Thirsty During Labor? Just Be Quiet and Suck on a Wet Washcloth
Posted by realityrounds on January 26, 2010
The The New York Times picked up on the recent Cochrane review that concluded eating and drinking during labor is not harmful (or helpful, although satiating hunger seems helpful to me). Historically hospitals restricted food and fluids to laboring moms, due to the possible risk of being put under general anesthesia, and vomiting and aspirating during the surgery. This is such a rare risk that making all labor patients NPO (Nothing By Mouth) does not make sense. I won’t go over the debate (I personally believe it is A-OK to eat during labor. Heck, I snuck food into my own delivery, and ended up with a C-Section, and survived to blog about it!) because I do not want to beat a dead horse. What I found interesting in the NYT’s article were some of the quotes embedded in the article. They actually made me laugh, and I do not think this was a comedy piece. Here is what I thought was funny, in a not-so-funny kind of way:
- Dr. Tranmer, (a nursing professor…yeah!) who said she had seen all too many women in labor complaining of thirst and dry mouth resort to sucking wet washcloths. This just makes me sad. The thing is, I believe her! The image of laboring moms sucking on washcloths seems so pathetic and demeaning. Thankfully I have not witnessed this. I have furiously spooned ice chips into laboring women’s dry mouths, but never had them suck on a wet washcloth. Jeez!
- “My own view of this has always been that you could say one shouldn’t eat or drink anything before getting into a car on the same basis, because you could be in an automobile accident and you might require general anesthesia,” said Dr. Marcie Richardson, an obstetrician and gynecologist at Harvard Vanguard Medical Associates in Boston, who was not connected to the new study. I have never heard of this analogy, and I like it. I may use it at work! It’s funny because I have heard of (she who will not be named) some anti-home birth advocates saying things like delivering at home is like driving without a seat-belt, or some weird sh*t like that, so I like when the car analogies are U-turned (tee hee) around.
- “From an anesthesiologist’s perspective, they missed the boat on this one,” said Dr. Craig M. Palmer, chairman of the committee on obstetrical anesthesia for the American Society of Anesthesiologists. They looked at the impact on the progression of labor, but to be honest, that’s not an issue for anesthesiologists. Our primary concern is patient safety.” Oh Craig, you are my hero. I completely agree with you. The researchers did ignore you, and that was mean! We can never predict who may need an emergency C-Section. I have seen women walk in off the street who have eaten, gasp, and have needed a crash C-Section right on the spot. So I propose that ALL pregnant women with a viable gestation, become NPO until they deliver. This is the safest way. We can insert central or PICC lines at around 23 weeks gestation, and have home health nurses hang total parental nutrition once a day. At around 36 weeks, all pregnant women should have Foley catheters inserted, so we are not futzing around in the OR and wasting time, in case she needs that emergency C. Let’s see, is there anything else I’m forgetting? How about weekly abdominal shaves? Sounds about right.
The NYT article was an enjoyable read. Not so enjoyable was reading the comments. I should know better!
RR
HeatherDoula said
I still can’t believe American women are NPO in labour. Here in Canada, we are encouraged to eat and drink until we can’t anymore. There’s no need to sneak any food in a hospital – all the L&D wards have kitchens with food ONLY for the labouring women! And they’re well-stocked, too. Muffins, cheese, toast, squares, yogurt, fruit – anything one could reasonably want. I’m not sure of the statistics, but presumably our maternal death rate by asphyxiation while under general for a C/S is not significantly higher than yours? The ACOG sucks.
Kathy said
From a 2006 study on the paucity of studies on maternal eating and drinking during labor: “Only one study evaluated the *probable* risk of maternal aspiration mortality, which is approximately 7 in 10 million births.” I think I’ll take my chances, Dr. Palmer.
Jill--Unnecesarean said
That’s hilarious. I laughed when I saw the car analogy “turned around,” too.
“Fasting in Labor: Relic or Requirement” (pdf) – http://bit.ly/5K3sKO <— another good one.
realityrounds said
Hi ya Jill,
Couldn’t open your link, but the title sounds great! It reminds me of the patients we see who come in on Ramadan who feel weak and go into preterm labor from fasting. Maybe I will blog about it one day. Remind me, ok?
Kathy said
Link worked for me — took a little while to download, though.
Re: Ramadan — I thought that pregnant women were exempted from fasting? Maybe different Muslim sects have different laws on that…
Diana J. said
Loved this article!! Such great points! Thanks!
Rebecca said
With my doula clients, I give them a niiiice big cup of ice chips and then watch it melt and refill it infrequently.
I once pointed out, to a nurse, the reality that ice chips become, you know, water, in the cup or in your stomach. She said “Oh yes, but our little secret is that you don’t eat the ice chips as quickly as you’ll drink the water!” So what’s the safe threshold of liquid (or convertible-into-liquid) to consume during labor? Does it exist? Because if there’s actually an evidence-based, measurable amount that’s out there (…har) at least you could give women the choice between ice chips and a predetermined limited amount of fluids.
I once watched a patient (who was also a nurse!) sneak a Snickers bar during an induction, because they were delayed in getting it going and she’d been NPO since she arrived. She’d hide it under the covers when any of the medical personnel came in. I, of course, kept my mouth shut, but I wanted to cheer.
realityrounds said
Nurses are so darn sneaky! I chose a much healthier option to sneak in my delivery room: bananas and power bars, yum!
Melissa said
We always tell our induction pts to eat before we start anything. And all our labors are on clear liquids. It’s not perfect, but at least it isn’t ice chips.
RR I heart this post almost as much as I hate empty stomachs in labor.
I’ve been known to say, “I’ll be out of the room for 20 minutes” to hungry moms. It breaks my heart that grown women have to sneak to do something as simple as eating when they’re hungry just because “zomg they might need surgery.”
Meghan said
Ugh! Why did I not think of this? I was so freaking starving. I ate right before my induction at 1900, but then did not deliver until 1900 the next day- via c-section. So they didn’t let me eat anything until morning. Then I only got full liquids for breakfast. Man, I scarfed that jello! At least I was able to sip on gatorade and water throughout the day, but I was SOOO hungry! I’ll know for next time- I’m packin a power bar or something- although, snickers does sound more appealing.
realityrounds said
To Kathy: “Re: Ramadan — I thought that pregnant women were exempted from fasting? Maybe different Muslim sects have different laws on that…”
You are right that pregnant women are absolutely not expected to fast during Ramadan. However, every year we do get very devout women who feel the need to fast. Their husbands encourage them NOT to fast, yet some still do. It rarely causes anything serious, but still.
Labor and delivery RN said
One of the Muslim women that I served said that “you have to pay back” and do the fast after the pregnancy is over. So she chose to fast with the rest of her family because it is easier to do with others.
L.R. said
So what I want to know is, when you do go in for a c-section, why do they ask you WHAT you ate? I had an “urgent” one (so, not under general, but done ASAP with an epidural) and the anesthesia guys grilled me not only on when I ate last, but what. Were they going to be calling it by name or something? If I had said “roast beef” instead of “banana pancakes” would they have called the whole thing off and let me try my luck with vaginal? I mean I’m being funny but OTOH I really do wonder.
Kathy said
I’m guessing that they were trying to estimate your stomach contents, because it takes longer for some foods to leave your stomach than others. If you had had a cup of chicken broth two hours ago, it would probably be quite different from a double cheeseburger two hours ago.
olivia said
I am so happy to see that study, and just really hope it makes a difference in hospitals.
Not being allowed to eat during labor was so incredibley difficult for me. I had labored at home for about 24 hours when I transferred (about 4 a.m.). I had no appetite because of intense back labor and had not eaten much since early afternoon. I got an epidural and after I was able to rest I felt hungry, but no food was allowed. By the time I was at 10cm I was begging for just a few crackers to give me strength to push. My was feeling sick because I was so hungry. It was so humiliating, frustrating and unnecessary.
Carrie said
I remember being asked not to eat during labour (the midwife came into the delivery room to find me eating). Okay, fair enough,I was at higher risk of needing a caesarean under general, because it was twins, and I refused epidural anaesthesia, because I was scared of the needle and the pipe, but… I did not deliver until approximately four days later- I had intermittent pre-term labour, and over the following days either I didn’t feel hungry, or I wasn’t allowed to eat.
One of my strongest memories is suddenly realising that I felt so hungry during pushing, and thinking about baked potatoes, and knowing that there was no way I would be capable of eating, even were I allowed, because of the contractions.
I’m so thankful that I was allowed, nay encouraged, to drink as much as I liked. If there had been rules restricting me to ice chips, I would have probably ended up on a drip for dehydration. I have sensitive teeth, and even before I developed those, I have never been able to stand ice cubes in my mouth. I can be incredibly thirsty, yet unable to drink a drink in a cafe, because I forgot to ask them not to put ice cubes in, making the drink too cold.
Yeah, pathetic, I know.
Margaret said
Sucking washcloths? That makes me so sad.
Hilary said
Just stumbled on your blog, and grateful for your common-sense attitude.
When my daughter was born in a hospital 20 years ago, I was restricted to fruit juice and ice cubes; after 24 hours of labor, the anesthesiologist (who’d been in and out of my room all day, bizarrely) finally got exhausted assent to administer an epidural. He expressed outrage that I’d been allowed the liquids, but I couldn’t help thinking that if I’d been permitted some damn food, I wouldn’t have needed the forceps.
It’s called labor for a reason, dude!
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[...] Rounds – Thirsty During Labor? Just Be Quiet and Suck on a Wet Washcloth: RR finds the humorous in the recent news that research says eating in labor is [...]
Jill B said
The sad thing is that I BEGGED and PLEADED to even get a wet washcloth to suck on during my c/s (after the baby had been delivered and whisked off to the nursery).
My mouth was so, so dry and felt like I couldn’t breathe due to my sinuses draining down my throat (I got stuffy after crying when they decided to section me). The poor nurse who had the unfortunate assignment of actually talking to me said (yes, this is a direct quote), “I don’t want you to have any liquid because I don’t want to clean after you throw up.” No, there was no concern of patient safety here.
I finally talked her into a wet washcloth, which she placed near my mouth, but not actually in it. Thus, I spent who-knows-how-long trying to reach it with my teeth while my arms were strapped down and my uterus was still outside of my body.
That single experience is why my c/s memories make me feel so weak, powerless and sad.
realityrounds said
Jill B.,
That sounds like a horrible experience. I am sad for you. Your nurse sounded like an insensitive cad. It is extremely unprofessional to put your own feelings “I don’t want to clean up after you,” ahead of your patients. This is nursing 101.
We usually unstrap the mom’s arms right after the delivery so she can at least touch her baby, even when they are still suturing up the wound. I wonder if other hospitals do this?
Jill B said
Thanks. I know there are great nurses out there, because I had the good fortune to have a few during the whole experience. We just celebrated my daughter’s first birthday last week, so the birth details are on my mind, and the blog title grabbed my attention (it really is funny in light of ACOG’s news). But, two good things have resulted: 1) my beautiful little girl, and 2) a passion burning inside of me to do… something. Don’t know what yet, but I’m working my way toward figuring it out. Thanks for your blog.
MomTFH said
I used the getting in a car analogy just today with my doula client.
Jessica said
What I really want to know is why women pay attention to the hospital telling them not to eat or drink? I’m completely confused by it, its got to be the easiest thing to ignore. When there isn’t anyone from hospital in room, eat and drink as you wish. I’m seriously curious as to what the hospital thinks it can do to enforce an NPO rule and what women think the hospital will do to them if they ignore it. Pump their stomach?
kait said
I have a different perspective, after 30 years as an OR nurse. We ask people to be NPO because of the risk of aspiration of stomach contents into the lungs. See that one time, see how dangerously ill one mother is, or see one death because of aspiration. It is not a short death. We ask what you have eaten, partly to determine how full or empty your stomach may be, but also because some foods, and especially some juices, are acidic, as in, will literally decimate lung tissue. Water or black coffee are different–MAYBE, depending on the amount. And if you want us to trust and to hear and respect your wishes, we really need for you not to lie to us–that’s when we end up under the gun, trying to suction and give steroids and do chest X-rays once you start vomiting as we put you under as all your muscles relax and up comes that snickers bar. The very first rule in any specialty is to protect the airway, because without that you risk the patient, and if she hasn’t delivered or been delivered yet, even that tiny other patient. That being said, in many places, we can figure out a slow slow labor, and if time permits, get at least some liquids into a patient. And as an aside, when dinosaurs roamed the earth, wet washcloths were given to patients as a comfort measure, so that they could suck tiny amounts of fluids, keep their lips from drying out, and yet keep their airways intact. It isn’t about a rule, or a punishment, or sneaking and being found out or getting away with anything. And yes, in an emergency, we deal with full stomachs–but that doesn’t mean we want to allow unnecessary risk, and it sure doesn’t mean that dealing with a trauma or an emergency section with stomach contents will have an optimum outcome. When it comes to an airway, we err on the side of caution 100% of the time because no one wants an entirely preventable death over an NPO issue. Ever. There’s a reason the A in the ABC’S of medicine is airway–without A there is no B, and so on.