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Monday
Sep042006

Barfing in Labor

In my experience, women in the hospital barf a whole lot more than women in home births. It makes perfect sense! Women in the hospital are starved! Women in the hospital have hypoglycemia which causes nausea which brings on vomiting. Women at home are encouraged to eat to hunger, even if it is simply nibbling. Those women who aren't very hungry are nudged towards eating something because they start to complain of nausea. Once they have eaten something, miraculously, their nausea disappears.

Do women who eat in labor throw up? Sure. Do women who don't eat not throw up? Sure.

But, by far, I see it as a definite cause and effect of no food = nausea/vomiting. (I also know I would much rather throw something up than nothing. But that's just me.)

That doctors continue saying digestion stops in labor is absurd. Oh, that's right, MIDWIVES say that, too! A local midwife just said that this week here! It might slow. But stop? C'mon. Why would it stop? Does elimination? No. Doctors have a vested interest in keeping women NPO (nothing by mouth) - they are easier/safer to anesthetize that way (supposedly). Why a midwife would want a woman to not eat is beyond me.

I believe doctors who continue the old saw that women in labor shouldn't eat simply have no experience with women who have. Just like a lot of other things like women who walk or squat or not have IVs or moan or or or.

Rise up and eat women! Barf no more.

Reader Comments (19)

Amen to that! My first birth with a CNM was horrible...they wouldn't let me eat or drink but complained that I looked "dehydrated." When I finally begged for water after the cranberry crap that I threw up...well..they gave me some..which I then threw up. Then I was scolded in a harsh tone, "See, that's WHY we don't let you have water!"

September 4, 2006 | Unregistered CommentercreepyUCmama

Like many 'rules' of childbirth, I think this one needs to be flexible to the particular woman.

Some women want to eat, some do not.

My dh fed me broth and sports drinks throughout labor. He offered me more substantial food, trying to get me to eat the chicken or noodles in the soup, but I did not want any. I did vomit a couple of times just before transition.

Should I have taken the chicken and noodles?? Maybe. Other women tell stories of eating a sandwich, etc while laboring. Sounded horrid to me though.

We should do what feels best for each of us.

Thanks for this!

September 4, 2006 | Unregistered CommenterLindsay

Hear, hear!
Its absurd to make a woman endure the rigors of labor without nurishment and calories. Labor is hard work. When will medical "knowledge" catch up to common sense?

September 4, 2006 | Unregistered CommenterLaborpayne

I *so* agree with you on this. It is one of my (many) pet peeves about laboring in a hospital setting. I am lucky to work with some good midwives, and even some docs who will say ok to letting a woman eat something light in labor. However, this is rare. I have also butted heads with a certain MD (an attending), when I have allowed his patients to have a light snack/light meal. One time, it was just a very light snack - fat free, sugar free ice cream - vanilla - poor girl was on pitocin, but wasn't in labor yet, nor was she in pain. No cervical change. I figured, she's hungry, give her a *little* something to tide her over. (I also gave her some shortbread cookies, which the doc never found out about). He had a hissy fit in the patient's room when he saw her eating the tiny little hospital size portion of non-fat, no sugar ice cream. "Studies show that eating in labor is not beneficial, leads to aspiration pneumonia with general anes for c/s"...etc. "If I had it my way, NO ONE on labor and delivery would have anything other than ice chips - and that's being generous! (the ice chips)" I swear......I thought *that* line of thought had gone out with the dark ages.......

I always tell women if they are being induced - EAT before you come in here, because most likely your doctor will not allow you any food.

Like I said, there are a few exceptions (CNM's and docs) who I love to work with, because they think "outside the box" and realize that laboring women need energy AKA nutrition during labor!

September 4, 2006 | Unregistered CommenterAtYourCervix

I barfed with all 4 of my labors....but it wasn't until the 3rd one (which was a HB) that I welcomed it instead of dreaded it. One barf is worth 3 or 4 good contractions and that labor was utopian-like.
I was hungry during that labor and wanted to eat and did....the 4th one I didn't want any food near me and had to force liquids. Go figure :)
As far as medical environment or caregivers insisting the they be accomodated instead of laboring mom....it's all about the caregiver, isn't it? LOL

September 4, 2006 | Unregistered CommenterWash Lady

Oh, but, some women in home births don't want to eat for HOURS... and I mean upwards of 10-12. While *they* might not be hungry, you wouldn't not feed a newborn for that long would you? Sometimes a laboring woman has to do things for the baby even if she doesn't want to do them. I don't mean that mean or flippantly at all; I mean that lovingly and kindly.

If a woman isn't wanting to eat for a couple few hours, goodness, leave her alone! Who cares! Don't push food. Sips of water offered, sure. (Electrolyte water is better than regular water in my mind and experience.) But food, even soft foods, don't have to be a matter of course all the labor long.

Does that make more sense?

I was more talking about the act of throwing up in labor itself, not eating in labor. But great point - and thanks for bringing it up.

September 4, 2006 | Unregistered CommenterNavelgazing Midwife

Ehh...I'm all for throwing up in labor...gets things moving. Usually I dread puking and will endure hours of shaking and misery to prevent said puke..but during labor...bring on the heaves.

September 4, 2006 | Unregistered CommentercreepyUCmama

so there is a small bit of evidence for feeding/light eating.

Anaesthesia. 1999 Apr;54(4):329-34.

Comment in:
Anaesthesia. 1999 Oct;54(10):1017-9.

Eating in labour. A randomised controlled trial assessing the risks and
benefits.

Scrutton MJ, Metcalfe GA, Lowy C, Seed PT, O'Sullivan G.

Department of Anaesthetics, St Thomas' Hospital, London, UK.

The aim of this study was to determine whether permitting women in labour to eat
a light diet would: (i) alter their metabolic profile, (ii) influence the
outcome of labour, and (iii) increase residual gastric volume and consequent
risk of pulmonary aspiration. Women were randomised to receive either a light
diet (eating group, n = 48) or water only (starved group, n = 46) during labour.
The light diet prevented the rise in plasma beta-hydroxybutyrate (p = 2.3 x
10(-5)) and nonesterified fatty acids (p = 9.3 x 10(-7)) seen in the starved
group. Plasma glucose (p = 0.003) and insulin (p = 0.017) rose in the eating
group but there was no difference in plasma lactate (p = 0.167) between the
groups. There were no differences between the groups with respect to duration of
first or second stage of labour, oxytocin requirements, mode of delivery, Apgar
scores or umbilical artery and venous blood samples. Relative gastric volumes
estimated by ultrasound measurement of gastric antral cross-sectional area were
larger (p = 0.001) in the eating group. This was supported by the observation
that those from this group who vomited, vomited significantly larger volumes
than those in the starved group (p = 0.001). We conclude that eating in labour
prevents the development of ketosis but significantly increases residual gastric
volume.

PMID: 10455830 [PubMed - indexed for MEDLINE]
-----------------------------------------
I love this one very clear review of the lit---with a decent clear cut set of odds

J Obstet Gynecol Neonatal Nurs. 1999 Sep-Oct;28(5):507-12.

Fasting in labor: relic or requirement.

Sleutel M, Golden SS.

Angelo State University in San Angelo, TX 76909, USA.

OBJECTIVE: To evaluate the scientific literature on restrictions of eating and
drinking during labor. DATA SOURCES: Computerized searches in MEDLINE and
CINAHL, as well as historical articles, texts, and references cited in published
works. Key words used in the searches included anesthesia in labor, childbirth,
eating and drinking, epidural, fasting, fasting in labor, fasting and pregnancy,
gastric aspiration, gastric emptying, intrapartum, intravenous fluids, i.v.s in
labor, ketonuria, ketonuria in labor, parturition, pregnancy, and stomach
contents in labor. STUDY SELECTION: Articles from indexed journals, excluding
single-person case studies. DATA EXTRACTION: Data were extracted and organized
under the following headings: historical review, effects of fasting on labor,
research on maternal mortality/morbidity from aspiration, research on gastric
emptying in labor, intravenous hydration in labor, and implications for nursing
research. DATA SYNTHESIS: Research does not support restricting food and fluids
in labor to prevent gastric aspiration. Restricting oral intake during labor has
unexpected negative outcomes. CONCLUSIONS: Little is known about the differences
in labor progress, birth outcomes, and neonatal status between mothers who
consume food and/or fluids during labor and women who fast during labor.
Research also is needed on the effects of epidural opioids on gastric emptying,
nutritional requirements during labor, and the physiologic implications of
fasting during labor. Fasting during labor is a tradition that continues with no
evidence of improved outcomes for mother or newborn. Many facilities (especially
birth centers) do not restrict eating and drinking. Across the United States,
most hospitals restrict intake, usually to ice chips and sips of clear liquids.
Anesthesia studies have focused on gastric emptying, measured by various
techniques, presuming that delayed gastric emptying predisposes women to
aspiration. Narcotic analgesia delays gastric emptying, but results are
conflicting on the effect of normal labor and of epidural anesthesia on gastric
emptying. The effect of fasting in labor on the fetus and newborn and on the
course of labor has not been studied adequately. Only one study evaluated the
probable risk of maternal aspiration mortality, which is approximately 7 in 10
million births.

PMID: 10507677 [PubMed - indexed for MEDLINE]

September 4, 2006 | Unregistered CommenterAnonymous

ok to not push food to a degree- was at a woman's birth who had made up her mind from her first birth experience that the midwives had made her eat some honey that we were to not mention food or drink... well fine until she was worn out and no strength for pushing- we went to suggest something and all along previous to this she was drinking- well her husband ran interference for her and reminded us of their wishes-- well ok until I smelled ketones on her breath- and all I had to do was announce that and she knew what that meant- and she asked for something- which made her feel better but she was worrying that it would make her feel more nauseated- pushed her kido right out after that gave her some energy - before that she just wanted to not move even though her legs were swelling and getting cramps and labor was "hurting more" - I think that a bit of food can help your coping abilities- and we do rarely see vomiting- maybe with rapid labors I have seen more vomiting.

September 4, 2006 | Unregistered CommenterAnonymous

ok to not push food to a degree- was at a woman's birth who had made up her mind from her first birth experience that the midwives had made her eat some honey that we were to not mention food or drink... well fine until she was worn out and no strength for pushing- we went to suggest something and all along previous to this she was drinking- well her husband ran interference for her and reminded us of their wishes-- well ok until I smelled ketones on her breath- and all I had to do was announce that and she knew what that meant- and she asked for something- which made her feel better but she was worrying that it would make her feel more nauseated- pushed her kido right out after that gave her some energy - before that she just wanted to not move even though her legs were swelling and getting cramps and labor was "hurting more" - I think that a bit of food can help your coping abilities- and we do rarely see vomiting- maybe with rapid labors I have seen more vomiting.

September 4, 2006 | Unregistered CommenterAnonymous

One word of warning...if you only eat blueberries during labor and then barf it looks like you're barfing blood.

I did that recently to the navelgazing one herself. There was a moment of "oh shit!" until everyone remembered the berries!

September 5, 2006 | Unregistered Commenternolabarb

http://www.cochrane.org/reviews/en/topics/87.html#topic_16

Apparently they are actually looking into it. No results posted yet though.

The thing that gets me are all these comments where they say, "The doctor will not ALLOW you to eat." Since when can a doctor decide what a patient does or doesn't do? I'd like for all my patients to exercise, take their medicines as directed, stop smoking, etc. Anyone who has any experience at all knows that this is rarely the case. Why is it that suddenly, a woman in labor can be *commanded* not to eat? Whatever happened to patient autonomy?

Even if the studies did show some risk, people are allowed to make informed choices about what to do with their bodies. I just don't get this.

September 5, 2006 | Unregistered CommenterThe MSILF

Very interesting...my doctor required the usual NPO after midnight for my 0730 surgery (a subtotal hysterectomy) this last week. I also had a spinal while my roommate had general anesthesia. Her surgery was pushed out to 1130 instead of 0800 because of an emergency (that had to be put in front of her TAH.) She was ALSO told by her doc that if she began on a liquid diet a full day in advance she'd have less nausea. I ate a big meal at 2130 and a snack about 2330 before I had to stop eating. The roomie ate last two days before her surgery except for liquids ("don't eat anything you have to chew" her doc told her.) She was SO NAUSOUS and vomiting post-op. I had NO nausea. NONE.

Interesting.

Hh

Come to think of it baby one I puked my guts up, baby two, no puking (I had some yummy jamba juice....)

September 5, 2006 | Unregistered CommenterAnonymous

I posted your post on my blog. I gave you credit and linked though!

September 6, 2006 | Unregistered Commentersajmom

You are probably right. However, during my Homebirth I puked about 6 times and I had eaten a good amount. For me, I just think my body was working good to open my cervix and the puking helped that. I don't mind puking so it was all good and my labor was estastic. Purely and utterly.
XOXO,
Leigh

September 7, 2006 | Unregistered Commenterleigh

just got back from a 40 hour labor that started with puking and continued throughout...seemed like every time there'd be a really huge o contraction that just sort of felt like there was some major cervical change, she would retch so violently you'd of thought the baby was going to come out her mouth rather than her vagina. She took it in stride. Ended up pushing her baby out after no sustenance for 60 hours (did sip on elecrolyte juice, but it all came up pretty quickly) Anybody got some ideas for how to quell this kind of puking once it gets going?

September 8, 2006 | Unregistered CommenterAnonymous

I see where you are coming from but I have to tell you that I just had a baby at home (and I ate before and during) and I kept throwing up. I know it's normal and all, but throwing up always sucks! I pretty much had my team trained (we had two throw up buckets going, too) that when I gasped, "Bucket!" someone put a clean bucket in my face. Many blessings on the dear friends who cleaned my bucket for me. :)

Food in labor is important, though, but sometimes you do still puke. (As I'm sure you know.)

September 14, 2006 | Unregistered Commenterbirthstudent

Interesting point.

The hospital where I volunteer is very liberal about food. I've seen them give a full meal to a woman shortly after she received an epidural. The nurse admitted that particular one was bending the rules a bit, but serving meals to women in labor is standard policy.

I have yet to see a mother throw up. Some have felt nauseous, but no actual vomit.

When I had my son, my OB allowed me to have a popsicle, against hospital policy (waaaay different hospital!). I was so glad to be throwing up grape flavored stuff rather than straight stomach acid.

September 22, 2006 | Unregistered CommenterAnonymous

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