Sunday, February 20, 2011

Re-Blog: Eating and Drinking during Labor from a Medical Anthropologist's Perspective

In this article, we see Robbie Davis-Floyd's explanation for the restriction of food and drink during labor as reinforcing the liminal status of pregnant women during her rite of passage into motherhood.


Re-Blog: Restriction of Food and Drink in Labor from a Medical Anthropologist’s Perspective via Birth Activist Blog
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.

2 comments:

  1. My clients that have received an epidural are told that they can only consume clear fluids. I've noticed that after they receive the epidural they are very hungry, and I wonder whether the restriction of food is justified? Not that you have the answer, but just putting the question out there!

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  2. Cochrane Reviews have shown that the nothing by mouth rule during labor should be changed, that there is no reason for it unless there is fear that in an emergency general anesthesia must be used (which occurs in many instances in which the woman was just eating 30 minutes prior to surgery anyway, which can't be helped...) and even then there is a small change of vomiting and inhaling it while under.

    I would say this the same goes for epidural... but I did look it up. This is one hospital's policy: "After a labour epidural is placed, the woman may continue to drink fluids and have ice-chips, but solid food is not recommended. We all use small doses of narcotics in the epidural, and some of this is absorbed into the woman’s blood stream. Narcotics are known to slow down stomach emptying, although much less of an effect from epidural narcotics than those given intravenously or intramuscularly."

    Not sure what the link is there between solid food and the narcotic in the epidural.

    One thing to keep in mind though is that nausea during labor is common, and so what goes in must come out! That is not necessarily a reason not to eat during labor, as food intake helps keep up your energy.

    Also, with an epidural you are always given an IV through which you are receiving some sustenance, so maybe they don't feel eating is needed?

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