E20: The History of Eating and Drinking During Labor

We're taking a deep look at the NPO policy, a guideline that has long dictated the do's and don'ts of eating and drinking during labor. Born in an era of general anesthesia prevalence, this rule aimed to mitigate the risks of gastric aspiration. But with today's medical advancements, we're questioning the necessity and exploring how these shifts affect childbirth experiences. From the stories of prolonged labors to the individualized care some hospitals are now embracing, this discussion will equip you with knowledge and strategies for navigating your birth plan with confidence.

You'll learn that the fear of aspiration during C-sections may be largely unfounded, given the current statistics and medical protocols. This episode isn't just about facts; it's about empowering you with the courage to have critical conversations with healthcare providers. Join us as we spark change in obstetric practices, one listener at a time.

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Show Credits

Host: Angie Rosier
Music: Michael Hicks
Photographer: Toni Walker
Episode Artwork: Nick Greenwood
Producer: Gillian Rosier
Voiceover: Ryan Parker

Transcript

Speaker 1: 0:10

Welcome to the Ordinary Dula Podcast with Angie Rozier, hosted by Birth Learning, where we help prepare folks for labor and birth with expertise coming from 20 years of experience in a busy Dula practice Helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.

Speaker 2: 0:46

Hello and welcome to the Ordinary Dula Podcast. My name is Angie Rozier, I am your host and we are sponsored by Birth Learning. So today we are going to dive into a little bit of a history of something, and I love the history of anything the history of policies surrounding childbirth, maybe the history of breastfeeding actually did a thesis gosh 25 years ago on the history of breastfeeding from 1900 to 2000. That was fascinating and I love the history of places. People shows history. I love pieces of history.

Speaker 2: 1:24

So, especially in my line of work, I like to look at the history of certain policies surrounding childbirth and labor and how those came to be. Like how did we get to where we are? I think it's important to look back to see where we came from. So our topic today, the thing we're going to dive into the history of, is the policy of NPO, or nothing by mouth, so limiting eating and drinking during the labor and delivery process. So this is a very widespread policy in the United States that is enforced at varying levels among different facilities and can even be enforced to varying levels among different staff members at facilities. So you may have a provider or a nurse who is really strict about this policy, while others are kind of more lenient about it.

Speaker 2: 2:13

So people have different experiences and, as we look at some research and how people have reported the experience of their labor and birth, this for some folks is one of the most stressful parts of labor. A lot of people are not aware going into the process that they may not be allowed to eat and drink, but they'd certainly become aware of it during the process. Others have heard friends, family members stories that say, oh, I couldn't eat and drink. So they might kind of have an awareness that they might not be allowed to eat and drink. So for it, 30% to 60% of folks looking back retrospectively on their births, not being able to eat and drink was one of the most difficult parts of the whole process for them. So the 30% is those who could not intake food throughout the labor process, and 60% of folks say it was the most stressful part was not being able to drink during their labor. So labor is very widely as far as how long they last. I've seen entire labor's be 45 minutes or less. I've also seen them be four and a half days. So there's a huge variance in how long we can expect this process to be. So, of course, if you have a pretty quick, straightforward, short labor not eating and drinking, not a big deal you're probably going to be too busy to do it anyway. But for those experiences that are more drawn out over a period of hours or days, think of the need to hydrate and nourish your body over a period of hours or days, especially for someone who's very pregnant. Water intake, liquid intake, is going to be a normal part, we hope, of a lot of people's days as they're pregnant. Even if you're not pregnant, we should be having good liquid intake and, of course, we're going to need nourishment at certain times through the day.

Speaker 2: 4:01

So as we talk to our clients, we give them all some talking points to take to their providers, and one of the talking points we have them discuss is will I be allowed to eat and drink during labor? And I actually want to reframe that. The word allowed is kind of interesting to me and it sounds as if someone else is making decisions for you, but a lot of that's based in hospital policy and provider preferences. So another way to phrase this talking point could be I would like to eat and drink during labor. Will that you know? Is that okay? Or you could just state I'm going to be eating and drinking during labor, but kind of become familiar as you take this talking point to your midwife or your doctor, if they're okay with that some of them are so fine with that and or your hospital. You might want to check with your hospital see what their policies are around that and I've seen in the last 20 years really positive changes in a lot of parts of the country and moving away from this traditional policy really. So you'll find some hospitals that bring you a whole food tray of regular solid food throughout the labor process or deep into it. Others, if you're on labor and delivery, it's only liquid, liquid trays of food or that's all that's accessible as liquids. I'd like to go back to when and why and how this policy came to be. So we're going to rewind about 80 years, nearly 80 years.

Speaker 2: 5:31

So in the 1940s some research was done that recommended to restrict oral intake for women in labor, like all women in labor, and their reasoning was and it came up in the data is to prevent gastric aspiration. So what gastric aspiration is is that the contents in the stomach make their way into the lungs. Right, so we aspirate into the lungs. That is a problem. However, during this time, childbirth was incredibly different than it is now. So during this time, general anesthesia was different than medications, and the drugs were different. Practices were different surrounding childbirth, positions that people delivered in were different and women were different.

Speaker 2: 6:23

Women were largely alone during this process. They did not have a care person with them, somebody who truly cared about them, was watching them. They had only professional staff with them. So, like their support, people were not with them and sometimes they were fully draped. So they were usually in a delivery specific delivery room. At this time they would labor in one space, generally lying on a bed, and then they would be wheeled into a delivery room, a separate space, when it was time to push and they would still be in the same position, like lying on a bed, and sometimes at that point they would be given different medications and sometimes fully draped so that all you could see of the woman was the perineum. Sometimes they were strapped to the bed or secured to the bed in some way, but their mobility was greatly, drastically reduced. They were also given drugs to we call them amnesiacs that would kind of make them forget the experience, so they might not be very aware of what was happening as the team, the staff members around them, delivered their baby. So we've had significant advancements in anesthesia medications and methods since the 1940s. So things have changed, but this policy for some reason has held on pretty tight in many parts of the country, and in some places more than others. So why does it hold on today? What are the reasons today that that policy might remain in place?

Speaker 2: 7:55

This takes us to a little bit of a different topic and that is and a topic I'm passionate about is our C-section rate in the United States. So our C-section rate is about 32%. It goes up or down a percentage point or so, but it's kind of maintained that for the last 15 years or more. And as we look at cesareans, most all C-sections are performed with epidural anesthesia. So the person giving birth is very well aware. They can hear, see, smell, feel, touch, they're conscious, they're alert, they're awake, they're aware of what's going on around them, and so only less than 1% of C-sections does the person have general anesthesia, where they are not aware of anything, they're totally asleep and the anesthesiologist is taking care of a lot of their body processes for them. So if all patients, not just people having C-sections, but all patients under general anesthesia. Less than 1% of patients under anesthesia will aspirate again their contents of their stomach into their lungs and that does present a medical challenge, it's true. So if we take the true numbers of folks who might have a challenge with that, we have, first of all, one in three women get a C-section and then less than 1% of those women will be under general anesthesia for their cesarean. Then less than 1% of those patients will aspirate. So of people getting C-sections which two out of three people are not so of those one in three they get a C-section. That is, one in every 10,000 will aspirate. So very, very slim chance that that's going to become a problem. But that is one of the main medical reasons.

Speaker 2: 9:53

Given now that women are not allowed to eat and drink during labor, when we know that can be a stress point or the having water and food withheld throughout a process that can be physically demanding and prolonged and use a lot of energy, it can be kind of difficult to realize wow, I'm not doing this with any hydration or energy. As far as nutrition goes, so we also hear that vomiting may happen. If you eat, you might throw up. That's true Even if you don't eat, you might throw up. Nauseousness and vomiting are common parts of labor. It doesn't happen for everyone for sure, but it can be common. And also think back to the time when these studies were done. If people were vomiting they were probably lying down and maybe strapped to a bed. So think of if you've ever vomited and I think most of us have there's a response in your body, your body moves to that. You can't just calmly lay down on your back and vomit, right, you're going to have a response to that. But yes, vomiting can be normal with or without food intake.

Speaker 2: 10:59

And for some folks I've heard reported by many of our clients have said it's hard to throw up. Nothing Like if I haven't eaten for X amount of hours, I'm throwing up. It's acidic, it burns. When I throw up but say you had some, whatever food you had had, and you throw that up, there, it's less acidic. So for some folks they'd rather throw up something than nothing, which could be valid. But I think understanding why this policy is in place, how long it's been around, how much things have changed since then, helps us to understand and to make our own choices.

Speaker 2: 11:37

So even if you have a provider who says, nope, absolutely not, you cannot eat and drink. Or a hospital or a nurse who says, absolutely not, you cannot eat and drink. I just want you to understand the why's behind that, and plenty of folks sometimes will have a doctor who will say, yeah, you can eat and drink whatever you want, just don't let the nurses see you doing it. Sometimes we'll have a nurse. I had a nurse years ago when this policy was much more enforced, and she winked at me and she saw this mom was tired of struggling and she winked at me and said I'm gonna bring you a popsicle. So I don't need a popsicle, I'm the doula, right, but she was not allowed to bring food to the patient. So she brought me a popsicle, left the room and it was very much understood that the, the laboring mom was to get that popsicle. And you know that that cool, refreshing, that energy, that little bit of sugar that she got from that changed her world. It really did. It gave her the energy she needed to continue on during that part of her labor.

Speaker 2: 12:35

So consider what you might want to eat and drink during labor. Usually people want something cool and refreshing, a quick bit of energy. We're not gonna want anything hot, heavy. They do have broth at a lot of hospitals, whether a vegetable, beef, chicken broth. So maybe something warm and comforting, and that's not a lot.

Speaker 2: 12:54

People are not eating a lot during labor. Like I said, if it's fast, there's not time, you're not thinking about it. If it's long, one bite of something will go a long way. I don't see people chomping down Philly cheesesteak sandwiches during labor. It's something like a bite of a luna bar. Or maybe they've made a smoothie that they're gonna sip on. A protein drink or grapes Grape are super awesome. It's quick energy, it's cool and refreshing.

Speaker 2: 13:20

So consider for yourself what you might want to take, and hydration as well. Do you want to take something with a little bit of energy to it? Some electrolytes, cold water, room temp water? They do give water very liberally at most hospitals. Some it's only ice chips for those in labor. But take some of your own things, consider what and have a little variety, because you might change your mind throughout the process.

Speaker 2: 13:42

So when there's policies like this, this one's hung on tight for decades now one way to continue to make change is to ask questions, to ask for change. So, using that statement, like I would like to eat and drink during labor. You can use that in statements in office with your provider. You can use that in labor and delivery with your nurse. So I would like to eat and drink during labor and this may not help you. You may get a little bit kickback. You may be fully supported, depending on the people in the place that are surrounding you and the policies that are there. But for folks down the road having babies five years, ten years, fifteen years from now, hopefully that'll make some change for them.

Speaker 2: 14:24

So take some solid information sometimes to inform your desires. Do some research. Easy to look this stuff up. Right, it's pretty easy to look up the benefits of eating and drinking. Lots of studies, lots of data have come out and said you know, actually it's beneficial for women to be hydrated and nourished during labor. That one's, you know, no duh. We are not surprised by that. So take some information and give some thought to what you might want to eat and drink during labor. This could help you have a more positive and empowering birth experience and eliminate one thing that many people report as being stressful. So that concludes our small little history lesson on the policy and the history of the policy of eating and drinking during labor. I want to thank you for being with us today. This is Angie Rozier with an the Ordinary Dula podcast with Birth Learning. Hope you go out and have a wonderful day. Reach out to someone and make a difference in their day today in a positive way. We'll see you next time.

Speaker 1: 15:32

Thank you for listening to the Ordinary Dula podcast with Angie Rozier, hosted by Birth Learning. Episode credits will be in the show notes Tune in next time as we continue to explore the many aspects of giving birth.