So, I am a new L&D RN, and just started working at my facility and love it. We have a great set of nurses and docs. I come from a homebirth background, so hospital birth (especially at a high-risk facility) is definitely much different than what I'm used to, but I really like working with this population of mamas.
I think we are really good at trying to implement evidence-based practice. The one thing that seems universally crazy to me is that we are restricting the diets of mamas in labor. I know that it is because of risk for aspiration in the event general anesthesia would be used, but really, how often would general anesthesia be used? The benefits seem to outweigh the risks. So far I have found this article on medscape, haven't researched journal articles yet:
Seems like every mama I work with, especially inductions, c/o how hungry she is and how she can't wait to eat. Seems crazy to me to withhold food or even juice from them.
What is your hospital's policy re: nutrition in labor?
No formal research, just in what I've read as far as midwifery books go (like the crazy but on-her-game Ina May Gaskin)...
I'm sure in the NICU you've seen/heard a lot of the pros for a NPO/clr liquid diet given cesarean rates at those facilities. Then again, the cesarean rate in general in this country is fairly out of control.
Our hospital policy is clear liquids for low risk. I did a report of intake during labor for my OB rotation, and from what I remember from the research is Europeans and Canadians allow clear liquids to regular diet for low risk mothers. Americans usually follow NPO based upon a 0.14% of aspiration during general anesthetic from a 1940's study.
I'm not a nurse yet. But I wanted to chime in here because I had my first child a year ago. At my 40 week check, they discovered that my amniotic fluid was really low, so I was admitted into the hospital to be induced. They admitted me at noon on a friday, started a low dose of pitocin, started increasing it at 6am saturday morning and I had my daughter at 1pm. From the time I was admitted, I was allowed nothing to eat or drink. I wasn't hungry, but wow did I get thirsty. No water, no ice...nothing at all. My throat dried out so badly that I was gagging everytime I tried to swallow. I may or may not have thought about trying to drink my IV. One of the awesome nurses I had finally gave me a popsicle shortly before it was time to push (bless that woman's heart) but it was a long 24 hours. My daughter was born healthy and awesome, so I shouldn't complain...but it was rough.
It is not evidence-based to have patient NPO. Both ACOG and the Anesthesiology professional organization have policy statements supporting clear liquid intake in labor. D5 is also not evidence based- tends to result in hypoglycemic babies. I have done this research but don't have time now to look for the files. In any case as someone else posted the majority of cases performed under GA are emergencies where people have not been NPO. The risk of aspiration is really very low. I chose to eat and drink as desired during my own four deliveries.
Also, it's not a matter of comfort. Going 12, 24 or more hours without food is torturous for a pregnant women and results in problems. When a pregnant woman comes into triage with ketones we scold her for her dietary habits then restrict her intake in labor.
As long as you don't end up being one of the ones who has problems, you can say "see, I told you so". :-)
Clear liquids are okay in small amounts. You don't need to be stuffing your face with pizza and big macs. The human body can survive a couple hours without food although people don't believe that anymore. No wonder there is an obesity epidemic and our pregnant women are rarely under 250 lbs.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
I believe that we generally deprive laboring women of nutritional and hydration support.
Low risk, moderate risk, and high risk labors are generally identified in the OB/GYN visit predelivery. I believe that when we care for low risk labors (who are the majority) and automatically put them on clear liquids, chips/sips, or make them NPO; we are inviting dehydration, depletion of glucose stores, and are really putting them squarely on the path that may well end in the OR.
Labor is HARD work and these women need the support and tools which will give them a better chance at a normal lady partsl delivery...IMHO
I worked for a number of years in a high risk L&D, a regional center that received patients from from "far far away" on a regular basis. The practice there also included clear liquids for laboring women. The women who delivered quickly were fine. The women who labored for long periods of time generally ended in the OR because they were so exhausted and were unable to push the baby out.
We take people in the OR everyday who have not been NPO or on clear liquids prior to their surgery. Heck I had surgery about 3 weeks ago, emergent, and I had not been NPO. As someone already pointed out, there is a risk for aspiration, but that is a small risk. I think we should care and advocate for our laboring patients in a fashion that will help them to be successful in lady partsl delivery. I think that would include helping them to maintain the strength and stamina to endure a 16 hour labor.
In my experience all that food tends to go nowhere during active labor. The patient's sympathetic system is too ramped up to allow any true digestion, and the only thing a full stomach of food is going to do is increase the chance of feeling nauseated and vomiting. I see nothing wrong with clears during active labor. There is no evidence that I know of that states eating improves outcomes.
"Scrutton, Metcalfe, Lowy, Seed, and O'Sullivan (1999) undertook a randomized trial to determine effects of a light, low-residue diet (N = 48) or water only (N = 46) during labor on women's metabolic profile, labor outcomes, and residual gastric volume. In the light-diet group, food consumption decreased as labor advanced. By the end of labor the water-only group demonstrated greater ketosis, as well as lower levels of plasma glucose and insulin. Gastric volume was greater in the eating group within 1 hour of birth. The eating group was twice as likely to vomit around the time of birth, and the volumes vomited were significantly greater than in the water group. The groups did not differ in duration of labor, use of oxytocin, mode of birth, Apgar scores, or umbilical blood gases."
Tewdles, because you didn't have a problem with aspiration and the fact that, because we take precautions FOR you in the OR, are you going to encourage people to go ahead and eat pre-op?
If people weren't so quick to sue whenever there is an adverse event--regardless of what part they themselves played in it--I would tell them to go ahead and do whatever they want.
No formal research, just in what I've read as far as midwifery books go (like the crazy but on-her-game Ina May Gaskin)...
I'm sure in the NICU you've seen/heard a lot of the pros for a NPO/clr liquid diet given cesarean rates at those facilities. Then again, the cesarean rate in general in this country is fairly out of control.
Actually, most of the babies that I've cared for who are born by emergent CS under general were not born at our center. Rather, they are women previously identified as low risk and laboring at small hospitals. Because, by nature, if the CS was unexpected and emergent enought to require GA, you probably didn't have any reason to plan to deliver at a high risk place. The elevated CS rate at our center would be due to identified conditions, not emergencies. (i.e. placenta previa, maternal CHF, etc.) We don't see many women go under general in our hospital. Once again, I haven't researched this and don't necessarily advocate NPO. Just throwing my 2 cents in about who ends up with crash CS.
nursie_pants
53 Posts
No formal research, just in what I've read as far as midwifery books go (like the crazy but on-her-game Ina May Gaskin)...
I'm sure in the NICU you've seen/heard a lot of the pros for a NPO/clr liquid diet given cesarean rates at those facilities. Then again, the cesarean rate in general in this country is fairly out of control.