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Sweet Peas, Pods & Papas: All About Birth, B@@bs & Babies

To Eat or Not To Eat…

To eat or not to eat…That was the question for families planning a hospital birth.  When you are laboring at home or a birth center, you have the freedom to eat as your appetite dictates.  If you choose to have a hospital birth, you are at the mercy of your doctor’s orders and the nurse’s interpretation of the hospital protocol.  

We love it when science catches up to Dr. Bradley.  Anecdotally, we could tell students that it was safer to eat before/during labor since anesthesia has changed from the days of "knock'em out, drag 'em out" birth, as Dr. Bradley called it.  Women used to be under general anesthesia, which is administered differently than today's spinal or epidural blocks.  

We are so excited to update this post (and our class info!) with a press release from the American Society of Anesthesiologists (ASA):

"Most healthy women can skip the fasting and, in fact, would benefit from eating a light meal during labor, suggests research being presented at the ANESTHESIOLOGY® 2015 annual meeting. Improvements in anesthesia care have made pain control during labor safer, reducing risks related to eating, researchers note."
ASA Press Release, "Most healthy women would benefit from light meal during labor", October 24, 2015

For other reading,  HERE is some research I had found before this 2015 press release to make the case for eating and drinking in labor (in case you want to do more poking around the subject).

Now...how long will it take for hospital protocols to change and reflect these recommendations from ASA? As we found out the hard way, sometimes the doctor approves something but if it is not in writing and signed off on the birth plan, it probably isn't going to happen in the hospital setting. The nurse will follow the hospital protocol or they may invent their own interpretation if none exists to cover their liability.  If you are going to have a hospital birth, I have a strong opinion about getting your wish list signed so that the nursing staff has “permission” to “break the rules” if they feel that something you are requesting is out of the ordinary.  Maybe you could ask for a copy of the ASA press release to be included in your chart that goes to the hospital.

Dr. Bradley always advocated that a healthy mom should eat if she is hungry and drink if she is thirsty.  As he said, “Birthing is like playing a full game of football without any substitutions.”  He recognized that labor is an athletic event, and that a well-nourished athlete would perform better than a hungry one.

Science and the ASA catch up to Dr. Bradley:
"The research suggests that the energy and caloric demands of laboring women are similar to those of marathon runners, Harty said. Without adequate nutrition, women’s bodies will begin to use fat as an energy source, increasing acidity of the blood in the mother and infant, potentially reducing uterine contractions and leading to longer labor and lower health scores in newborns. Additionally, the studies suggest that fasting can cause emotional stress, potentially moving blood away from the uterus and placenta, lengthening labor and contributing to distress of the fetus."  

A Note About Hospitals and Nourishment
If you are having a hospital birth, you need to find out how your care provider feels about nourishment during labor, even with this announcement by the ASA. If your care provider is on board with mom eating and drinking as her body directs, great!  Get it into your birth plan, aka "wish list", that you have permission to eat and drink.  If they restrict intake, you need to think about your options.  You may question whether or not your care provider is truly supportive of your plans for a natural birth.  

You should also ask what the hospital policy is on food and drink during labor when you do your hospital tour.  It helps to know what kind of potential situations you may be facing so you can avoid stress-inducing encounters during labor.

The potential conflict between a laboring mother’s needs for nourishment and her care provider or hospital protocol comes from the days when general anesthesia was standard for hospital births.  There was a very real danger of a mom “aspirating”, meaning that food or drink the mom had consumed before labor would be regurgitated and accidently enter the trachea and lungs, creating a life-threatening condition to mother and baby.  [See reference 1]

From the press release:
"Researchers said aspiration today is almost nonexistent, especially in healthy patients. In the United States, there was only one case of aspiration associated with labor and delivery between 2005 and 2013, involving a complicated case of a woman who was obese and had pre-eclampsia (a precursor to eclampsia, or high blood pressure that can lead to seizures), according to the American Society of Anesthesiology’s Closed Claims Project database. Researchers also noted that no cases of death due to aspiration were reported in the United Kingdom between 2000 and 2005, compared to 1.5 cases per 1,000 during the 1940s. They say this is likely due to advances in anesthesia care, including increased use of epidurals and spinal blocks in place of providing anesthesia through a mask over the nose and mouth. Before these improvements, women were more likely to need a tube placed in the windpipe for breathing, which potentially increased the risk of aspiration." 

Although very few women have births under general anesthesia nowadays, the practice of restricting food and drink still persists.  You may hear it called “NPO”, which stands for the Latin, “non per os”, meaning nothing by mouth.  With the press release from the ASA, we can keep our fingers crossed that hospitals will start to change their practice protocols.

In the past, it was likely that you would only be allowed ice chips if you opted for an epidural.  The chance of needing general anesthesia was within the realm of possibility since some moms and babies “crash” after the epidural dose is dispensed.  As with all labor interventions, you don’t know how you will react until it’s administered.  Although it’s a small percentage of women that have life-threatening complications, the prospect of the drugs dropping your heart rate, blood pressure or respiration to dangerously low levels exists once they are in your bloodstream.  In the instance of a “crash”, you would need general anesthesia to perform an emergency cesarean to save your or your baby’s life, thus your nourishment options become limited to ice.

Eating and Drinking During Labor
Have your refrigerator stocked with your favorite healthful foods and/or meals as you near your estimated due date.  Labor is a funny thing – you never know what your body is going to like.  If you think you are in labor, you can go through Dr. Bradley’s list of things to do to see if you are in pre-labor (contractions slow down or stop) or actual labor (contractions continue at same pace or get closer and harder despite the change in position or activity).  To "test" for labor, he suggests that a woman should eat, drink, go for a walk, shower and nap – in that order.  

When you start with the “eat” part of the list, it will be more satisfying to eat something you really enjoy.  If you are not in labor, at least you ate something you like and you can move on with your day with a tummy-full of your particular “comfort food”.  If you are in labor, then you have eaten something that is fueling your body for the labor.  It will put you in a good frame of mind if you ate something that is a favorite and you create a positive emotional state.

The best drink during labor is water.  Water is a key to staying hydrated and avoiding the slippery slope of interventions.  A hydrated body has the energy for the work of labor.  Ample water also allows for effective hormone distribution throughout the body: the chemicals and hormones being made to stimulate and progress labor are able to circulate freely.  If you have a longer labor, consider an electrolyte replacement: trace minerals added to the water you are drinking, Emergen-C makes a powder, or coconut milk is a "natural" version of sports drinks.

Dehydration causes a spike in temperature and blood pressure, while at the same time depleting your energy by as much as 30%.  Can you see that simple dehydration can also be interpreted as the mom being “in distress”?  Your care team will not want to take a chance of making the wrong call, so they are likely to intervene or suggest drastic measures to “save” mom and baby.

Whether you are laboring at home, a hospital or birth center, small-portioned, protein rich snacks are nice to have on hand.  As your labor progresses, a laboring woman’s appetite will naturally decrease as the body shuts down other functions such as digestion to allow for full focus on the progression of labor and birth.  

Here are some foods that we and other students have found useful for quick energy boosts when mom doesn’t have the desire to eat a full meal.  These snacks are also handy for the coach to get the energy boost he needs to be a great support person for mom.  We don’t want hungry, cranky coaches during labor!!

What the ASA recommends:
"A light meal could include fruit, light soups, toast, light sandwiches (no large slices of meat), juice and water. Most women lose their appetites during very active labor, but can continue to drink fluids such as water and clear juices, researchers said." 

- Honey sticks.  According to honey.com, “Honey is also a rich source of carbohydrates, providing 17 grams per tablespoon, which makes it ideal for your working muscles since carbohydrates are the primary fuel the body uses for energy. Carbohydrates are necessary in the diet to help maintain muscle glycogen, also known as stored carbohydrates, which are the most important fuel source for athletes to help them keep going.” [2]

- Cheese sticks.  Cheese sticks are a great source of quick protein and will also provide an energy boost if you want to chew something rather than sip it.  Another benefit is that it is something the eat that provides energy without being too filling.


- Trail mix.  You get the nice variety of nuts, dried fruits and if you want, candy, in one bag.  I found myself picking out my favorite nuts and fruits and snacking on them – literally one or two at a time – as we got into the active phase of first stage labor.

- Protein bars or chews.  Look for bars that are low in carbs and added sugars –the key is to provide an energy boost without an energy crash afterwards. We have had students that use the “PowerBar” brand Energy Bites, as well as Gel Blasts that are bite size energy foods.

- Handful of nuts.  If you have a favorite nut (besides your coach-lol), bring some with you.  You can eat 1 or 10, whatever you are in the mood for.  I like nuts because you get the energy boost in whatever quantity you are in the mood to chew and swallow.  Trader Joe’s sells packages nuts in handy single serve packets.  I usually eat 2 or 3 pieces, and Bruss would finish off the bag for his energy boost.

- Popsicles.  While working hard in labor, a popsicle can be refreshing.  To prevent an energy crash, look for a brand that uses natural fruit as a sweetener instead of added sugars.  Added bonus: you can also push it against the top of your palate to stimulate oxytocin production.

- Applesauce cups.  Provide potassium along with a little protein.  The nice thing about applesauce is that while some people prefer them cold, they don’t need to be refrigerated.  Again, look for naturally rather than artificially sweetened sauces.

- Banana.  Another source of potassium that is portable and easy to eat.  To prevent a sugar burst, pair this with a cheese stick to balance out the carbs.



- Soup or clear broth.  Campbell’s came out with the “Soup at Hand Cups” that are single serve, portable and microwaveable.  They were a God-send during our third birth.  The nurse didn’t want me to eat “just in case”, but she was okay with me drinking – hence, I could drink my meal and stay nourished through our 34 hours at the hospital.

- Single serve smoothies or juice drinks.  I am thinking along the lines of Stonyfield Farm Smoothies or Drinkable Yogurts for a liquid protein boost, or the Odwalla line of Protein Beverages.  It’s a little sip of something sweet with carbs that still offers a protein source for energy.

As you noticed from the list, some of these foods need refrigeration or a heating source.  These are considerations if you are having a hospital birth.  It stands to reason that if you will not have access to a refrigerator or microwave, the items that won’t stay cool with an ice pack or the foods that need to be heated need to left out of the cooler.

The bottom line: eat to appetite and drink to thirst for the best labor possible!  I hope this list gives some ideas with which you can fill your refrigerator or cooler.  What did you eat during your labor?

Disclaimer:
Bradley Method classes offered in Arizona convenient to Chandler, Tempe, Gilbert, Mesa, Ahwatukee, Scottsdale, Phoenix and Payson, AZThe material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

References:
[1] http://en.wikipedia.org/wiki/Pulmonary_aspiration

[2] http://www.honey.com/nhb/benefits/natural-energy/


4 Comments to To Eat or Not To Eat…:

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Rachel Davis on Friday, June 24, 2011 7:10 AM
Another fantastic post, as always! During our hospital birth, I mostly had bites of protein bars, yogurt, emergen-c, and honey sticks. For our out-of-hospital birth next month, we are planning to have eggs, whole wheat toast, and a variety of fresh fruit...in addition to most of the other awesome things you mentioned.
Reply to comment
 
Krystyna on Friday, June 24, 2011 7:20 AM
Hi, Rachel. I debated putting hard-boiled eggs on the list since they are "portable"...I just didn't know how laboring moms would react to the smell and texture of eggs during labor. I agree that toast and fresh fruit are going to be a wonderful addition to labor energy foods! Please let me know how your labor goes in regards to this aspect. I can't wait to hear what you craved and actually ate outside of the parameters of what you are allowed in a hospital.


Ashley Bennett on Wednesday, June 29, 2011 7:15 PM
I'm loving your posts Krystyna! I'm one of the students from Freedom and the Seed (was at you initial visit). This is great and I'll be sure to recommend it to other moms, and my other midwifery-student freinds. What a great way to share such valuable information. Thanks for all you do:)
Reply to comment
 
Krystyna on Wednesday, June 29, 2011 9:48 PM
Hi, Ashley. Of course I remember you! I am glad to hear you found this information to be a helpful resource. Thanks to you, too, for your dedication to the study of midwifery. You are now, and will continue to be, a blessing to many lives!! I look forward to seeing you again soon.

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