*TW: Topic of maternal mortality.
Why do I need an advocate if I'm going to deliver at a hospital staffed with trained nurses and doctors who deliver babies everyday?
This question is quite complex. I think the majority of nurses and doctors genuinely care about each patient's birth experience, but unfortunately the gap in research getting to these healthcare providers is what is causing an abundance of issues.
"In March of 2001, the Institute of Medicine report Crossing the Quality Chasm stated, “It now takes an average of 17 years for new knowledge generated by randomized controlled trails to be incorporated into practice, and even then application is highly uneven.” - Munro and Savel
This gap is known as The 17-Year Research to Practice Gap.
We progress as a society and learn more through new and ongoing research, but it takes more than 17 years for us to practice. This means that my hospital clients are getting outdated, misinformation. I want to *sadly* point out that the United States has the highest rate of maternal mortality amongst developed countries.
"According to new estimates, the 2018 maternal mortality rate in the United States was 17.4 maternal deaths per 100,000 live births, ranking the nation last among similarly wealthy countries. When compared to the World Health Organization’s maternal mortality rate rankings, the US ranks 55th, falling behind Russia which has a maternal mortality rate of 17 maternal deaths per 100,000 live births."(One Health Trust)
Mother the Mother Birth Services wants to help bridge the gap between new research and outdated hospital policies. We believe to our core that mothers should have the newest information and research to base their decisions on. We are super excited to take you on series where we are going to take hospital policies or common practices and give you a different point of view! This series is just to give you a different perspective than what you might be hearing from your OB. This is not medical advice.
The beauty of healthcare is you are in charge of your health so you get to decide what you are comfortable with.
This week we are going to focus on the 17-Year Research to Practice Gap regarding eating and drinking in labor.
Eating and drinking in labor.
I can't speak for every hospital, but speaking for the Central Florida area and the hospitals here, eating and drinking in labor is a "no-no". The reasoning behind this, is fear of the birthing woman aspirating while under general anesthesia during a surgical birth (c-section) in an emergency situation. Basically, doctors are afraid that women will choke on their stomach contents during an unforeseen surgical birth.
Women have been eating and drinking in labor since the beginning of time. Birth is a marathon, how are we expected to run it without energy? Our ancestors would laugh if we told them they couldn't eat in labor.
Unfortunately in the 1940s, views changed. It was believed that womens chances of aspirating were increased if she ate in labor. Hospital policy followed this belief and doctors started requiring moms to fast in labor. Now here we are, 83ish years later with so much research showing new information debunking this theory, and yet at hospital, we are still restricting moms from food and liquid in labor.
New Research.
The National Library of Medicine published an article in January of 2010 sharing this new research data. Their conclusion stated:
"Since the evidence shows no benefits or harms, there is no justification for the restriction of fluids and food in labour for women at low risk of complications. No studies looked specifically at women at increased risk of complications, hence there is no evidence to support restrictions in this group of women." (Singata et al.)
My immediate thought is this data was published in the National Library of Medicine 13 years ago and yet...... here we are.
Parents.com shares the findings of Dr. Michael Bautista, M.D., an associate professor of anesthesiology at Memorial University,
"Here are a few interesting takeaways that Dr. Bautista and his team discovered: Labor is comparable to running a marathon in terms of calories and nutrition needed to sustain energy levels. Fasting during labor forces a person's body to burn fat as an energy source, causing acidity in the blood for both parent and baby to rise. Rising acidity in the blood can reduce contractions in the uterus, which can make labor last even longer, which can lower health scores in a newborn. Fasting can impact a person emotionally, triggering stress to divert blood away from the uterus and placenta, making labor last longer and possibly causing stress on the baby. Low-risk people can safely eat small meals during the early stages of labor. By the time later active stages of labor are in full swing, the parent's appetite is usually decreased or gone." (Hanawalt)
That suggests that restricting food and liquid could actually do more harm than good.
What does Evidence-Based Birth say?
"The issue of eating and drinking during labor should be reframed as one of bodily autonomy and human rights. All laboring people, whether they have an epidural or not, or have diabetes or not, have the right to choose whether they would like to eat and drink during labor. Here at Evidence Based Birth®, we urge the American Society of Anesthesiologists and the American College of Obstetricians and Gynecologists to revisit their current guidelines and adjust them according to the evidence and ethics. Any revisions in guidelines should also consider parental satisfaction. There is abundant research showing that people often complain about their distress in being forced to fast during labor (Manizheh & Leila, 2009)." (Dekker)
What should you eat in labor?
I would suggest sticking with light, healthy meals and snacks in labor. Throwing up in labor is common and throwing up light foods is a lot more pleasant than throwing up a greasy cheeseburger. Fruit is a great option as it is mostly water so it will help keep you hydrated. Toast, Body Armor, soups, granola bars, light sandwiches, and nuts are some other great options.
How do I eat in labor if hospital policy does not allow?
If you decide you are comfortable to eat in labor but hospital policy does not allow, I suggest packing a small cooler of snacks and drinks for "your partner". When its just you and your trusted birth team, take some sips and nibbles. If your provider asks you when they last time you ate was, do not lie. We always want you to be honest with your provider. As Evidence-Based Birth says, this is a human rights issue. You have the right to eat and drink in labor.
Girl. If you want food in labor, eat! Run your marathon with all the necessary energy!!
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Happy birthing <3
Kinsey Drea, Birth Doula
www.motherthemotherbirthservices.com
Citations.
Munro, Cindy L., and Richard H. Savel. “Narrowing the 17-Year Research to Practice Gap.” American Journal of Critical Care, 1 May 2016, aacnjournals.org/ajcconline/article/25/3/194/3121/Narrowing-the-17-Year-Research-to-Practice-Gap.
“Worldwide Maternal Mortality Rates.” One Health Trust, 17 Nov. 2022, onehealthtrust.org/publications/infographics/worldwide-maternal-mortality-rates/#:~:text=When%20compared%20to%20the%20World,deaths%20per%20100%2C000%20live%20births.
Singata, Mandisa, et al. “Restricting Oral Fluid and Food Intake during Labour.” The Cochrane Database of Systematic Reviews, 20 Jan. 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC4175539/#:~:text=The%20rationale%20for%20withholding%20food,is%20required%20(Mendelson%201946).
Dekker, Rebecca. “Evidence on: Eating and Drinking during Labor.” Evidence Based Birth®, 2 Aug. 2022, evidencebasedbirth.com/evidence-eating-drinking-labor/.
Hanawalt, Zara. “Why You Can’t Eat during Labor-but Maybe Should.” Parents, 22 Jan. 2023, www.parents.com/pregnancy/giving-birth/labor-and-delivery/should-you-eat-when-youre-in-labor/.