Withholding food in the media!

Hospital policy of withholding food during childbirth coming under scrutiny

Published: Tuesday, August 10, 2010, 6:00 AM Updated: Tuesday, August 10, 2010, 7:45 AM
Angela Townsend, The Plain Dealer

CLEVELAND, Ohio -- The last thing on April Baer's mind while awaiting the birth of her first child was where her next meal was coming from.

A good thing, since she wouldn't have gotten anything to eat even if she had asked.

Like most women who deliver in a hospital, Baer -- who gave birth to baby Stella in early June -- didn't get a morsel of food to munch during her six-hour labor.
"It wasn't really an issue for me," says Baer, a former WCPN FM/90.3 reporter/producer who now works at Oregon Public Broadcasting in Portland.
"Frankly, I was so consumed by the experience -- and by the 'experience,' I mean pain -- I wasn't really thinking about food," she says.
But for some women, especially those who don't eat a substantial meal before heading to the hospital, that absence of food can be irritating.

Earlier this year, the Cochrane Library, a publication of the Cochrane Collaboration, which evaluates medical research, published an article from an international team of three researchers calling for physicians to revisit the long-held notion that food during labor is bad.
It's hard to find a hospital policy -- informal or written -- that doesn't restrict laboring women to clear liquids and ice chips, or the occasional Popsicle or Jell-O. The Cleveland Clinic, University Hospitals, MetroHealth Medical Center and their affiliates are in lock-step with hospitals across the country on this issue.
Women have the American Journal of Obstetrics and Gynecology to thank for those restrictions.

In 1946, the journal published a report by a physician who warned of the risk of a woman aspirating -- accidentally throwing up food or fluids from the stomach and breathing it into the lungs while unconscious -- while under general anesthesia during birth.

That condition -- a risk for anyone who is unconscious from anesthesia, while drunk or during a seizure -- is called aspiration pneumonitis, or Mendelson's Syndrome, named after the physician. The condition can be deadly.

Today, with the advent of spinal and epidural anesthesia, a woman who delivers by C-section almost never goes under general anesthesia unless it's an emergency with little time to administer a more local anesthesia.

"I don't remember the last time I saw general anesthesia in labor and delivery," says Dr. Marjorie Greenfield, an OB-GYN at University Hospitals MacDonald Women's Hospital. "It could have been a year ago. It's just really rare, unless there is a dire emergency [to get the baby out quickly]."
As rare as it is, the mere possibility of needing general anesthesia means taking every precaution, including withholding food.
Based on an analysis of five previously published studies involving 3,130 women who had given birth, the researchers concluded in the journal article published in January that "since the evidence shows no benefits or harms, there is no justification for the restriction of fluids and food in [labor] for women at low risk of complications."
As well regarded as the Cochrane Library is viewed by physicians, no one is quite ready to ditch decades-old practices just yet.
"The fear of aspiration, that's driven everything," Greenfield says. "For the thousand women, or 100,000 women that we don't feed, we're maybe preventing one case of aspiration."
Adds Dr. Edward Ferris, an OB-GYN who is director of the OB-GYN residency program at Summa Health System in Akron: "Labor is a dynamic process, and things can change at a moment's notice."

Even given some flaws in the data, many studies that say it's OK to give women food during labor look promising, Ferris says.
"But quite honestly, in the medical legal age we live in, a lot of people don't want to take that risk," he says. "Everything we do, we do with the best interest of the baby and mother in mind."

Although labor in a low-risk patient can seemingly go along fine, most OB-GYNs and anesthesiologists "prefer patients to have very little in their stomach," Ferris says.

But if a woman's labor is induced, and delivery seems to be far off, she may be allowed to eat a small meal, Ferris says.
"Most people don't want to eat in the middle of contractions," he says. "That's the furthest thing from their mind."
To help eliminate the chance of becoming dehydrated, women get liquid nutrients intravenously, with enough sugar to prevent hypoglycemia. Diabetics might also get an insulin drip to keep the blood sugar in normal range.
For early labor (which can last for a few hours or a few days, until the cervix dilates to 3 centimeters), it's OK to eat things that are digested quickly, such as carbohydrates and liquids.
But once a woman goes into active labor (as with early labor, the duration varies but is typically six to 12 hours, until the cervix dilates to 7 centimeters), food and liquids aren't digested as quickly.

Over the years, thanks in part to the anesthesiology community, the amount of liquids that physicians are comfortable giving women in active labor has increased. At UH, for example, a woman's birth plan can specify certain clear liquids. If her physician feels that she is in no danger, she'll get it.
' Physicians haven't budged, however, on the stance to forbid food.

In July, Lamaze International, based in Washington, D.C., issued a news release condemning the no-food policy.
"Women should be allowed to eat or drink while undertaking one of the body's most physically demanding tasks," stated Sharon Dalrymple, president of Lamaze International.

View full sizeTina Fineberg, APHospital officials say that most mothers are "laser-focused" on their baby and not thinking about eating in any case.

"Marathon runners keep themselves well hydrated by drinking fluids during their races and so should most laboring women," she said. "Every system in a woman's body is taxed during labor, and all that effort takes fuel. When women are deprived of food and drink, it's no surprise when those systems don't work as intended."

While the group does not have policies regarding specific protocols, members of the National Association of Certified Professional Midwives also support natural childbirth and generally encourage food and drink in labor, group president Mary Lawlor said in an e-mail.

After delivery, most new mothers are laser-focused on their new baby and little else. But not always.
"Sometimes the food demands come at a furious clip," Ferris says.
After natural deliveries, women often can eat right away. C-sections, however, require waiting several hours before eating because, as with any major surgery, one's intestinal functions must first recover from the effects of anesthesia.
"I've pretty much heard it all," says Ferris. "I've had patients demand McDonald's, pizza, a Pepsi. Sometimes they can't wait to have their first beer."