Saturday, May 17, 2014

On Eating/Drinking to Thirst/Hunger in Labor, vs. IVs-- an excerpt

These paragraphs from Optimal Care in Childbirth (Henci Goer & Amy Romano, 2014) are so good I had to share them.

From Chapter 11 "IVs Versus Oral Intake in Labor," pages 256-257:
(after several pages presenting empirical evidence in favor of allowing women to eat & drink as they desire during labor)
"Why Doesn't Evidence Change Practice?

Why don't clinicians abandon routine IVs and let laboring women drink and eat as thirst and hunger dictate?

One reason is that NPO (nothing by mouth) and routine IV fluids fit the medical-model of childbirth, which holds that labor and birth are pathological events in which something is likely to go wrong at any moment.  What therefore feels right, safe, and proper-- in this case, treating women undergoing a physiologic process as surgical patients-- will supersede science and logic, blinding pracitcioners both to the harms of their policies and the benefits of treating labor and birth as normal events.

Another has to do with the nature of research.  In order to alter care, new treatments must prove themselves superior to current care, the presumed "gold standard."  Eating and drinking at will have not been show to produce what medical-model thinkers would consider clinical benefits, ergo practice need not be changed.  But, of course, eating and drinking are not treatments but normal, spontaneous behaviors during a normal physiologic process, and withholding oral intake and IV infusions were never established as safe or effective before they became standard management.

Finally, as Robbie Davis-Floyd (1992) writes, NPO and routine IVs serve the symbolic ritual purposes of inculcating beliefs about the nature of society and the proper role of childbearing women within it:

To deny a laboring women 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 need 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" (p. 92).
The IV, she says, serves as an umbilical cord linking the woman to the hospital in the same way that her baby is linked to her within the womb.  In this way, she receives the message that we are all dependent on society's institutions for our lives and that the institution, not she, is the giver of life.

A more appropriate model for childbirth than the presurgical analogy is a prolonged, demanding athletic event that poses a small risk of serious injury.  A sports medicine physician would be horrified at the thought of depriving an athlete of foods and fluid in such a case.  And as for risk, until such time as we require "nothing by mouth" and "just in case" IVs for downhill skiers, football players, and, for that matter, drivers entering the freeway, we should not require them of laboring women."

They go on to give recommended strategies for optimal care, which include encouraging laboring women to eat and drink as they feel the need-- not overloading on fluids nor making themselves eat, and reserving IVs for those times of dehydration or other medical indication.  Also, they recommend infusing "physiologic volumes of fluid"-- that is, giving fluids in amounts that would be similar to what a healthy person would or could intake on their own.

They just summed it all up so well!!

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