An OB question

CrunchyMama, ASN, RN · Jan 18, 2010

Do you mean for the mom? Because as far as I know babies, especially newborns shouldn't have water due to risk of fluid overload. Babies shouldn't have anything but breastmilk.

Guerilla04 · Jan 18, 2010

I agree. The question is vague and states "Rationale for first feeding being water". I've been reading the text for the past hour and found nothing of the sort, although I did find information confirming your claim on breastmilk. I'm stumped :down:

NSALVADORE · Jan 18, 2010

Yeah more info needed.. And if it is mom? I didn't do my OB rotation, my assumption would to make sure she tolerates it as you can get sick to stomach during/after birth however after my lady partsl they didn't actually tell me I had to have water first.. My section of course was a slow diet progression as with any abdominal surgery!

CrunchyMama, ASN, RN · Jan 18, 2010

I agree. The question is vague and states "Rationale for first feeding being water". I've been reading the text for the past hour and found nothing of the sort, although I did find information confirming your claim on breastmilk. I'm stumped

Oh ok, I thought you were just asking. I didn't know that's actually in your book. Hmmm...weird. I also start my OB rotation next week and there's a few things I don't like about the book. Anyway, I'm not sure...it sounds more like they're talking about a postpartum c-section mom....not a newborn. I'm stumped too....I wouldn't feel confortable giving a newborn water.

Daytonite, BSN, RN · Jan 18, 2010

i was looking in my copy of foundations of maternal-newborn nursing, 4th edition, clinical companion, by sharon smith murray and emily slone mckinney and while it doesn't specifically mention using water as a first feeding (this refers, obviously, to the newborn) it does say that during first feeding(s) the baby needs to be watched for choking, gagging and cyanosis which would indicate an esophageal problem. water is a better medium for anyone to aspirate compared to milk or formula even if they are sterile.

Bug Out, BSN · Jan 18, 2010

The neonates first meal is the mamas teet. Bonding is extremely important early on plus colostrum is very important.

The mother gets water.

The mother basically just had surgery, even if it was a vag birth it is still traumatic. You do not want anything solid running through her until you are 100% sure she has #1 bowel sounds, and #2 can tolerate food. Last thing you want is mother tossing her cookies into the babies face, or aspirating.

EDIT: If this question does refer to the baby recieving water as a first meal then tell them this is 2010, this isn't 1945 where Docs encouraged mothers to smoke to relax the mother and child...

I have never heard or or seen giving little guys water as a first meal...can't even think of a rationale for doing so... so glad I am not in school anymore...

Elvish, BSN, DNP, RN, NP · Jan 18, 2010

There is absolutely no good reason to keep a hungry postpartum mom from eating after a normal lady partsl delivery. Some of our docs will even order diet as tolerated immediately after a c/section, though most will be on clear liquids (NOT just water) for at least 12 hours afterward.

We used to feed bottle-fed babies (NOT breast babies) their first feeding as a couple sips of water to r/o esophageal atresia/TEF, but not anymore.

callingtheshots · Jan 19, 2010

There is absolutely no good reason to keep a hungry postpartum mom from eating after a normal lady partsl delivery. Some of our docs will even order diet as tolerated immediately after a c/section, though most will be on clear liquids (NOT just water) for at least 12 hours afterward.
We used to feed bottle-fed babies (NOT breast babies) their first feeding as water to r/o esophageal atresia/TEF, but not anymore.

There is ABSOLUTELY a good reason post c-section moms can't eat after birth until they pass gas. It's major abdominal surgery where peristalsis is often halted. Why would you put solid food through a duct when you don't even know if it's working???? I'm shocked your saying you work for a doctor who immediately puts them on diet as tolerated. How do you even know her bowels are working again after the anesthesia?!?!

Elvish, BSN, DNP, RN, NP · Jan 19, 2010

There is ABSOLUTELY a good reason post c-section moms can't eat after birth until they pass gas. It's major abdominal surgery where peristalsis is often halted. Why would you put solid food through a duct when you don't even know if it's working???? I'm shocked your saying you work for a doctor who immediately puts them on diet as tolerated. How do you even know her bowels are working again after the anesthesia?!?!

Please note that I said some doctors sometimes will put mothers on diet as tolerated. That doesn't mean they go immediately to a regular diet; it just means they don't have to be on clear liquids for the entire 24 hours as they would otherwise. I have, however, seen c/section moms who had their section in the morning eating real food at night and do just fine. Many times.

C/sections are major abdominal surgery, but it's not quite the same as major abdominal surgery on organs of the GI tract. To begin with, most (I would say about 99%) of our c/section mothers do NOT receive general anesthesia, which would increase the risk of postop ileus. Most of our moms receive spinal/epidural in the form of Duramorph, which does not halt peristalsis much, if at all. As well, these moms tend to be healthy and able to get up and move within a very short time after their sections.

Even post-op after general anesthesia there is not a need to make c/section moms NPO. They do fine on clear liquids. And from what I can tell in the Ob/Gyn forum, this isn't that different from other OB units across the nation.

I can count on one hand the number of c/sections that have been complicated by postop ileus in the time I have been working at my facility.

In any case, I think the OP was referring to babies. :)

CrunchyMama, ASN, RN · Jan 24, 2010

After my 1st c-section I was allowed a regular diet....but I was mainly thirsty so I mainly drank anyway. After my 2nd c-section (different hospital), I was only allowed clear liquids. I was bad though, I snuck the food I brought. So I guess it just depends on the hospitals policy.

Meriwhen, ASN, BSN, MSN, RN · Jan 24, 2010

For the baby, you would not give water for the first feeding. The first feeding should be from the breast (ideally) or a bottle of formula.

For mom...she should have only clear fluids until peristalsis returns AEB return of bowel sounds, passing of flatus. Then you can advance her diet as tolerated/ordered.