OB around. She says that she's been sued once successfully, and it's becoming more common for midwives to get it. The 'supervising' OB also gets the suit, but apparently the lawyers have caught on to the fact that there's fresh meat. She's considering quitting because of the risk.

 

[nap$ter]

isnt that what D5W is for? Titrate then with insulin if needed.

ummm, no. that's not what d5w is for. hope you weren't serious.

the point was, that hypoglycemia doesn't exist outside of insulinoma patients or diabetics on meds (or liver failure dude/ettes).

if a patient comes in complaining of hypoglycemic episodes, it usually means they're crazy and get hungry sometimes. usually the overweight chronic-pelvic-pain-fibromyalgia ladies who somehow manage to paint on more make-up than tammy faye, yet have shoulder pain and such marked chronic fatigue syndrome that they can't lift a finger to get off disability to support their 6 kids, yet nearly jump out of bed like a gazelle screaming bloody murder when you stick a 22g into that last tiny little wormy vein on their volar wrist...

 

[rmbsstock]

I have never heard of a mama animal wanting to eat and drink while going through labor!! Although, I did not grow on a farm and I could be wrong. What I know is that who the he-- has an appetite after they break your water, (or it breaks naturally), and you're having constant pain, and you're being checked every once in a while, I feel its disgusting.
I can understand feeling thirsty, but I think ice chips are fine and very helpful, but eating...why not drinking wine and some whisky too that's my favorite, unfortunately, I didn't think about it when I was giving birth

 

[nap$ter]

I have never heard of a mama animal wanting to eat and drink while going through labor!! Although, I did not grow on a farm and I could be wrong. What I know is that who the he-- has an appetite after they break your water, (or it breaks naturally), and you're having constant pain, and you're being checked every once in a while, I feel its disgusting.
I can understand feeling thirsty, but I think ice chips are fine and very helpful, but eating...why not drinking wine and some whisky too that's my favorite, unfortunately, I didn't think about it when I was giving birth

 

[rmbsstock]

slavin, Whisky= Anesthesia (Numbs the emotional+ physical pain.
Drinking during delivery= Sarcasm 😀
I have a joke for you,
- If they get a donkey two buckets one filled with water and one filled with whisky, which one will he drink from?!
- The water bucket
:
:
:
BECAUSE he is a DONKEY

(I hope I don't get killed on this forum)

 

[Licoricestick]

I'm coming at it from a pediatrics perspective, but the attitude affects all of us. While I don't deal with the actual delivery, I see more and more moms refusing GBS antibiotic prophylaxis because "I've never seen anyone get GBS." Doesn't matter I've seen plenty of devastating and permanent damage from GBS. Likewise they refuse vitamin K, then don't understand why we won't circ the kid.

Perhaps they should talk to Mrs Linnell. Thankfully I wasn't involved in the case, but as I had previously lived in the town as a med student...it did hit rather close to home in many ways.

 

[Licoricestick]

ummm, no. that's not what d5w is for.

Sure it is - really good for convincing supposedly hypoglycaemic patients that they can't possibly be - "you're getting sugar through the drip"😛...although I prefer Hartmann's myself.

 

[2win]

slavin, Whisky= Anesthesia (Numbs the emotional+ physical pain.
Drinking during delivery= Sarcasm 😀
I have a joke for you,
- If they get a donkey two buckets one filled with water and one filled with whisky, which one will he drink from?!
- The water bucket
:
:
:
BECAUSE he is a DONKEY

(I hope I don't get killed on this forum)

👍👍👍

 

[nap$ter]

👍👍👍

looks like someone's avatar is disrobing - niiicccee...

 

[fab4fan]

This article and its comments are symptomatic of the problem with American culture and its attitude towards health care in general. Care is so good here that complications are generally rare, so patients have come to believe that they never happen while those of us who see those complications are accused of being 'too old fashioned.' Notice the resentment towards medical providers and hospitals in those comments. Moreover, Americans have been conditioned by politicians and lawyers to believe that when complications do happen, they are the fault of the medical provider. 😡

Add to this administrators who feel that making the patient 'happy' is more important than keeping a patient safe and you've a recipe for disaster. Personally I feel that people (women/infants) will need to start dying again before anyone will appreciate what we give to patients as standard of care. So have your home births and eat all you want. It's fine with me if they do, but please don't come to the hospital and expect me to fix it. I'd rather not have my name on the chart.

When I used to work in pre-op, I frequently came across people who felt that the NPO requirements didn't apply to them. I remember one morbidly obese man who had decided to have two bagels w/ cream cheese, bacon and coffee. He was scheduled to go to surgery in 2 hours. When I asked him why he'd eaten even though he'd been instructed the night before not to eat after MN, he said, "Well, I figured you had drugs to take care of that, and I was hungry."

While this isn't specifically related to OB, it does speak to the increasing disregard patients have for their physicians. I've been around long enough to remember when patients generally used to follow directions, not defy them.