Recent discussion at the hospital where I have privileges has centered around the anesthesiologists’ desire to restrict oral intake when women are in labor. The anesthesia department’s concern is Mendelson’s Syndrome, a bronchopulmonary disease that can rapidly develop when gastric contents are aspirated (inhaled) when a woman receives general anesthesia. Because this syndrome can lead to sudden death, anesthesiologists are understandably reluctant to administer general anesthetic to women who have had anything to eat or drink within the last 6-8 hours.
However, other studies indicate the importance of fluid and food intake during labor. One study, published in the European Journal of Obstetrics and Gynecology, examined mortality (death) rates due to Mendelson’s Syndrome in the Netherlands, where 75% of obstetricians and midwives allow women to eat and drink as they wish during labor. They found that mortality rates were no higher than in countries where oral intake was restricted. See this study at http://www.ncbi.nlm.nih.gov/pubmed/9605447
In the 23 years that I have been a midwife, I have attended one c-section performed under general anesthesia. All the rest of the c-sections I have assisted with have been performed under regional (epidural or spinal) anesthetic. It seems a bit of overkill to me to prohibit all women from food and fluids because they might need general anesthesia. Perhaps we should make a law prohibiting drivers from eating or drinking 6-8 hours before they drive their car, in case they get in an accident and need general anesthesia?
As the cesarean section rate has risen to incredible levels in this country, our fear of birth has increased correspondingly. And no wonder–cesarean sections carry many risks, including possible need for general anesthesia and potential risk of aspiration of gastric juices. So. . .instead of restricting women from eating or drinking in case they might need general anesthesia during a c-section, why don’t we start by reducing the need for c-sections in the first place? Here’s my list of ways to reduce c-sections:
- Allow the woman to move about freely in labor. (Actually, I hate the idea of ‘allowing’ a woman in labor to do anything. We should be encouraging and supporting her in being active during labor).
- Avoid induction of labor unless there is clearly more risk to the baby or mother by allowing pregnancy to continue.
- Do not artificially rupture the membranes.
- Use a care provider with a low c-section rate (under 15% minimally, and around 5% optimally)
- Labor at home until you “hit the wall” and feel like you can’t do it any more.
- If you are low to moderate risk, refuse continual fetal monitoring. Ask for intermittent auscultation instead (listening with a doppler or fetoscope at periodic intervals).
- Avoid the routine use of IV fluids. This can cause fluid overload and will make it more difficult for you to move about freely. There are occasions where IV fluids are helpful, such as when the mother is dehydrated.
- Avoid fasting during labor. It increases the length of labor and the level of ketones in the body.
- Don’t start pushing when you are 10 centimeters dilated. Start pushing when your body is doing it without you.
- Take a doula or other female support person to the hospital with you.