Would you run a marathon without water or food?
Would you climb a mountain?
Would you have a baby?
Women giving birth expend a tremendous amount of energy. They sweat, urinate, defecate, and generally lose bodily fluids of all kinds.
Yet many hospitals in America continue to restrict what a laboring woman can eat or drink.
“It’s against hospital policy,” a laboring woman is told when she begs for some nutritious food.
These restrictions are a holdover from the late 1940s when Dr. Curtis Mendelson, a New York obstetrician, posited that food could be vomited and then aspirated into the lungs if a patient was under general anesthesia. Today the relevance of Mendelson’s findings, mostly done on experiments with rabbits, is disputed. And the fact is that the vast majority of pregnant women, even those who end up delivering via Cesarean section, will not be under general anesthesia.
A systematic review of the scientific literature, published by the Cochrane Institute in 2009, found no benefit to restricting eating or drinking during labor.
Despite these findings, the American College of Obstetricians and Gynecologists (ACOG), continues to recommend restricting food.
“Allowing laboring women more than a plastic cup of ice is going to be welcome news for many,” William H. Barth, Jr, MD, of Massachusetts General Hospital in Boston and chair of ACOG’s Committee on Obstetric Practice, is reported as saying in a press release about ACOG’s updated guidelines. “As for the continued restriction on food, the reality is that eating is the last thing most women are going to want to do since nausea and vomiting during labor is quite common.”
Eating is the last thing a pregnant woman is going to want to do?
Ah, Dr. Barth, one sees you have never been in labor or given birth to a baby.
Yes, women sometimes vomit. Yes, they sometimes feel nauseous. But they also feel hungry. Sometimes tremendously hungry. And a woman’s body knows what it needs.
If you have a baby in a hospital in Norway, the doctors won’t restrict your food intake.
At the Ullevål Delivery Department at the Oslo University Hospital in Norway, which I visited twice this September, the obstetricians or the midwives (midwives oversee 70 percent of the births in Norway) may even send you downstairs to the cafeteria to get something nourishing to eat.
If you don’t have the energy to walk that far, there are snacks on hand. In a window-lined room for laboring women and their families in the ABC (Alternative Birth Center) at Ullevål, which has a kitchen, table and chairs, toaster, and microwave, there’s a nice big refrigerator. Tubs of liver paste, tubes of caviar, butter, fruit juice, and frozen whole grain bread are available to anyone — the laboring woman, the eager spouse, or the hungry journalist.
It strikes me as ironic that in countries that have the best birth practices (and the best maternal and fetal outcomes), the evidence used often comes from studies done partially or entirely in the United States.
In Iceland a baby is not washed after birth, because science has shown that this does more harm than good and that the fluids on a baby’s body are actually good for her skin. Continuous fetal monitoring is not used during low-risk pregnancies, because studies have shown that this kind of monitoring only leads to more unnecessary C-section and other intervention, not to better outcomes. And women are allowed to eat what they want when they want it.
Is it naive or clairvoyant to imagine that one day our birth system will be more like Scandinavia’s — that in America we, too, will start paying attention to the science and best evidence? That we will try to empower a woman to have the best birth she can? That we will treat her with dignity and respect as she does the hard work of birthing a child? And let her eat and drink what she wants when she wants it?