February 17, 2010
Research You Can Use
February systematic review: Eating and Drinking in Labor
For decades, women entering the hospital for labor and birth have been told not to eat or drink, typically receiving only ice chips and sips of water from the time they enter the hospital until the baby is born. The reason for this policy is to avoid the risk of a rare but serious problem in the event that the laboring woman needs emergency general anesthesia. Research conducted in the 1940’s showed a heightened risk under general anesthesia of vomiting and inhaling the stomach contents into the lungs, where its high acidity can cause damage to the lung tissue (a condition called Mendelson’s syndrome). While some women in active labor do not feel like eating or drinking, others may be hungry or thirsty, or need to replenish their energy during a long labor. In recent years, regional anesthesia is most often used during labor and birth, and general anesthesia techniques have improved in cases of emergency.
A new Cochrane systematic review looked at the pooled results of 5 experimental trials including 3130 women at low risk for complications requiring general anesthesia. The review compared the outcomes for women whose intake was restricted to water only to those who were allowed to eat and drink various substances. No statistically significant differences were found for any of the outcomes studied. These included, as primary outcomes, cesarean birth, operative delivery and Apgar scores, and secondarily, maternal nausea and vomiting, use of pain medication, length of labor, labor augmentation and NICU admissions. Mendelson’s syndrome is so rare that it was impossible to assess whether eating and drinking in labor made any difference to the incidence of this problem.
The take-away: Many people have questioned the basis for restricting women’s oral intake at a time when they are exerting great physical and metabolic energy and when exhaustion and dehydration can negatively impact the progress and outcomes of labor and birth. None of the studies in the review assessed how women in labor feel about policies that do not allow them to eat or drink during labor. The results of this review support allowing women at low risk for surgical complications to make their own choices about dietary intake during labor and birth, eating and drinking to their own comfort level.
California Task Force Confronts Rising Maternal Mortality Rate
While the rate of women in California who die from pregnancy-related causes has tripled in the past decade, that state’s department of health has chosen not to release a report highlighting this alarming trend. “More women dying from pregnancy complications; state holds on to report” was published on February 2nd by California Watch, and featured on the front page of the San Francisco Chronicle. The story discusses the potential reasons behind the trend and, using data from Childbirth Connection, touches on the financial incentive to perform c-sections.
The article states that findings by national bodies including the Centers for Disease Control and Prevention also point to a rise in maternal death rates across the country. Factors including obese mothers, older mothers, fertility treatments and better reporting on death certificates cannot fully account for the rise in mortality. In California, there was also a 50% increase in the number of c-sections over the past ten years. A California state task force concludes that altering the way providers are practicing could prevent a large number of deaths. The staff at Childbirth Connection would like to wish you joy and peace as we look forward to the new year.
A Tribute to Susan Hodges
Susan Hodges, co-founder of Citizens for Midwifery, has just stepped down after serving as the group’s president for 13 years.
We salute Susan for her many contributions to support the Midwives Model of Care, which includes:
Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
Minimizing technological interventions
Identifying and referring women who require obstetrical attention.
Under Susan’s leadership, Citizens for Midwifery has supported such care by working collaboratively with like-minded organizations, maintaining a website, producing the Midwives Model of Care brochure, sending Grassroots Network email messages, publishing a newsletter, using social media, and many other means. We wish Susan and her family and Citizens for Midwifery well!
NIH Conference on VBAC to Develop Consensus
Since 1996, VBAC rates have consistently declined, while c-section rates have been on a steady rise. The National Institutes of Health is hosting the Consensus Development Conference on Vaginal Birth after Cesarean, March 8-10 in Bethesda MD. Experts will present findings from a systematic review of the scientific evidence, discuss key questions, listen to public comment, and prepare a consensus statement on the key questions. Questions include: what are the benefits and harms of trial of labor after prior cesarean?; what are the factors that influence the use of trial of labor after prior cesarean? The conference is free and open to the public and will be broadcast live via the Internet.
Two Major Reports Released to Make Maternity Care Better
Last month, we released two reports that are the culmination of over two years’ work by more than 100 maternity care leaders. Just as the Institute of Medicine's Crossing the Quality Chasm defined high-quality health care, the “2020 Vision for a High-Quality, High-Value Maternity Care System” presents a shared view of fundamental values, principles and attributes that constitute a high-quality, high-value maternity care system. The “Blueprint for Action” provides detailed strategies developed by five stakeholder workgroups to achieve the Vision. Specific strategies in 11 critical areas are outlined and answer the question: "Who needs to do what, to, with, and for whom to improve the quality of maternity care over the next five years?"
Read and tell others about out our web page “Tips & Tools: C-Section” for tips you can use during labor to increase your chances of having a vaginal birth.