Nurse (smiling): "You can't eat that."
Laboring mother (smiling): "It's a cracker."
Nurse (not smiling): "You don't want to hurt your baby."
Laboring mother (smiling even bigger): "A cracker can hurt my baby?"
Nurse (actually frowning): "Well, you can't eat that."
Ok then. What's a laboring mother to do? She's hungry, been in labor for hours, now at the hospital and she wants a cracker (or an apple, a burger, a piece of toast, a candy bar, you name it - she's still pregnant, remember?).
But if her hospital is like thousands of other hospitals in America she has an extremely restricted diet while in active labor (in some hospitals, any labor at all). She can have artificial flavor, food coloring, artificial sweeteners, sugar, salt, some fruit juices, gelatin (and we all know where that comes from, boiled hooves are ok I guess), water and ice. She can have it in the form of popsicles, juice (may actually be sugar water), diet soda, Jell-o or broth. YUM!! (Actually popsicles can be tasty in labor, but maybe something else sounds good after, say, 36 hours of "orange or grape?"). Did you notice the complete lack of protein in this diet? Or any other nutrients at all? What each item on this menu has in common is that you can see through it. (Actually, you can't. But hospital officials will say that if you boiled it down or melted it, you could see through it. Are you following all this? No protein and you can see through it. I guess we could add snow to the list.)
Would you feed this to your baby? Or how about if you were running a marathon, would this sustain you? I've had a few marathoners in my birth class or as doula clients. Do you know what they say? Birth is WAY harder than running a marathon. And marathoners eat whatever they want, including a lot of protein, simple and complex carbs, etc. They have to in order to race well and not just lay down and die out there.
So what is going on? Long long ago a doctor decided that because women in labor were at risk of a cesarean, which under rare conditions might be performed under general anesthesia, they should be treated as surgical patients. Each and every one. Even though the vast majority would not be having surgery (especially back then - today 1/3 of women will be having surgery, but we'll come back to that).
What will happen if that poor hungry mom I quoted above actually has to have a cesarean? Not that unlikely since maternal exhaustion leads to fetal exhaustion, a common cause of cesarean (and I don't know about you, but I get tired when I'm running mile after mile on an empty stomach, especially when someone is jogging right along with me telling me "You can't eat that!"). So mom has to have surgery. 95% of cases will NOT require general. She has a 5% chance of general.
If she's in the 5%, her anesthesiologist will intubate her (putting a tube down her throat to keep her airway open) JUST IN CASE. In case of what, you ask? The very thing that this doctor long long ago was so afraid of - that she would vomit, while out, and breathe the vomit into her lungs, possibly dying. Death by cracker. They didn't have intubation back then. BUT WE DO NOW. ( I just had surgery (knee) under general, I starved for more than 12 hours before, and guess what they did anyway, that's right - intubate me).
There is a huge problem with the logic that starving a mom in active labor will keep her safe from aspiration anyway (that's the complication). I was in active labor all of 3 hours with my first baby. No way was the pizza I had for dinner was out of my stomach by the time I went to the hospital. General? I would have needed intubated anyway. And no anesthesiologist on the planet is going to risk taking a mother's word for it that she hasn't eaten in 12 hours. ( I wouldn't - I see moms lie about eating all the time). So they just intubate everyone who gets general to be safe (and remember it's only 5% of the 30% who even get general).
So why still no food for mom? I don't have a clue. It makes no sense. It's like a triple, double, super, extra fail-safe. Except that it's not a "safe" at all because starving mom has risks.
Now I'm going to get serious. Very serious. Have you ever spent time with a laboring mother who is being starved? They are cranky. The don't like being out of control. Sometimes they are downright angry. Their blood sugar is a mess. They vomit more. They cry and scream more. They need way more pain management (either natural measures or drugs). Their babies are exposed to more drugs, to more stress, to longer labors. Mothers and babies get depressed. They are more likely to have that surgery, just from starving. They suffer. I am not a fan of suffering, just to give birth to your baby. Suffering is really obnoxious when there is a perfectly good cracker sitting right there, and there is NO GOOD REASON WHATSOEVER why she can't eat it. (You might think all of the unpleasantness above is just what labor looks like - I have seen women eat, and women starve - the starving suffer far more, both physically and psychologically).
So, if you are a mom about to have a baby, or someone who is helping a woman do that hard work, what can you do?
- Don't have your baby in a hospital. Birth centers and homebirths have no restrictions whatsoever on what you eat. They have a much lower cesarean rate and among their cesarean transfers, there is no higher risk of aspiration (obviously women who've been eating through labor).
- Tell your doctors or nurses you are going to eat whatever you darn well want, and show them the evidence to support your choice. A doctor or hospital's policy is not the LAW ladies. If the doctor or nurse tries to pass the buck to the anesthesiologist, ask to speak to her and show her the evidence. Ask for proof to back their refusal to let you eat. And if you are not convinced, eat.
- Eat whatever you want whenever no one's looking.
- Or starve yourself and hope for the best.
The mom I quoted above did #3. She ate that cracker as soon as the nurse left, and several more. She also ate a couple bananas later on and some homemade cookies, with peanut butter, oats and nuts. She had a long labor, first time mom, and she had been vomiting in early labor. But she stopped as she found her groove, ate something she wanted, and she went on to have a completely natural labor, all on her own power. Her baby was great throughout the whole labor.
I encourage you to read the evidence and decide for yourself. Take responsibility for your birth, your baby and your body.
Blog post comparing your risk of aspiration to dying in a plane crash or from complications from an elective cesarean. (Eating can prevent cesareans). 8X more like to die in plane crash, 900 X more likely to die from a cesarean, than from aspiration from general anesthesia during a cesarean.
Favorite labor foods:
- whole grain cookies
- nut butter
- apples
- grapes
- pears
- yogurt
- smoothies - yogurt, banana, nut butter
- real fruit juice
- turkey
- bananas
- Luna bars
- cheese
- crackers (with or without a frowning nurse)
- and yes, popsicles. I like orange best.
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