Remember my very first client in the 1980's? Vaginal breech? Well, you might remember that I wrote about her stopping off to pick up a hamburger on the way to the hospital. Yes, her doctor was in the car with her, encouraging her to eat. All was well...and boy, was that birth smooth! During my early years as a doula, though, I discovered that the hamburger-eating client was not the norm. Eating in labour was discouraged. "The digestive system shuts down in labour..." "If you eat and then have general anesthetic, you might vomit and then aspirate the contents..."
Way back in 1993, one of the (apparently radical) studies presented at the International Congress of Midwives in Vancouver encouraged women to eat and drink as needed in labour, and argued that it was probably detrimental to the flow of labour to starve a woman during the process. The audience applauded. We thought this would start a movement to allow all low risk women to eat in labour. But, the protocol at most hospitals in our area remained the same. Women were allowed clear fluids only - water, ice chips.
In the 1990's, despite the general recommendation of "clear fluids only" in many hospitals, older nurses (most of them midwives from overseas) would still bring in lunch trays for women in labour at St. Paul's Hospital. I remember one senior nurse (a former UK midwife) at Lion's Gate Hospital running the bathtub, helping the labouring woman into it, then passing her a big fat sandwich. "Oh, honestly, you need to eat!" she said, hands on hips.
Then, as the years passed, more family doctors would encourage my clients to eat as much as possible before they left home. One client took her doctor's recommendation to heart, and ate six scones in the car while we drove to the hospital (she gave birth soon after). Another client made sure her husband and I (and her) cleared our plates of roast beef, yorkshire pudding, roast potatoes and loads of gravy, before dashing off to Richmond Hospital. She'd huff and puff and then eat some meat, huff and puff and eat a potato. She also gave birth soon after arrival at hospital.
But, the majority of women in hospital found it very challenging to get any food to eat during labour. One woman became so distressed when she wasn't allowed to eat during her induction. She started crying, and her contractions disappeared. "I just want peanut butter on toast!" We eventually got an official "go ahead" from her obstetrician. The toast came, she devoured it, and her labour started again. She progressed from 2cm to 10cm in about 15 minutes. Now, I'm sure not every woman is going to have such remarkable results after eating one piece of toast, but the emotional benefits of being able to eat and drink as needed in labour cannot be questioned.
At home births, women have always been able to freely eat and drink throughout labour. Homemade soup, papaya, omelettes, coconut water...even one client's beloved peanut butter chocolate chip muffins (eaten in the shower)...these are what sustain women. I would love to see a world where there is no difference between home and hospital (I hope I'm not a dreamer!)
So, it was heartening to see that a January 2010 Cochrane review identified no benefits or harms from restricting food and fluids during labour in women at low risk of needing anesthesia (Singata M et al. Cochrane Database Syst Rev. 2010;:CD003930). The authors concluded, "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.”
Thank you. Now, let's go eat!