I was backing up a fellow RN on labor and delivery in her conversation with an OB resident about the other nurse's patient. The woman was having baby #4, she wasn't in labor yet, and they were unsuccessfully (thus far) inducing her labor. It was day #2 of her induction. Things were winding down for the night: everything for her induction was stopped.
What would you want to do, if it's been a two day process, so far, and you were pregnant? You'd want to be able to eat and drink, right? That was what this other nurse was advocating for her patient. Let her eat a light dinner, and let her rest for the night, before restarting her induction in the morning.
The OB resident (who I admit is still very green behind the gills) was arguing with the nurse about it -- saying no, this woman can just have ice chips and maybe a Popsicle or two. The doc was mumbling about aspiration risk, blah blah blah.
I piped in: well, since she's a G4 who has given birth vaginally before, just how do you think she's an aspiration risk? Chances are extremely low that she'll need a c/section, and even lower that she'll need general anesthesia for a c/section --- which is precisely where the "worry" for aspiration of stomach acid lies.
How many times do women need general anesthesia for a c/section? I can count on one hand per month how often that we do general anesthesia. How often are c/sections under dire emergency conditions requiring general anesthesia actually seen on labor and delivery? Even less than the one handed count of cases of G.A. we see per month.
This patient? Extremely low risk for G.A., much less the need for a c/section, even less of a chance of aspiration of stomach acid.
I argued the fact that aspirating pure stomach acid will actually do more damage versus aspirating fluid/food laced stomach contents, which will be less acidic.
Both of us nurses also brought up the fact that even ACOG recommends liberal fluid intake during labor ---- and this woman wasn't even in LABOR!!! So, you want to continue to starve her for another day, putting her body into a further ketotic state? (The resulting symptom is the lovely ketotic breath that laboring women in longer labor tend to get - the body isn't being nourished, so it starts burning it's sugar stores to maintain some kind of energy level --- and energy required for labor is higher than not being in labor.)
I brought up - how about practicing some evidence-based medicine here? Let the poor woman eat something light, if you're so worried. How about some chicken noodle soup and some saltines? Something to help hold her over, but yet makes her feel like she's actually "eating" something, versus a simple Popsicle?
In the end, the resident gave up arguing back with us, and told the nurse taking care of the patient to get the order if she wants it, from the attending MD about a light food diet for this non-laboring woman.
We're trying folks. We're trying hard (as nurses) to help the newer doctors see the light about evidenced-based practice. However, even when ACOG backs up our arguments, the doctors still refuse to listen.
Oh, and the NPO in the title of the post? That's one particular doctor who is notorious for making every single woman under his care NPO. Even when not in labor.
24 comments:
While I was actually in labor, I was not too hungry, but I had not had breakfast and it has been several hours since the last time I ate so I snuck in some honey sticks. The sugar was just enough to fuel me up. If I had wanted to actually eat, however, I did bring snacks. I wasn't going to let a nurse stop me from eating if I was actually hungry. Way to go!
Is there any way you could just drop a hint to the dad or other support person that maybe nobody would notice if he brought in some food for himself and accidentally brought enough for her too?
There's something really wrong with a system when the least knowledgeable and least experienced person on the floor is the one giving all the orders.
Thank you! I am so sick of doctors who think they know what is best all the time. I wish more patients knew how to advocate for themselves too, or that they can. Most women would never think to tell their doctor no. I would have looked at this doc (as a patient) and said "Ya know, thanks for your advice but I'm gonna do what feels right for MY body and MY baby" Love your blog, btw, usually I'm just a silent follower; but somethings hit a little closer to home right now since I'm 12 weeks with our fourth baby.
wow. that's pretty archaic in the rule department. It's been a long time since I have seen a laboring mom NPO.
When I was in labor even as a first time mom with a predicted large baby (he was 10 lbs 4 oz at birth) my midwife told me to eat whatever I wanted but just to be aware that I might throw up later (which I did) so to take that into consideration when choosing what to eat.
Oh I totally blew off the "no eating" rule when induced with my first. We brought a labor bag just cram packed with protein bars and snacks, and I was very free with eating them. It was a 3 day induction with me as well and I'm sure they'd just have preferred I'd starved into complacency.
thank you for continuing to advocate for patients! i advise doula clients to pack a bag of snacks and eat if they feel like it. one lady "snuck" a sandwich and kept looking back over her shoulder at the door with every bite. silliness.
btw ketosis=burning FAT not sugar.
Thank you for that correction Abundant B'earth. However, sometimes it's just easier to say it the way I did, because your body is using up the glycogen stores in your liver.
Hear, hear! I snuck food during my second labor after being starved through my first and was tsk-tsked and threatened to not be eligible for an epidural later if I wanted one. I knew that my body needed fuel to to its job and understood that the risks of needing a C-Section and GA were very, very small for me. So I ate! Forget their scare tactics. I find it absurd to routinely starve a woman during labor.
Yes, do educate those who are ignorant! Torture, not a good way to start out prelabor! Ugh. Makes me think the induction might not be necessary. I'd hint that going home and coming back might be an option if the parents wanted to sleep in their own bed! Of course, if there's a medical reason she'd be stuck, but yes to dad sneaking in food if doc doesn't let her eat.
I had a c-section under general anesthesia with my first. I woke up that morning and didn't feel well, so I thought I'd try eating. I ended up not being able to keep anything down, so I called my OB. They told me to go to L&D to have fluids. When I got to L&D, it was determined I probably had an infection of some sort--my WBC was 23,000, fetal heart tones of 209. Since they didn't know WHERE the infection was, they didn't want to do a spinal, so I had general anesthesia. They were nervous because I had been vomiting non-stop that whole day, but they applied cricoid pressure. Guess what? I (and the baby) was fine. I had a horrible case of chorio (not sure how because I had intact membranes). Anyway, that is the long way of saying that, even in the event of general anesthesia, aspiration risk is low. Think of all the traumas that require emergency surgery--those people certainly weren't NPO. I understand NPO if the plan is general anesthesia, but to starve a pregnant woman isn't fair! I had to starve for my second c-section (3:30 PM section time). They told me NPO at midnight. I made myself NPO at 7:30 AM and didn't tell them. I figured NPO at midnight with a 7:3o AM section is the same as NPO at 7:30 with a 3:30 section!
That is the most ridiculous thing I've ever heard!
Glad you guys rallied and stood your ground!
I was 'starved' during my first (induced) labour. I'm diabetic and the nurses were supposed to be controlling my sugars for me (they kept me hypo-glycemic for most of the time). I ended up blacking out in the bathroom at around hour 22. Obviously, something wasn't right! I wish I'd have just snuck some of the snacks we brought for my husband. I ended up throwing up anyway after my c-section, and it wasn't any nicer than throwing up real food. With this next one (I'm at 24 weeks) there's no way I'm letting them starve me! What are they going to do, take the food out of my mouth? What stupidity the hospitals here (Calgary, Canada) insist on!
I say, let them eat pie. :)
I was allowed to eat a popsicle with my third. This was a bad idea since I almost barfed it up two seconds later. I don't see anything wrong with clear liquids and "lighter" foods.
Lucky mom to have you advocating for her. Moms should eat when they are hungry! They need energy.
One of my biggest pet peeves as a nurse is brand new residents who think they know everything and can't be convinced otherwise by the lowly nurses, even though some of those nurses have been doing this work since the doctor was in grade school.
I'd probably have told the patient "technically I am required to say that you're not allowed to have anything to eat except this popsicle. But your husband can bring in whatever food he wants, and if I am out of the room between X time and Y time then I guess I just wouldn't know if you ate some dinner, right?"
The NPO thing pisses me off.
UGH!! I am a nursing student & had Mat last semester (I am also a doula & a CPM student) and this was so frustrating for me! I actually had a nurse who I was shadowing me tell that NPO is a MUST in L & D for aspiration risk. UGH!!! Then her patient had her family "sneak" her food on day 2 of her slow going induction. The woman was HUNGRY!!! It was hilarious, her trying to hide her chewing in front of this nurse. I just gave her a look & when the nurse left, to be careful. Know full well, her appetite would cease when "real" labor began.
Anon 2:14 "knowing full well that her appetite would cease when "real" labor began." I was hungry through my entire labor. From early morning to the birth of the child in the afternoon, and starving afterwards. So when did the "real" labor not begin with me? I snacked on hard candies the whole way through, begging for a granola bar or something with more substance. I hate the NPO, or only ice chips rule. It's only to make the anesthesiologist job easier, they could use a different intubation method that decreases the risk of aspiration in non fasting patients, similar to those used in the emergency field, but they prefer not to.
I am wondering about our local hospitals and how much they inforce this policy. I guess I will find out when I start doula work.
I was all set to sneak food into my room, but labor went really fast, so I didn't have to worry about it.
Personally I ate chinese food at 8:00 pm, started labor at 11:45 pm, and birthed my daughter at 4:56 am. If I had needed a c-section, that food would still have been in my stomach. You just can't control for all circumstances!
wow this is really upsetting. I had my first daughter in a hospital and they would not let me have a sip of water. I was soooo thirsty. They put the water by my bed and told me when I pushed the baby out I could have it. It was like torture.
I had my second daughter in a birth center all natural in a tub. It was the most amazing thing I have ever done. They encourage you to eat and drink. Giving birth is hard work and you need your strength. While I was in labor the midwife every once in a while would hold my drink in front of me so I could have some sips.
I've been reading you for at least two years, since I was pregnant with my first baby, and maybe I'm misunderstanding but if she doesn't eat doesn't it make it MORE likely that she'd need a c-section since a person can only function without food and fluid for so long? I mean, isn't this doctor sort of setting her up? I haven't read the above comments so this might be a duplicate you've already addressed.
BTW, I've learned so much from your blog. I felt so much more informed when I had my son and that took away a lot of fear. :)
Before my first birth of my first twins I asked my doc if he wanted to know that I was eating and drinking in labor or should I just sneak it when no one was in the room. He waited a beat and said, "well I guess I would rather know" and that was that, lol! Then I got smart and got midwives for the next four!
Oh and it was a 42 HOUR induction. Don't think I would have made it without that big pancake and sausage and egg breakfast hubby brought from the cafeteria on day 2!
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