General Hospital Birth Obstetricial Interventions: Cochrane eating in labor non per os birth non per os labor restriciting drink in labor restricting food in labor Robbie Davis-Floyd
by Unnecesarean
Restriction of Food and Drink in Labor from a Medical Anthropologist’s Perspective
The recent Cochrane review, Restricting oral fluid and food intake during labour, analyzed five studies and concluded that women should be free to eat and drink in labor at will.
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.
The rationale behind denying laboring women food is that the danger of aspiration and the potentially lethal complication known as Mendelsohn’s syndrome while under general anesthesia is greatly reduced.
Medical anthropologist Robbie Davis-Floyd wrote extensively about the cultural myths about non per os and childbirth in the 1992 book, Birth as an American Rite of Passage. Mendelsohn’s original 1946 article reported several cases of aspiration and subsequent pneumonia, but no deaths. Davis-Floyd cites Baggish’s 1974 study which showed that at most 2 percent of maternal deaths were caused by aspiration under general anesthesia and Scott’s 1978 work that placed the risk of death at 1 in 200,000 women.
So what purpose would denying food and drink to all laboring women serve more than six decades after Mendelsohn’s work and with the great improvements made to regional anesthesia? Davis-Floyd wrote:
According to Feeley-Harnik, “persons undergoing rites of passage are usually prohibited from eating those highly valued foods that would identify them as full members of society” (1981:4). In rites of pregnancy and birth across cultures, food tabus serve the purpose of marking and intensifying the liminal status of the pregnant woman. The pseudo-foods (ice chips and lollipops have no nutritional value) allowed in the hospital are often fed to the laboring woman by her partner as if she herself were the baby, a symbolic process that can heighten her own sense of weakness and dependence.
In a recent article in Birth, Broach and Newton (1988) address the question of why laboring women are still prohibited from eating and drinking in labor in spite of mounting evidence that such prohibitions are medically contraindicated. Pointing out that this custom started in the 1940’s when general anesthesia was widely used for childbirth and the danger from aspiration was therefore higher, they posit that its continuance is the result of “culture lag”—that is, of “culturally patterned behavior that continues to be practiced long after the reasons for doing so have disappeared” (1988:84).
Davis-Floyd views denying food in labor as indicative of the confirmation of a woman’s initiate status as a dependent of the institution.
On the contrary, I would suggest that this custom forms an integral part of the technocratic tapestry of birth in the United States, continuing as routine procedure not because of culture lag but because it serves so well to legitimate and further necessitate the technocratic interventions we investigate here as transformative rituals. To deny a laboring woman access to her own choice of food and drink in the hospital is to confirm her initiatory status and consequent loss of autonomy, to increase the chances that she will require interventions, and to tell her that only the institution can provide the nourishment she needs—a message that is most forcefully conveyed through the “IV.”
Restriction of food and liquids in labor was the subject of many discussions last year following the American Congress of Obstetricians and Gynecologists’ press release that women should be allowed “modest amounts” of water and clear liquids in labor, with physicians defending IV use and telling women to calm down their rhetoric and fight for things that matter.
Have you dug into Childbirth and Authoritative Knowledge yet?
I have often thought that it was insane to deny me an oppportunity to fortify myself for the nearly 24 hours of labor. I ended up not being able to eat for almost 1.5 days while giving birth inbetween. I almost passed out when they wanted me to go to the bathroom for pity sake. I didn’t see why I couldn’t have eaten a light dinner the night before. This confirms my every suspicion given my experiences since: nobody really knows what they’re doing or why.
Speaking of “rites of passage,” what is with making the dad put on scrubs before he can go with his wife to the OR? She wears the same hospital gown into the OR that she’s been wearing for hours in labor…but he needs to put on scrubs. As a doula, when I’m allowed to go in, I’m given a set of hospital scrubs to put on…even though I’m already wearing my own scrubs. I’ve never argued it because it just doesn’t seem worth the ill will…but really, what is the point?
I understand why the medical staff wear scrubs–in case they get bodily fluids on them while performing surgery, they don’t want to carry potentially infectious materials home with them. But the father? Presumably he has exchanged fluids with the mom. And me, as the doula? Well am I really any more likely to get fluids on me when sitting next to the mom’s head during a cesarean than I am holding her leg during a vaginal birth?
by Childbirth Education | Doula Support | Allentown | Lehigh Valley | Baby Birthing | Knitted in the Womb » Speaking of “Rites of Passage”
[...] The Birth Activist recently wrote about restrictions of food and fluids for laboring and women, and how Robbie Davis-Floyd has written about this phenomenon as a “rite of passage.” The Birth Activist highlighted a recent Cochrane Review that found that food/fluid restrictions in labor are unnecessary, something I agree with whole heartedly, having eatten a VERY large breakfast more than 12 hours after contractions had started in my first labor. She then points out that Robbie Davis-Floyd has long identified the ban on eating/drinking in labor as a “rite of passage.” [...]
Hi knitted in the womb - the idea of changing into theatre scrubs (even if you are already in your own scrubs) is not to reduce your risk of being contaminated by the woman but to decrease her risk of being contaminated by all the people in theatre, and to try to reduce the pathogens brought into theatre from outdoors and within the hospital. Similarly wearing a theatre cap is to reduce any loose hairs floating around and getting into the wound, and face masks also help protect the woman from airborne pathogens. Changing into theatre scrubs helps protect not only the woman you are working with but all the other people needing surgery by keeping theatres as clean as possible. The woman is generally not made to change because she’s probably got enough to deal with at that time. The need of the general population for cleanliness in theatre is balanced with sensitivity towards the individual’s circumstances.
We all see doctors walking around the wards in their theatre scrubs. When they do this they are not supposed to go back in without changing into fresh scrubs.
RE eating in labour - here in Australia women eat if they want to, once they are in good labour they generally can’t eat much anyway, and often vomit anything in their stomach up. The digetsive system slows right down in order that as much energy as possible is concentrated on the uterine muscles.
It would be interesting to know about cultural differences in foods taken in labour.
Oooh I LOVE Robbie Davis-Floyd! I have “Birth as an American Rite of Passage” on my shelf waiting to be read. Its so true; the food rules to enforce the liminal status of the woman during the birth ritual!