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Tuesday
Aug252009

The Big Push For Midwives: ACOG Wants to Keep Women Hungry in Labor

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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!

 

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Reader Comments (37)

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.

August 25, 2009 | Unregistered CommenterLeah

No one should tell me if I'm hungry or not!

August 25, 2009 | Unregistered CommenterNever teh Bride

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.

August 25, 2009 | Unregistered CommenterMargaret

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.

August 25, 2009 | Unregistered CommenterShotgu Mar

“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*

August 25, 2009 | Unregistered CommenterAmanda

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.

August 25, 2009 | Unregistered CommenterNoble Savage

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.

August 25, 2009 | Unregistered CommenterReality Rounds

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}

August 25, 2009 | Unregistered CommenterKathy

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).

August 25, 2009 | Unregistered Commenterrixa

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.

August 25, 2009 | Unregistered Commenterdoctorjen
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