Birth Myths Busted “Let & Allow”
I heard that you’re “not allowed” to eat while in labor. My doctor said that it’s hospital policy and that they will “let me” have clear fluids, but that’s it.
Ok, so here’s the deal. That’s not a thing. If you are in a position to eat something and actually want to, that is 100% your call. You need not adhere to strict fasting protocols that have no place in low risk birth experiences. If you are high risk or are planning to have surgery, sure. After all, NPO - which means “nothing by mouth”, is part of a patient’s pre-operative instructions. The general idea behind NPO is that the risk of pulmonary aspiration would be decreased with a fasting protocol in place.
“Pulmonary aspiration is the entry of material such as pharyngeal secretions, food or drink, or stomach contents from the oropharynx or gastrointestinal tract, into the larynx (voice box) and lower respiratory tract, the portions of the respiratory system from the trachea (windpipe) to the lungs.”
When aspiration was recognized as a major problem during birth in the 1940s, the practices surrounding anesthesia were less safe, and so aspiration was much more common than it is today. But we are living in a different time. Today we are far more advanced, and complications from pulmonary aspiration are rare.
“It is noted that aspiration during emergency department procedural sedation and and analgesia has not been reported in the medical literature and that aspiration during general anesthesia and labor and delivery is uncommon. The literature provides no compelling evidence to support specific fasting periods for either liquids or solids prior to procedural sedation and and analgesia, and existing guidelines for elective patients are of necessity arbitrary and based upon consensus opinion”.
The guidelines we use today come from the early 1900s, when most birthing people gave birth under the sedation of chloroform or ether alcohol by inhalation, or during something called “twilight sleep.” This effect of twilight sleep was achieved by using a combination of scopolamine and morphine given by intravenous injection.
Although aspiration is a widely feared complication of general anesthesia, clinically apparent aspiration in modern anesthesia practice is exceptionally rare, and in healthy patients the overall morbidity and mortality is low.- STEVEN M. GREEN, MD, BARUCH KRAUSS, MD, EDM
So should all birthing people be expected to fast during labor/birth to decrease the already low risk of pulmonary aspiration? This routine blanket recommendation comes from a time when our medical technology wasn’t the greatest and anesthesiologists were using very primitive tools to keep a person’s airway open when under general anesthesia. Or they were not using airway tools at all. Obviously things have changed…
And then there’s the fact that labor and birth is a very athletic event. Moreso than a medical one.
Did you know that childbirth requires an extraordinary amount of energy? Researchers analyzed 385 studies published in 1990 or later… and that research suggests that the energy and caloric demands of birthing people are similar to those of marathon runners. No kidding. It’s no wonder things can slow down for many who are deprived of nourishment during their birthing times. Again, NPO - nothing by mouth - is surgery prep. Unless you are considered high risk due to things such as pre-ecclampsia, or using IV opioid medications during birthing, it should be fine to eat lightly and is even considered beneficial.
The American Society of Anesthesiologists state…
“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.”
The body needs fuel (food) and hydration (water) to keep energized, prevent exhaustion, and for the uterine surges to remain strong and regular. Without these things, it’s easy to become dehydrated, and exhausted.
I really envisioned myself giving birth while on hands and knees or something similar, but the nurse that conducted the hospital tour says they “don’t allow” people to give birth in any way other than on your back. I’m going to ask my doctor at my next appointment if they will consider “letting me” push on my hands and knees.
Hold up. There’s no such thing as “not allowing” someone to birth in a specific position. It’s a made up fly-by-night protocol, and a lie for someone’s convenience, but it surely isn’t the birthing person’s.
This myth is perpetuated through the experiences of friends and family, the media, and those that tell stories of suddenly needing to lie on their backs once it was time to push. This practice is not evidence based and survives on the backs (pun intended) of the people that fall for and believe that nonsense. It’s not a thing. The birthing person simply says “no thank you” if asked to lay on their back and that’s it. If the medical staff push for it, you can simply say no, and have your birth partner help you move into a position of choice. Your experience matters, and you get to call the shots.
Another thing to note is that pushing on your back can cause decreased oxygenation to the baby. Especially for those with supine hypotensive syndrome - also known as inferior vena cava compression syndrome - which is caused when the weight of the uterus compresses the inferior vena cava while in a supine position, and leads to decreased blood return to the heart. Symptoms can be dizziness, low blood pressure, pallor, nausea, sweating, and tachycardia (increased heart rate.) This can in turn lead to fetal distress.
If you are interested in learning more information about why one should be free to push in their position of choice, check out Healthy Birth Practice #5 - Avoid Giving Birth on Your Back and Follow Your Body’s Urge to Push. Joyce T. DiFranco, RN, BSN, LCCE, FACCE and Marilyn Curl, RNC, CNM, LCCE, FACCE state that “Throughout the course of labor, including the second stage, birthing people benefit from frequent position changes and, ideally, should be free to select or reject them at will.” And it’s the truth.
Also stated…
“Research today indicates that most people give birth in a supine position using a directed style of pushing despite a growing body of knowledge that confirms that this has disadvantages for both birthing person and baby.”
Photo by Sharon McCutcheon
If your provider is set against you assuming your position of choice, ask your nurse to advocate for you. Let them know that you have chosen to push in a specific position and do not consent to being on your back. If you are feeling nervous, you can ask the provider for some time alone, and share your thoughts with your partner, nurse, and/or doula. Ask one of them to amplify your voice, preferably your partner/husband who is best suited to speak on your behalf. They may have to be straightforward and firm. If your provider tells you that they don’t know how to catch a baby in any other position besides supine, thank them for their help, let them know that you will be pushing in your preferred position, and if they haven’t the skillset to assist you - that you will happily switch care to someone who does. Simple.
I know it may feel confrontational and, being in such a vulnerable state, difficult to use your voice under such extreme pressure - but take a deep breath and speak your piece. Prepare your partner to address this if it should come up. In the weeks leading up to birth, practice scenarios and get comfortable with different ways of saying no. Your provider will get over it. They will not be kept up nights thinking about your birth and how it went down. But you most certainly will. That’s why your decision matters more here. This is your body, your birth, and your baby. It’s called bodily autonomy and it’s a basic human right.
There are many other preference that you may have regarding your birth experience. It is important to consider what your preferences are in advance, and take some time to delve deep into why you have them so that you are more prepared to advocate for yourself when the time comes. You will not want to be willy nilly about certain things, as that can open the door for someone to challenge your decisions without your having a solid reason or rebuttal. Be sure about what, when, and why so that you are empowered and able to speak up when it matters most.
Have these conversations with your providers beforehand, and get a good idea of how they operate in the birth room throughout all stages and phases of labor. If you see red flags, please do not ignore them. You may regret it later on. Settle down with a practice that is supportive of the way their patients choose to give birth. Ask open ended questions - it’s too easy to answer “yes,” “no,” or “we’ll see.” If you have a hunch that your providers are brushing off your concerns, go find one/some that won’t.