Friday, August 28, 2009

ACOG gradually getting with the evidence

ACOG released a new comittee opinion on oral intake during labor...you can check it out here. It's really nice to see that ACOG is gradually catching up with the evidence. They must be behind on their journal reading like I am :p

Midwives have long encouraged women to eat and drink to comfort during labor. However, hospitals and ob/gyns enforced a policy of no food and only ice chips. The concern being that if a woman had to have an emergency section, she could aspirate the contents of her stomach, causing aspiration pnuemonia, which is no joke.

ACOG now 'gives permission' for women to have 'moderate' amounts of clear fluids during labor. Wow. That's pretty frickin' generous of them! They are so kind and benevolent. :pppp

So I'd like to make a couple points...

1. When women are 'allowed' only water and ice chips, the contents of their stomachs become more acidic...so if they were to aspirate these contents, this would only increase the damage and severity (imagine pouring acid into your lungs).

2. Simple carbs are often beneficial to women in providing energy for labor.

3. The article states that N&V is quite common in women in labor so therefore women won't want to eat. In my experience, rarely do I see pukers! Now granted, many women in labor do not want to eat once they get pretty active. But that's not the point! The point is that women should have that choice.

4. The concern of aspiration is pertinent when general anesthesia is used. I can count on one hand how many time in 6 years I have seen general anesthesia used. It's not common. Bad for baby. So the risk of aspirating is minimal (can't quote a percentage here off the top of my head but have read research on this).

5 comments:

womantowomancbe said...

Yes, and even when general anesthesia is used, proper technique will eliminate any risk of aspiration. They operate on people all the time in emergency situations when they have no clue whether their stomachs are empty or not (or they know that they have recently eaten), and we don't see people dropping dead of aspiration from having a broken bone reset after a car wreck that happened just after eating at a restaurant!

Yes, aspiration is no joke -- a friend of a friend died from this, following a tonsillectomy -- a planned surgery. But I would assume she was not intubated (this happened probably 20+ years ago). She choked on her vomit, was declared brain dead, and taken off of life support a few days later. But as you said, the incidence of general anesthesia in childbirth is rare, so any complications from it would be a much smaller percentage of this already tiny percentage. Eating in labor is much ado about nothing! :-)

-Kathy

Sheridan said...

Ahhh, yes. I talk about this in my Death by Cheeseburger post.

http://enjoybirth.wordpress.com/2009/07/16/death-by-cheeseburger/

I actually figured out what the percentage would be... well rounding of course.

Joy said...

And this is why women in labor SNEAK FOOD when the nurse is out of the room. It's not like they have hidden cameras in delivery rooms (though that wouldn't surprise me). I have seen such evidence on Facebook while visitors are helping their laboring friend and taking picture of her eating after getting the epidural in place.

And this is why I plan to labor at home as long as possible and eat a protein bar or something if I feel I need nourishment. I vomited 5 times during the labor and delivery of my 2nd daughter because I hadn't eaten anything and needed energy and sustenance (so did my baby!). Had nothing to do with anything else.

Joy said...

P.S. My doctor is a member of ACOG so I'm printing off this article and stapling it to my birth plan because I specifically asked to not have an IV but to take fluids by mouth, which he originally refused. We shall see!

pinky said...

Most of the Docs I know let folks eat until they get really active. And like you said, a really active woman really does not want a steak and cheeze sub.