Friday, March 14, 2008
You want to eat during labor
You want to eat during labor
A seeker once asked a Zen master how he knew he had attained enlightenment. "I eat when I am hungry and I drink when I am thirsty" was the reply.
What we have, once again, is an obstetric belief system that defines childbirth as a medical-surgical event. Eating and drinking do not fit this model. IVs do.
Henci Goer, The Thinking Woman's Guide to a Better Birth
"I won't be any trouble, because I don't eat a thing!"
Dorothy, in Noel Langley's The Wizard of Oz
We can dispatch with this chapter in the time it takes to read what's worth reading in the weekday New York Times.
If you give birth in a hospital, you will probably be allowed to eat nothing but Jell-O cubes during labor. These Jell-O cubes will be provided by nurses who believe that Jell-O is food.
Although the majority of hospital personnel consider Jell-O to be food (a nonpoisonous ingestible substance), other nonpoisonous ingestible substances that actually are food, such as avocados, tomatoes, lettuce, tahini, apples, oranges, pears, etc., will be denied you. Thus you will find yourself spinning down the vortex of the following Catch 22 oxymorons: nourishing nonfood (Jell-O), nonnourishing food (vegetables, fruit, etc.), and noncaregiving caregivers (nonfood-providing, nourishment-withholding, nonnursing nurses).
The justification for the oxymoronic behavior of giving solely Jell-O to a laboring woman is simple and straightforward in the hospital mind. It is the belief that, because Jell-O turns quickly into liquid, you won't be likely to choke on it and die if you throw up.
Will you, by the same reasoning, be allowed to put your veggie sandwich in a blender and press "liquefy"? Sorry. Against hospital policy. What is hospital policy? A conglomeration of beliefs the majority of which have withstood the test of time but not science. (For an insightful treatise on the anti-scientific, anti-common sense nature of the Western hospital, see Robert Mendelsohn's book, Confessions of a Medical Heretic, especially his chapter, "The Temples of Doom.")
In short, although there is no reasoning behind it, Jell-O is your predictable fate in the hospital maternity ward.
Don't make me puke
Let us examine the hospital policy of "nothing by mouth" (NPO) in the light of reason and obstetric history.
Is there any rationale at all behind NPO?
Actually, once upon a time there was. NPO was an intervention created to attempt to correct a flaw, not in nature, but in another obstetric intervention – general anesthesia. In the old days, general anesthesia was given by mask. If a woman laboring on her back (also a cultural intervention) threw up into the mask, she ran a substantial risk of choking on, and dying from, her own vomit. Doctors, ever ready to save women from nature (vomiting), but not from culture (the backlying position, nauseating anesthesia, and death-dealing masks), devised the callous coup, "nothing by mouth," to remedy a much more simply remedied problem.
The unsympathetic intervention of "nothing by mouth" ostensibly ensured laboring women an empty stomach and, it was believed, risk-free retching. In fact, all it did was make women hungry.
Science, a field of endeavor given short shrift by modern medicine, was not originally given the chance to weigh in on the modern hospital policy of "nothing by mouth." Today, finally having led the horse back in front of the cart, science tells us that no amount of fasting necessarily empties the stomach. In an article interestingly titled, "Nutrition and position in labour," C. Johnson, et al. conclude: "No time interval between the last meal and the onset of labour guarantees a stomach volume of less than 100 ml." In other words, a laboring woman could fast for the entire duration of her labor, and her stomach might still carry contents enough to fatally choke her, were she unfortunate enough to throw up while lying down.
Thus, another routine hospital obstetric procedure is found to be based, not on science, but on belief. What belief? The belief in a defective nature, summarized in this way: "Since, according to nature's law, women are throwing up on themselves, we'll just have to starve them to save them from themselves."
NPO is another way for techno-advocates to cloak women in the darksome myth of female incompetence. That this myth might be turned into medical gold goes without saying, but unfortunately not without doing.
Choking down the numbers
Today, it is no longer necessary to give general anesthesia by mask. Thus, aspiration (choking on one's vomit) has become an event so rare that even as long as 30 years ago it was the sole cause of maternal death in only 2.6 out of 1,000,000 births. Today, even those 2.6 women survive labor choking-free.
These days, aspiration during labor is simply unheard of. In three large studies recently conducted in the U.S., women who ate freely during labor had no choking problems. In 78,000 cases, not a single case of aspiration occurred. Indeed, not a single case of maternal death from aspiration can be found in the medical literature in the last 30 years.
But modern-day hospital staff, ever ready to do the right thing – even if the right thing is the wrong thing – will deny you food, as your body, working overtime in the exhausting maternity ward, cries out for nourishment. On the extremely unlikely chance that at some point in your labor you might need general anesthesia (as opposed to the more commonly administered regional anesthesia, such as an epidural), hospital staff will starve you. And they will starve you in good conscience, for they live in the belief that all hospital policy has reason behind it.
But NPO has no rational foundation of any kind. No process of reason ends with the conclusion, "And therefore, NPO is medically indicated." As far as reason and science are concerned, "nothing by mouth" benefits no one.
Even if NPO did have demonstrable benefits for laboring women, one would still have to weigh those benefits against the risks. And what science tells us is that 1) NPO benefits do not exist and 2) NPO risks exist in great number. So weighing benefits against risks still sends NPO to the locker room.
"Oh, no, NPO!"
Being deprived of nourishment during labor may be hazardous to your health.
Severe restriction of oral intake can lead to ketosis. Ketosis is an abnormal increase in chemicals that your body produces after it has used up its available store of glycogen (blood sugar) and begins to burn fat. Maternal fat-burning results in acid buildup, which if allowed to proceed unchecked can result in maternal vomiting, coma, and even death.
Is your hospital staff concerned? In no way. They're happy to believe in the touted benefits of NPO, even if it could result in such "side-effects" as coma or death. (Am I making this up? I wish I were.)
Prolonged lack of food can be dangerous to your in utero baby, as well. Research shows that NPO may result in infant oxygen deprivation. Infant oxygen deprivation can lead to infant brain damage.
Although the 1999 World Health Organization report, Care in Normal Birth, informs us that ketosis and its unfavorable sequelae for both mother and fetus can be prevented by offering the mother "light meals" during labor, your obstetrician probably has not read this report. Why should he? No birth is "normal" in his eyes. His training has told him that birth is by definition pathological and that care is synonymous with intervention.
To a hospital obstetrician, the WHO report Care in Normal Birth contains an oxymoron in its title. The only normal birth your obstetrician knows is the one that miraculously didn't go wrong. And as your obstetrician's Brother In The White Coat, Dr. Robert Galser at the University of Pennsylvania Medical Center reassuringly asserts, "Only a small minority of women find not being allowed to eat stressful." This charming sentiment is backed up by . . . well . . . nothing at all.
Delving further into scientific research, far from the quick-fix quips and gymnastic quunks of the indoctrinated and madding mediclown crowd, we find that NPO may even slow the progress of labor. This makes sense. Inadequate consumption of complex carbohydrates results in low blood sugar, which results in less effective (and sometimes painful) uterine contractions. Less effective contractions slow labor and may contribute to your chances of receiving the dreaded diagnosis "failure to progress," which significantly increases your chances of receiving a cesarean section, along with its common maternal complications (hemorrhage, infection, hematoma, pneumonia, blood poisoning), as well as infant injury, infection, bond-breaking isolation, formula feeding, respiratory distress, and so on. (For a more "full-bodied" list of maternal and infant complications from cesarean section, see Reason #3, "You don't want a cesarean section.")
At this point in your labor (which has failed to progress), the intervention of NPO – itself the ostensible solution to a prior intervention – justifies yet another intervention: IV placement.
In the warm and fuzzy myth of the safety and efficacy of hospital childbirth, the cavalry IV brings life-saving "nutrients" to the depleted maternal bloodstream. In fact, an intravenous simple-sugar solution brings empty calories to an empty host, as well as a plethora of risks that justify – you guessed it – further interventions. (For a deeper look at the hazards of using IV sugar-water to remedy the "no water" part of NPO, see Reason #41, "You want to drink during labor.")
Since its inception, the standard policy of "nothing by mouth" has been a bad idea through and through. Like most routine hospital obstetric policies, it is based on myth and scornful of science. The best that can be said about it is that, because it results in so many additional interventions, it gives hospital staff something to do to make themselves feel useful.
NPO is another example in an endless catalog of examples of the hospital institution's attempt to dehumanize you, to turn you into a patient, to strip away your comforting and competent humanity, to force you to find identity as the daughter of an institutional father.
NPO is yet one more example of modern medicine's century-long endeavor to convince women that their bodies are not their own and that their powerful fecundity must be manhandled if creation is to occur. Starving you to the point of pain, your hospital obstetric caregivers will cheerfully show you their concern by performing further interventions to save you from their myth-based ignorance, interventions that could have been avoided with a little research and a will to care.
But research requires effort, especially effort of the mind. And effort of the mind is verboten in the mindless maternity ward, where reason long ago gave way to myth. And caring requires effort, too – effort of the heart. And the heart has no place in the modern-day hospital maternity ward, where "the standard of care," not love, runs the show.
(The above is excerpted from Jock Doubleday's book, Spontaneous Creation: 101 Reasons Not to Have Your Baby in a Hospital, Vol. 1: A Book about Natural Childbirth and the Birth of Wisdom and Power in Childbearing Women, www.SpontaneousCreation.org)
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