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Sweet Pea Births

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To Eat or Not To Eat…

Posted on November 5, 2015 at 8:07 AM Comments comments (156)
To eat or not to eat…That was the question for families planning a hospital birth.  When you are laboring at home or a birth center, you have the freedom to eat as your appetite dictates.  If you choose to have a hospital birth, you are at the mercy of your doctor’s orders and the nurse’s interpretation of the hospital protocol.  

We love it when science catches up to Dr. Bradley.  Anecdotally, we could tell students that it was safer to eat before/during labor since anesthesia has changed from the days of "knock'em out, drag 'em out" birth, as Dr. Bradley called it.  Women used to be under general anesthesia, which is administered differently than today's spinal or epidural blocks.  

We are so excited to update this post (and our class info!) with a press release from the American Society of Anesthesiologists (ASA):

"Most healthy women can skip the fasting and, in fact, would benefit from eating a light meal during labor, suggests research being presented at the ANESTHESIOLOGY® 2015 annual meeting. Improvements in anesthesia care have made pain control during labor safer, reducing risks related to eating, researchers note."
ASA Press Release, "Most healthy women would benefit from light meal during labor", October 24, 2015

For other reading,  HERE is some research I had found before this 2015 press release to make the case for eating and drinking in labor (in case you want to do more poking around the subject).

Now...how long will it take for hospital protocols to change and reflect these recommendations from ASA? As we found out the hard way, sometimes the doctor approves something but if it is not in writing and signed off on the birth plan, it probably isn't going to happen in the hospital setting. The nurse will follow the hospital protocol or they may invent their own interpretation if none exists to cover their liability.  If you are going to have a hospital birth, I have a strong opinion about getting your wish list signed so that the nursing staff has “permission” to “break the rules” if they feel that something you are requesting is out of the ordinary.  Maybe you could ask for a copy of the ASA press release to be included in your chart that goes to the hospital.

Dr. Bradley always advocated that a healthy mom should eat if she is hungry and drink if she is thirsty.  As he said, “Birthing is like playing a full game of football without any substitutions.”  He recognized that labor is an athletic event, and that a well-nourished athlete would perform better than a hungry one.

Science and the ASA catch up to Dr. Bradley:
"The research suggests that the energy and caloric demands of laboring women are similar to those of marathon runners, Harty said. Without adequate nutrition, women’s bodies will begin to use fat as an energy source, increasing acidity of the blood in the mother and infant, potentially reducing uterine contractions and leading to longer labor and lower health scores in newborns. Additionally, the studies suggest that fasting can cause emotional stress, potentially moving blood away from the uterus and placenta, lengthening labor and contributing to distress of the fetus."  

A Note About Hospitals and Nourishment
If you are having a hospital birth, you need to find out how your care provider feels about nourishment during labor, even with this announcement by the ASA. If your care provider is on board with mom eating and drinking as her body directs, great!  Get it into your birth plan, aka "wish list", that you have permission to eat and drink.  If they restrict intake, you need to think about your options.  You may question whether or not your care provider is truly supportive of your plans for a natural birth.  

You should also ask what the hospital policy is on food and drink during labor when you do your hospital tour.  It helps to know what kind of potential situations you may be facing so you can avoid stress-inducing encounters during labor.

The potential conflict between a laboring mother’s needs for nourishment and her care provider or hospital protocol comes from the days when general anesthesia was standard for hospital births.  There was a very real danger of a mom “aspirating”, meaning that food or drink the mom had consumed before labor would be regurgitated and accidently enter the trachea and lungs, creating a life-threatening condition to mother and baby.  [See reference 1]

From the press release:
"Researchers said aspiration today is almost nonexistent, especially in healthy patients. In the United States, there was only one case of aspiration associated with labor and delivery between 2005 and 2013, involving a complicated case of a woman who was obese and had pre-eclampsia (a precursor to eclampsia, or high blood pressure that can lead to seizures), according to the American Society of Anesthesiology’s Closed Claims Project database. Researchers also noted that no cases of death due to aspiration were reported in the United Kingdom between 2000 and 2005, compared to 1.5 cases per 1,000 during the 1940s. They say this is likely due to advances in anesthesia care, including increased use of epidurals and spinal blocks in place of providing anesthesia through a mask over the nose and mouth. Before these improvements, women were more likely to need a tube placed in the windpipe for breathing, which potentially increased the risk of aspiration." 

Although very few women have births under general anesthesia nowadays, the practice of restricting food and drink still persists.  You may hear it called “NPO”, which stands for the Latin, “non per os”, meaning nothing by mouth.  With the press release from the ASA, we can keep our fingers crossed that hospitals will start to change their practice protocols.

In the past, it was likely that you would only be allowed ice chips if you opted for an epidural.  The chance of needing general anesthesia was within the realm of possibility since some moms and babies “crash” after the epidural dose is dispensed.  As with all labor interventions, you don’t know how you will react until it’s administered.  Although it’s a small percentage of women that have life-threatening complications, the prospect of the drugs dropping your heart rate, blood pressure or respiration to dangerously low levels exists once they are in your bloodstream.  In the instance of a “crash”, you would need general anesthesia to perform an emergency cesarean to save your or your baby’s life, thus your nourishment options become limited to ice.

Eating and Drinking During Labor
Have your refrigerator stocked with your favorite healthful foods and/or meals as you near your estimated due date.  Labor is a funny thing – you never know what your body is going to like.  If you think you are in labor, you can go through Dr. Bradley’s list of things to do to see if you are in pre-labor (contractions slow down or stop) or actual labor (contractions continue at same pace or get closer and harder despite the change in position or activity).  To "test" for labor, he suggests that a woman should eat, drink, go for a walk, shower and nap – in that order.  

When you start with the “eat” part of the list, it will be more satisfying to eat something you really enjoy.  If you are not in labor, at least you ate something you like and you can move on with your day with a tummy-full of your particular “comfort food”.  If you are in labor, then you have eaten something that is fueling your body for the labor.  It will put you in a good frame of mind if you ate something that is a favorite and you create a positive emotional state.

The best drink during labor is water.  Water is a key to staying hydrated and avoiding the slippery slope of interventions.  A hydrated body has the energy for the work of labor.  Ample water also allows for effective hormone distribution throughout the body: the chemicals and hormones being made to stimulate and progress labor are able to circulate freely.  If you have a longer labor, consider an electrolyte replacement: trace minerals added to the water you are drinking, Emergen-C makes a powder, or coconut milk is a "natural" version of sports drinks.

Dehydration causes a spike in temperature and blood pressure, while at the same time depleting your energy by as much as 30%.  Can you see that simple dehydration can also be interpreted as the mom being “in distress”?  Your care team will not want to take a chance of making the wrong call, so they are likely to intervene or suggest drastic measures to “save” mom and baby.

Whether you are laboring at home, a hospital or birth center, small-portioned, protein rich snacks are nice to have on hand.  As your labor progresses, a laboring woman’s appetite will naturally decrease as the body shuts down other functions such as digestion to allow for full focus on the progression of labor and birth.  

Here are some foods that we and other students have found useful for quick energy boosts when mom doesn’t have the desire to eat a full meal.  These snacks are also handy for the coach to get the energy boost he needs to be a great support person for mom.  We don’t want hungry, cranky coaches during labor!!

What the ASA recommends:
"A light meal could include fruit, light soups, toast, light sandwiches (no large slices of meat), juice and water. Most women lose their appetites during very active labor, but can continue to drink fluids such as water and clear juices, researchers said." 

- Honey sticks.  According to honey.com, “Honey is also a rich source of carbohydrates, providing 17 grams per tablespoon, which makes it ideal for your working muscles since carbohydrates are the primary fuel the body uses for energy. Carbohydrates are necessary in the diet to help maintain muscle glycogen, also known as stored carbohydrates, which are the most important fuel source for athletes to help them keep going.” [2]

- Trail mix.  You get the nice variety of nuts, dried fruits and if you want, candy, in one bag.  I found myself picking out my favorite nuts and fruits and snacking on them – literally one or two at a time – as we got into the active phase of first stage labor.

- Protein bars or chews.  Look for bars that are low in carbs and added sugars –the key is to provide an energy boost without an energy crash afterwards. We have had students that use the “PowerBar” brand Energy Bites, as well as Gel Blasts that are bite size energy foods.

- Handful of nuts.  If you have a favorite nut (besides your coach-lol), bring some with you.  You can eat 1 or 10, whatever you are in the mood for.  I like nuts because you get the energy boost in whatever quantity you are in the mood to chew and swallow.  Trader Joe’s sells packages nuts in handy single serve packets.  I usually eat 2 or 3 pieces, and Bruss would finish off the bag for his energy boost.

- Popsicles.  While working hard in labor, a popsicle can be refreshing.  To prevent an energy crash, look for a brand that uses natural fruit as a sweetener instead of added sugars.  Added bonus: you can also push it against the top of your palate to stimulate oxytocin production.

- Applesauce cups.  Provide potassium along with a little protein.  The nice thing about applesauce is that while some people prefer them cold, they don’t need to be refrigerated.  Again, look for naturally rather than artificially sweetened sauces.

- Banana.  Another source of potassium that is portable and easy to eat.  To prevent a sugar burst, pair this with a cheese stick to balance out the carbs.

- Soup or clear broth.  Campbell’s came out with the “Soup at Hand Cups” that are single serve, portable and microwaveable.  They were a God-send during our third birth.  The nurse didn’t want me to eat “just in case”, but she was okay with me drinking – hence, I could drink my meal and stay nourished through our 34 hours at the hospital.

- Single serve smoothies or juice drinks.  I am thinking along the lines of Stonyfield Farm Smoothies or Drinkable Yogurts for a liquid protein boost, or the Odwalla line of Protein Beverages.  It’s a little sip of something sweet with carbs that still offers a protein source for energy.

As you noticed from the list, some of these foods need refrigeration or a heating source.  These are considerations if you are having a hospital birth.  It stands to reason that if you will not have access to a refrigerator or microwave, the items that won’t stay cool with an ice pack or the foods that need to be heated need to left out of the cooler.

The bottom line: eat to appetite and drink to thirst for the best labor possible!  I hope this list gives some ideas with which you can fill your refrigerator or cooler.  What did you eat during your labor?

Bradley Method classes offered in Arizona convenient to Chandler, Tempe, Gilbert, Mesa, Ahwatukee, Scottsdale, Phoenix and Payson, AZThe material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

[1] http://en.wikipedia.org/wiki/Pulmonary_aspiration

[2] http://www.honey.com/nhb/benefits/natural-energy/

Can I eat and drink in labor?

Posted on September 10, 2013 at 7:48 AM Comments comments (143)

We had a great question come up in class on Friday, one that bears writing about because at least one student every session plans to give birth at a hospital where they are told to have a good meal before they come in, because their food will be restricted or prohibited once they check into the labor and delivery department. 

To begin with, even having to ask that title question begs another question: why are we asking permission?  The female body, left to it’s own devices, will naturally shut down appetite as the serious work of labor progresses.  Dr. Bradley teaches to eat to appetite if you are hungry, drink if you are thirsty.  Even after mom is no longer asking for water, Dr. Bradley admonishes coaches to keep mamas hydrated so that the labor progresses with ample hydration to circulate all the hormones that keep labor on track.

As students of natural birth, we know that as labor gets harder and moves closer to birth, the body shuts down appetite because it needs to focus on the work of labor, not digestion.  If labor is prolonged, maybe mom will want literally “a bite” of something: a bite of banana, a bite of cheese, a bite of fruit, a couple of nuts, etc.; definitely not a full meal.  Since we had long labors, we found that clear broths or simple soups (thin tomato soup in my case) were a great compromise.  Although I wasn’t hungry, the liquids gave me a few calories to lend some energy to continue to labor, while also meeting my hydration needs.

Science confirms that hospital policies need to catch up with evidence-based care.  Here are excerpts from the Cochrane Review, plus two other articles for you to consider as you decide what is best for your family.

From the review, “Restricting oral fluid and food intake during labour” [1]
In some cultures, food and drinks are consumed during labour for nourishment and comfort to help meet the demands of labour. However, in many birth settings, oral intake is restricted in response to work by Mendelson in the 1940s. Mendelson reported that during general anaesthesia, there was an increased risk of the stomach contents entering the lungs. The acid nature of the stomach liquid and the presence of food particles were particularly dangerous, and potentially could lead to severe lung disease or death. Since the 1940s, obstetrical anaesthesia has changed considerably, with better general anaesthetic techniques and a greater use of regional anaesthesia. These advances, and the reports by women that they found the restrictions unpleasant, have led to research looking at these restrictions. In addition, poor nutritional balance may be associated with longer and more painful labours, and fasting does not guarantee an empty stomach or less acidity. This review looked at any restriction of fluids and food in labour compared with women able to eat and drink. The review identified five studies involving 3130 women. Most studies had looked at specific foods being recommended, though one study let women choose what they wished to eat and drink. The review identified no benefits or harms of restricting foods and fluids during labour in women at low risk of needing anaesthesia. There were no studies identified on women at increased risk of needing anaesthesia. None of the studies looked at women's views of restricting fluids and foods during labour. Thus, given these findings, women should be free to eat and drink in labour, or not, as they wish.

From the Science Daily article, “Restricting Food and Fluids During Labor Is Unwarranted, Study Suggests” [2]
"There should be no hospital policies which restrict fluids and foods in labor; nor should formal guidelines tell women to take specific foods, such as energy drinks," states one of the study's authors, Gillian ML Gyte, M.Phil, of the department of women and children's health at the University of Liverpool in the U.K.

She and her co-authors point out that prior research has shown that many women in labor do not feel like eating, but for others the notion of long hours without any food or drink can be anxiety provoking.” …

"Our study found no difference in the outcomes measured, in terms of the babies' wellbeing or the likelihood of a woman needing a C-section," said Gyte. "There is no evidence of any benefit to restricting what women eat and drink in labor." The researchers also emphasize the value of allowing women to make choices regarding these matters. 

From the Science Daily article, “Eating and Drinking During Labor: Let Women Decide, Review Suggests” [3]
Throughout much of the last century, eating and drinking during labour was considered dangerous and many maternity units operated "nil by mouth" policies or restricted what women in labour were allowed to eat and drink, regardless of women's preferences. This was largely due to concerns about possibly fatal damage to the lungs caused by "Mendelson's syndrome," where particles of regurgitated food are inhaled under general anaesthetic during Caesarean sections. Recently, however, attitudes have begun to change and in many maternity wards, particularly in the UK, women are now allowed to eat and drink what they want during labour…

"Since the evidence shows no benefits or harms, there is no justification for nil by mouth policies during labour, provided women are at low risk of complications," said lead researcher Mandisa Singata, who is based at the East London Hospital Complex in East London, South Africa. "Women should be able to make their own decisions about whether they want to eat or drink during labour, or not."…

"While it is important to try to prevent Mendelson's syndrome, it is very rare and not the best way to assess whether eating and drinking during labour is beneficial for the majority of patients. It might be better to look at ways of preventing regurgitation during anaesthesia for those patients who do require it," she said. 

So what is a couple to do when the hospital has a policy that restricts food and drink during labor?  Do you feel confident in your choice to eat and drink?  Do you want to circumvent the system by bringing in “Coach’s Food”?

That is a very individual choice.  You can labor at home as long as possible and follow your own cues if you want to prolong going to the hospital where your intake is going to be restricted.  You can pack some “Coach’s Food” and circumvent the system by snacking out of the coach’s cooler.  You can do neither and go with the system.  You can also talk to your care provider, bring in the scientific literature, and see if they will sign off on a birth plan that allows you to eat and drink in the hospital in spite of the policy.  Their hands may be tied, and it may not be a possibility, however as the saying goes, you won’t know unless you try.

Did your birth place have a policy that restricted food and drink?  What did you do; how did you handle it?
Please leave us a comment – it will be moderated and posted.

[1] Singata M, Tranmer J, Gyte GML. Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD003930. DOI: 10.1002/14651858.CD003930.pub3.

[2] Health Behavior News Service, part of the Center for Advancing Health (2013, August 22). Restricting food and fluids during labor is unwarranted, study suggests. ScienceDaily. Retrieved September 10, 2013, from http://www.sciencedaily.com/releases/2013/08/130822141954.htm

[3] Wiley-Blackwell (2010, January 22). Eating and drinking during labor: Let women decide, review suggests. ScienceDaily. Retrieved September 10, 2013, from http://www.sciencedaily.com/releases/2010/01/100119213043.htm

The material included on this site is for informational purposes only.  It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson