The Big Push For Midwives: ACOG Wants to Keep Women Hungry in Labor
Tuesday, August 25, 2009 at 12:48PM
I hate copying and pasting entire press releases, boilerplate and all, but this one is full of great quotes and writing a new post wouldn’t do it justice. It’s from The Big Push for Midwives, so please go there, click around and read liberally.
I had to scroll up to the top to make sure that The Big Push didn’t link to the satirical newspaper, The Onion, instead of the ACOG web site when I read this:
“Allowing laboring women more than a plastic cup of ice is going to be welcome news for many,” Dr. Barth said. “As for the continued restriction on food, the reality is that eating is the last thing most women are going to want to do since nausea and vomiting during labor is quite common.”
Dr. Barth needs to define “many.” I’m also waiting for Reality Rounds to come around and call a “Code Bullshit” on Barth’s paternalistic embarrassment of a statement that “the reality is that eating is the last thing most women are going to want to do [in labor].” How would he ever arrive at that conclusion if he’s never allowed women to eat in labor in the first place?
Dr. Barth’s hospital, Massachusetts General in Boston, sections 32.7 percent of its patients.
Here is the press release:
Physician Group Pulls the Plug on Women’s Autonomy
Issues Policy Statement About What Women in Labor Will be “Allowed” to Eat and Drink
WASHINGTON, D.C. (August 25, 2009)—Displaying a stunning lack of regard for patient autonomy, the American College of Obstetricians and Gynecologists (ACOG) issued a statement this week declaring that the group will “allow” laboring women to drink “modest amounts” of clear fluids during labor while continuing to prohibit access to solid food.
“Once again ACOG has issued a position statement with little regard for the evidence or for the ability of women to make decisions for themselves,” said Susan Jenkins, Legal Counsel for The Big Push for Midwives Campaign. “It’s insulting that ACOG actually believes that laboring women should be grateful that they will now be ‘allowed’ to have more than just ice chips, when we have long known how vital nutritional sustenance is to mothers and babies not only during pregnancy, but during labor as well.”
Hospitals routinely adopt ACOG position statements as standard policy governing the treatment of pregnant and laboring women, despite the fact that a number of the organization’s position statements do not acknowledge all of the risks and benefits associated with common procedures.
“ACOG is asking laboring women to do the physical equivalent of a marathon on the power of a ‘modest’ amount of clear liquid,” said Sabrina McIntyre, mother of two. “Thanks but no thanks. I’ll stick with my midwife and her wisdom of keeping up my physical stamina for such a monumental event.”
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 in my birth center 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.”
The Big Push for Midwives Campaign represents thousands of grassroots advocates in the United States who support expanding access to Certified Professional Midwives and out-of-hospital maternity care. The mission of The Big Push includes educating national policymakers about the reduced costs and improved outcomes associated with out-of-hospital birth and advocating for including the services of Certified Professional Midwives in health care reform.
Related post:
Eating During Childbirth? Yes, You CAN, Says BMJ!
View Printer Friendly Version
Email Article to Friend
Reader Comments (24)
With my first I only got ice chips and was absolutely ravenous by the time I had her (and was only in the hospital for 4 hours before having her). With the 2nd I went with a midwife at a hospital alternative birthing center. I went to my scheduled appointment with 7-10 min apart contractions, she checked me and said I was at 7cm and so "go have lunch and meet me at the hospital". I had a BBQ beef sandwich, went to the hospital, and had him 2 hours later. No nausea at all. Screw Dr. Barth.
No one should tell me if I'm hungry or not!
It was 43 hours from my water breaking to my cesarean. I was at the hospital for 31 of those hours Can you imagine being told not to eat for 31 hours, let alone when your body is working so hard? I'm glad I packed snacks. I have no idea if it was ok with that hospital or not, I just was discreet. I was still starving after my cesarean, I can't imagine if I hadn't eaten at all.
I am due in 12 weeks and my current OB encourages his patients to eat during labor. Thank goodness.
ACOG can tell me not to eat when each one of them has gone for 31 hours without eating while exercising (and there better be an equivalent to four hours of pushing in there!). Then they can state whether or not women in labor would truly want food. Sheesh. The paternalism in their statements definitely irks me.
I just can't imagine giving birth in a hospital. ACOG should stand for Anti-Commonsense Organization of Guys. (sorry folks, thats all the better I could do) When I had the Birdie at home I ate and drank when and what I wanted and then promptly threw it all up. I don't know what I would have done without my toast and chamomille tea.
“As for the continued restriction on food, the reality is that eating is the last thing most women are going to want to do since nausea and vomiting during labor is quite common.”
Are you kidding me?!!
I had a hospital birth with a midwife, with both of my children. I was allowed to eat and drink all I wanted both times (she especially pushed drinking on me to keep me hydrated). I had no traces of nausea or vomiting at all. I believe it's because I had food in my stomach and energy to keep me going.
And how the heck would Dr. Barth know anyways? Since when has he actually, physically, experienced labor? Oh, that's right, he probably gets his statistics from books and 1960's research. *Rolling eyes*
Oh gee, thanks for ALLOWING me to drink some water and Sprite while I'm trying to push a human out of my body, Omnipotent And All-Benevolent OBGYN Gods Who Have Likely Never Birthed Vaginally, Or Even Have a Vagina.
Subversive subs (make mine a footlong!) all the way. Lovin' that graphic.
OK, here you go "Code Bullshit!" Sorry it took me so long, but I have been in virtually blog fights with virtual doctors over the Michael Jackson case. (yes, that's what I said). This somehow pertains to your topic, strangely enough. Some doctor bloggers are insisting that crazy ass , looney tunes, whack-a-doodle, medical treatments administered by a physician, like the one's MJ had in his home, should NOT be allowed to be tried in a criminal court. Like doctors who are bat shit negligent should be held at a different standard than the unwashed masses. I have been spewing "Code Bullshit" all over the web today. I actually came over to your blog for some soothing happy birth info. Thanks a lot.
*For the record, I a nurse, sneaked food into my room while I was in labor. Bad girl.
For the record, I had a large meal right before my water broke and my first labor started. Yes, I threw it all up within a few hours. No, I did not want to eat or drink anything at all while I was in labor. Yes, the midwife made me drink apple juice. Yes, it all came up every time within a contraction or two. I was in labor a grand total of 8 hours plus 40 minutes of pushing, and when I was about halfway done with pushing, I felt a little weak and asked for apple juice. Yes, it stayed down. Yes, it restored my blood sugar and gave me the extra *oomph* I needed.
My second labor was basically 24 hours of contractions every 7-15 minutes, with no regular pattern, so I didn't know if I was in labor "for real" or not. I ate if I was hungry and drank when I was thirsty. No, I did not throw up at all.
Maybe -- just maybe -- if you are ALLOWED to eat, but not forced nor forbidden to eat, you might eat if you're hungry without throwing up?? But let's check with the doctor first -- after all, he's bound to know more than our own stomachs. {rolls eyes}
I ate light snacks like yogurt during my first labor most of the way through and a bit less in my second, once it really kicked into gear. You're right--how would they even know if women are hungry or not if they've never even allowed them to eat??? If you're hungry, eat. If you're thirsty, drink. And if you puke it up at some point, big deal. (I was never nauseated during my labors and never puked, by the way).
I actually do see most women not wanting to eat in hard active labor, but I try to keep them drinking if possible (not forcing, of course, but frequently women far into labor land forget if you don't point it out every so often!) I have seen some women really ravenous in labor, though - including one 17 yr old woman who ate a whole turkey sandwich, a package of graham crackers and a bag of chips and drank a soda at 8 cms, and then became shakey and started grunting with contractions and when she finally gasped out a sentence, I was totally expecting "I need to push" but instead she said "Is there ... grunt ... anything else .... grunt ... to eat?!" She had the baby before I had the chance to find her anything else, though. My last labor client didn't want nearly so much. She was really wanting some Skittles for some reason half way through labor - but when her partner found her some, she managed only to eat one of each color before she decided she just didn't want any more!
I once read a comment about how the liklihood that you would need an urgent cesarean, and need general anesthesia, and vomit during induction of anesthesia before your airway was protected, and aspirate being about as common as getting in a car accident on the way to the hospital in labor.
I'm a fan of just letting my clients call the shots - eat if your hungry, drink when your thirsty. I have seen folks in late labor who are exhausted and it seems that labor has stalled really pick up again if they are able to eat and drink a little bit. I myself didn't have a lot of interest in food in labor, although I remember having several raspberry sorbets while laboring with #3 in an in-hospital birth center. The cold and slightly sweet was really appealing for some reason.
Oh what a load of patronizing, condescending CRAP. "Well, women don't want to eat during labor anyway so we're going to continue to FORBID IT."
One of the WORST things about my hospital labor prior to C-section was not being allowed even a sip of water. Yup, I got the standard cup of ice chips. I was SO thirsty. I labored for 46 HOURS. I did not even care about meeting my baby, I just wanted to get him out so I could have SOMETHING TO DRINK. It was pure torture and I am enraged for any woman who has to go through that. (and then when I was in recovery and they handed me a big mug of water, the nurse actually had the balls to chastise me for DRINKING TOO FAST. Fuck you, lady!)
No, I was not hungry during the heavy labor part of my homebirth, I made sure to eat in early labor so I would have energy later when I didn't feel like eating. But I did drink. Water, water, water, and juice, and more water, and maybe even some RRL tea in there, I don't remember. I am a constant water drinker, I have a 40-oz. KK bottle that I refill about five times a day - why would I be any different in labor? Hell, I was probably even MORE thirsty than usual! Yes, I threw up once, but so what? Because we might throw up, we can't eat? What the hell does that even MEAN?!
I wonder if ACOG will ever realize that they are the ones driving women away from hospitals with their nonsense. Code Bullshit, indeed.
With my HBAC I ate when I was hungry and chugged water like crazy between contractions at the end....and I kept it all down. I lost count of what reason number this was why I can't ever picture myself laboring/birthing in the hospital. I just love phrases like "allow".
Margaret said: "Can you imagine being told not to eat for 31 hours, let alone when your body is working so hard?"
No. I think it's one of the dumbest things I've ever heard. I am almost positive that anyone who says this to a laboring woman is thinking only of their own fears of being sued, which is obviously a nasty and inhumane way to make decisions about a patient's welfare.
Reality Rounds said: "I actually came over to your blog for some soothing happy birth info."
Ha! You wanted happy and you came here. ;) The entire month of July was so grim that I want to spend the rest of 2009 writing about unicorns.
Kathy said: "Maybe -- just maybe -- if you are ALLOWED to eat, but not forced nor forbidden to eat, you might eat if you're hungry without throwing up??"
doctorjen said: "I actually do see most women not wanting to eat in hard active labor, but I try to keep them drinking if possible (not forcing, of course, but frequently women far into labor land forget if you don't point it out every so often!) "
That makes sense to me... not forcing or forbidding food. Personally, I was grateful for my doula's reminder to eat which consisted of handing me a Luna bar while I was focused elsewhere.
Also, a clarification of "labor" would have been good in the original press release. I'd like to think that maybe he was thinking about that final hour of labor when you're sort of too busy to eat.
On Twitter, an Australian woman picked up on the press release and was asking some American friends on Twitter if it was true that hospitals won't allow women to eat food in labor. She was shocked.
"Effect of food intake during labour on obstetric outcome: randomised controlled trial
Geraldine O’Sullivan, consultant anaesthetist1, Bing Liu, research associate2, Darren Hart, agenda for change midwife3, Paul Seed, senior lecturer in medical statistics2, Andrew Shennan, professor of obstetrics2
1 Department of Anaesthesia, St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, 2 Maternal and Fetal Research Unit, King’s College London, London SE1 7EH, 3 Guy’s and St Thomas’ NHS Foundation Trust
Objective To investigate the effect of feeding during labour on obstetric and neonatal outcomes.
Design Prospective randomised controlled trial.
Setting Birth centre in London teaching hospital.
Participants 2426 nulliparous, non-diabetic women at term, with a singleton cephalic presenting fetus and in labour with a cervical dilatation of less than 6 cm.
Intervention Consumption of a light diet or water during labour.
Main outcome measures The primary outcome measure was spontaneous vaginal delivery rate. Other outcomes measured included duration of labour, need for augmentation of labour, instrumental and caesarean delivery rates, incidence of vomiting, and neonatal outcome.
Results The spontaneous vaginal delivery rate was the same in both groups (44%; relative risk 0.99, 95% confidence interval 0.90 to 1.08). No clinically important differences were found in the duration of labour (geometric mean: eating, 597 min v water, 612 min; ratio of geometric means 0.98, 95% confidence interval 0.93 to 1.03), the caesarean delivery rate (30% v 30%; relative risk 0.99, 0.87 to 1.12), or the incidence of vomiting (35% v 34%; relative risk 1.05, 0.9 to 1.2). Neonatal outcomes were also similar.
Conclusions Consumption of a light diet during labour did not influence obstetric or neonatal outcomes in participants, nor did it increase the incidence of vomiting.Women who are allowed to eat in labour have similar lengths of labour and operative delivery rates to those allowed water only."
I guess the consumption of ANY diet would have shown similar results. Why should they tell me whether I am hungry or not, or what I would like for dinner, in labour or not?
I ate a macoroni and cheese with beef and tomatoes casserole, some yogurt, and some cookies and cream ice cream while I was in labor I also drank several litres of water. I didn't feel nauseous or throw up until after my daughter was born. I only vomited once. I hardly thought of it as a big deal.
When I was writing my birth plan, I called the hospital to find out their policy on eating during labor. The nurse said, "Well, we don't *provide* food to women in labor..." (I don't think it's a question she gets very often.) I brought grapes, almonds, oatmeal cookies, and Clif bars, which I snacked lightly on throughout labor. I had a long, slow labor. My Bradley teacher had told me I would be ravenous after the birth, so after holding her grandbaby my mom went to get me a chicken sandwich from Wendy's - I ate it, but I wasn't terribly hungry. Though, come to think of it, it's probably good I did eat it, since it was 4 hours before I was settled in my recovery room and able to sleep.
*Disclaimer* -> There are many great OBs out there (mine is one), I am not talking about them. It's the run of the mill scared of labor OBs I'm referring to below...but I posted this to an email list and thought it would apply here as well:
I was thinking, maybe it's lack of skill? Apparently, a general surgeon in the ER has the skill to operate on people who've been in a wreck after eating a cheeseburger. Maybe when our OBs tell us we shouldn't have food in labor we should say, "Oh, are you telling me you don't have the skills to operate on me in an emergency situation?" Or something like that. If they know so much and are so vital and skillful, a little food in the tummy shouldn't inhibit them when any ER general surgeon can handle it.
That was my response to someone saying ACOG and OBs lacked commonsense...really to me if we all started making it a skill issue I wonder if they'd backpedal a bit?
FWIW, I labored at home for 47.5 hours. Good thing I was able to eat and drink huh. Baby would have likely been born with severely low blood sugar if not.
Everyone else said everything else, so I don't think it needs repeating.
Well how is this for crappy...While I was in labor with my son the nurse came in and told my husband and MIL that they could order food from the menu of they would like...Dads and labor support get 1 meal per day. Great! What can I order? Nothing. FU Lady...Hubby order 2 meals and I ate one of them unknowingly to the nurse. I also brought Belly Bars and recharge to drink. My labor started at 11pm on a Sunday and I got section on Tuesday at 6:30 PM.
My next will not be like that as I will not be gong anywhere near a hospital. My kitchen never closes.
Makes me think of the OB who told my doula client not to eat a cheeseburger on the way to the hospital, "It is the number one cause of deaths." Hmmmm, really?
http://enjoybirth.wordpress.com/2009/07/16/death-by-cheeseburger/
Apparantly ACOG is still behind the times.
I remember driving to the hospital with my first and I was starving. It was about dinnertime, so I hadn't eaten since lunch at least. I asked my husband to stop and get me something to eat, and he told me that once we got to the hospital they wouldn't let me have anything but ice chips. (This was my husband's third child, so he knew lots of things that I didn't know.) I answered that it was all the more reason to eat now! So he stopped at my favorite fast food place and I ate in the car. We've done that with all the other kids, except my homebirth.
I don't remember ever being hungry DURING labor, but I'm certain my husband would have made sure I got something to eat whether the nurses liked it or not. I have a vague recollection of him once giving me some food they brought for him, but I can't remember if that was during labor or not.
BTW, I throw up at least once a day (usually more) all nine months every single time I am pregnant, but I've NEVER thrown up once in five labors. Would the ACOG encourage me to fast for my entire pregnancy??
I labored at a birth center and I had some really awesome pizza and coffee early in labor. However, later I had zero interest in food and only wanted soda (which I was "allowed" to have). In fact, because my labor went on for so long, my midwife's assistant began forcing me to eat bits of food -- a spoonful of peanut butter and honey and grapes. I later trasnferred to the hospital after pushing for hours and I was still throwing up those damn grapes on the way to the OR. Egads, I wanted to take those grapes and chuck them at the assistant's head (the post-vomit version of them).
I'm all for allowing and encouraging women to eat, drink, and be merry during labor, but next time I think I'll listen to my body instead of the MW's assistant when it comes to food intake during the later stages of labor.
With my first labour I stayed home for a few hours, but wasn't hungry. I was in hospital for 21 hours before giving birth. At one point, pretty far in, I was eating some trail mix which the nurse promptly swept away from me, clucking about some policy. I had no idea they didn't allow it and was so shocked and stunned! At least they let me drink, I refused any IV fluids (they try to hook you up the minute you set foot in the maternity ward you know!)
After I had my son I ate like an entire large pizza and half a dozen muffins plus the hospital served breakfast and probably a few gallons of juices. Sooo hungry!!