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ricevermicelliSo I think it was yesterday or something that Schrodinger decided food was good, and I've been liking that a lot. Good Schrodinger. Nice Schrodinger. And thank you to the housemate who appears to have hit the fall clearance sale at the Cracker Barrel Factory Outlet just in time for me to become unreasonably obsessed with cheddar cheese.
Now that I'm back on food, I don't particularly want to quit. My OB tells me that, once I check in to the hospital (which - counts - will probably be sometime in the vicinity of 23 weeks from now), I'm only allowed clear liquids until the baby is out. I have no idea how long labor will be. I know that I suck when I'm hungry. I like the OB I see, although the selection process was kind of non-existent (convenient to red line, check; takes my insurance, check; not stupid with scheduling, check). But this food thing...
How kosher is it to stay out of the hospital until contractions are like two minutes apart, so that I can keep snacking?
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Date: 2006-10-12 06:02 pm (UTC)THAT said, all the food you eat? Gotta go somewhere. And, um, not so much on the normal digestion during labor. Really. Fine print, side effects, etc. Women tend to do a whole lot better sucking on ice chips, based on what I've seen. YMMV, of course.
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Date: 2006-10-12 06:10 pm (UTC)no subject
Date: 2006-10-12 06:28 pm (UTC)If so, I guess it's a tradeoff between sucking 99% of the time, and possibly saving your life the other 1%, which is a tough tradeoff to evaluate. I wonder what the increased risk of surgery with food in your stomach is...
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Date: 2006-10-13 12:01 am (UTC)no subject
Date: 2006-10-12 06:31 pm (UTC)no subject
Date: 2006-10-12 06:41 pm (UTC)no subject
Date: 2006-10-12 07:05 pm (UTC)no subject
Date: 2006-10-13 11:49 am (UTC)no subject
Date: 2006-10-13 03:34 am (UTC)Kit
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Date: 2006-10-12 06:43 pm (UTC)no subject
Date: 2006-10-12 06:52 pm (UTC)no subject
Date: 2006-10-12 06:50 pm (UTC)Here is the thing. The things.
1. Crash cesarians are extremely rare. They happen, but they are not even remotely the norm.
2. Any remotely competant anaesthesiologist can deal with a patient with a full stomach. Because -- hello? -- if I get run over by a bus right after lunch, it's not like they're going to be able to have me fast for eight hours before surgery. They'll work around it.
3. Withholding food from a laboring woman can itself cause problems, for all the obvious reasons.
4. Apparently the whole fasting thing is questionable even for planned surgery, because when you fast, you end up with a stomach full of stomach acid, and you can throw THAT up and aspirate it, and it's even worse for your lungs than regular aspirated vomit. Or at least not a significant improvement.
I have blood sugar crashes when I don't eat. I would be completely and totally screwed if I had to push out a baby during a blood-sugar crash. So I told Ed from the outset that this was a dealbreaker for me. Either the hospital could let me eat, or cope with the fact that I was going to bring snacks and eat even if they didn't like that fact (what are they going to do, snatch it away from you?), or I was going to have a homebirth. I didn't particularly want a homebirth, but I was not going to go through labor fasting.
Fortunately, our hospital was very progressive (about a lot of things) and had this great group of midwives who practiced there and not only did they allow eating during labor, they kept food on hand. Light stuff: fruit, yogurt, bagels. They did note that some women puke during labor so they didn't recommend that, say, you order a pizza. But most women don't want to eat past a certain point in labor anyway.
With Molly, I arrived at midnight and was in transition within an hour or two. I had no interest in eating at all. It wasn't an issue.
With Kiera, my water broke and I didn't go into labor right away. But, I am GBS+ (you might be, too, something like 60% of women are) so they wanted me to have IV antibiotics during labor. (The odds of the baby getting an infection from the strep are very low, but the potential consequences really suck, so I was willing to have the IV.) So I was sitting in L&D for over 24 hours (yes, you can go more than 24 hours after your water breaks without spontaneously combusting -- they just didn't do any vaginal exams, and checked my temperature every couple of hours) waiting to go into labor. The evening before Kiera was born, I called
If you are GBS+ (and they won't usually test for that until later in the pregnancy), they will very much want you to come in before the contractions are 2 minutes apart, because they will want to give you antibiotics for about an hour before the baby is out. Some hospitals have weird procedures involving keeping the newborn in the nursery for observation (which is ALSO BS) if you didn't get sufficient antibiotics. So I would check on that before counting on the "I just won't go in" plan.
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Date: 2006-10-12 06:51 pm (UTC)(And have you considered a midwife rather than an OB? I really like midwives. I swear I'm not as freakishly anti-THE-MAN and crunchy as I'm sounding in these posts. My blood sugar is low right now, and that makes me grumpy...)
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Date: 2006-10-12 07:24 pm (UTC)I thought I would want to eat while I was in labor, and I wrote that into my birth plan. Then it turned out that I didn't feel like I could manage anything but clear liquids. I alternated between ginger ale (cold) and chicken broth (hot), until I got very nauseated, at which point I stuck to water and then ice chips. I wound up wanting to restrict myself much more than my midwife wanted to restrict me. BUT: I had a relatively short labor, seven hours from the onset of full active labor to delivery. A longer labor might've gone very differently.
You say you "probably shouldn't worry" about things like this yet, but I think this is an excellent time to really interview your OB about how flexible she, the other doctors who share coverage with her, and the hospital are. Food vs. no food might not be a dealbreaker, but an inflexible attitude towards policies and a tendency towards unnecessary interventions (like starving you) could really mean bad things for your birth.
I would ask about routine use of:
- electronic fetal monitoring - required? how often? continuously or intermittently?
- IVs. Will they start one "just in case," and if so, will you wind up having to stay in bed?
- separation of mother and infant after birth.
- a "labor clock" - such as the expectation that you will dilate 1cm per hour and that anything slower is a problem calling for intervention.
I highly recommend Penny Simkin's book Pregnancy, Childbirth, and the Newborn for a very clear explanation of the various interventions and policies that doctors may want, and how they might affect your birth.
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Date: 2006-10-12 08:48 pm (UTC)You might also ask them about how they deal with water breaking and labor not immediately starting. Some hospitals have a very firm "baby must be out in 24 hours, one way or another" policy.
Other things to ask about:
* Episiotomy. Episiotomy to prevent tearing has been demonstrated to be a bad idea. (Natural tears heal better and with less pain -- they're just trickier to stitch.) Not that episiotomy is always unjustified -- it's an entirely legitimate way to deal with certain emergencies. As a routine thing, though, the research says nooooooooo.
* Inductions. At what point and under what circumstances would they want to induce? There are some really, really legitimate reasons to induce: complications like pre-eclampsia, for example. I was induced with Molly because I was past my due date and her amniotic fluid was extremely low (this is an indicator that the placenta may be giving out -- bad news). But there are doctors who get antsy over really strange stuff. The problem with inductions is that a disproportionate amount of the time, they end with a c-section. Which is not the end of the world, but it's major abdominal surgery and that just kind of sucks all around. (I had my appendix out when I was 15, and recovering from childbirth was much, much, much faster and easier.)
* The breastfeeding policies of the hospital. If the baby requires supplementation for some reason, do they use a bottle, or will they cup feed or help you use an SNS to ensure that they don't screw up breastfeeding? Nipple confusion is a lot easier to avoid than to treat. Also, do they have lactation consultants available to help you with breastfeeding? What kind of training do they have? (Optimally, you'd like IBCLCs.) What hours are they available? (Optimally, you'd like 24x7 coverage.)
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Date: 2006-10-13 12:07 am (UTC)But needles and I? We don't get along. It's not a phobia thing (I've given gallons of blood); it's a "they have to try two or three or four times before the needle goes in, and then my vein collapses" thing. The one IV I've had was, in fact, excruciatingly painful, to the point it had to be taken out and reinserted in a nonstandard place. So anyone who is interested in inserting a prophylactic IV during a time when I need to be calm and relaxed can, quite frankly, bite my shiny metal ass.
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Date: 2006-10-13 07:12 pm (UTC)Midwife practices kick ass. (Independent midwife practices, I mean, not midwives who are supervised by doctors and required to follow the doctor's rules.) I had a hospital birth with a midwife, and I think it was the best of both worlds. Afterward, my 65-year-old mother said "I'm so jealous - *I* want to have a baby with a midwife!" She was so impressed by the combination of technical skill and loving attention I got from my midwife.
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Date: 2006-10-13 11:15 pm (UTC)no subject
Date: 2006-10-12 07:51 pm (UTC)no subject
Date: 2006-10-12 08:34 pm (UTC)I preferred that it not come to that, however.
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Date: 2006-10-12 11:01 pm (UTC)no subject
Date: 2006-10-12 08:37 pm (UTC)no subject
Date: 2006-10-13 02:37 am (UTC)no subject
Date: 2006-10-13 04:06 am (UTC)The doctor will not be in the hospital with you when you are in labor. The nurses will have his call service contact him or his on-call backup when it looks like birth is imminenet. So you don't need to worry about his policy - he won't be there to enforce it. The people present will be nurses, and they will be enforcing hospital policy. They might get upset with you, but their options are limited. They're not going to call the labor police to wrestle your cheddar cheese out of your hands. In fact, there's a good chance they'll be so busy tending to paperwork and other patients that they won't notice you eating.
You should check on the policy on IVs and fetal monitoring, and find out your docs policies on induction and episiotomy. And if they suck, you should find a new doc, even if it means a longer subway ride.
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Date: 2006-10-13 01:58 pm (UTC)That pretty much sums it up, I think. :grin:
It used to be that women checking into L&D were given an enema. Why? Because when you start pushing, sometimes you poop. It took a long time for this custom to go away, even though it offers no medical benefit to the women and most found it embarrassing and uncomfortable. (There are still a tiny handful of hospitals where it's routine unless you refuse it, but, like shaving for vaginal deliveries, it's one of those customs that has pretty much gone away in the U.S.) In a discussion of this once, I saw a woman who'd delivered back in the enema days asking in a clearly shocked tone, "but what if you poop on the delivery table?" Well, er, then you poop on the delivery table and someone whisks it off and tosses it in the "bodily yuck stuff" bin. Any nurse, midwife, or OB who is freaked out by a little poop is in the wrong line of work. And birth is messy. Really, really messy. Whether anyone poops or not.
(Now, there are women who are totally freaked out by the prospect of pooping while pushing, and who WANT an enema to guarantee that they won't. And I totally respect that choice because things like this in labor should be all about making the mother more comfortable during what is fundamentally not going to be a comfortable experience. Ditto eating -- some women don't want to eat, either because they're not hungry or because they're afraid they'll throw it all up later. Whatever works for you is the right way to handle it.)
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Date: 2006-10-13 10:05 pm (UTC)I went into the hospital fully prepared to ask for an enema if I thought there was the slightest chance I'd want one. As it turns out I didn't, but just because it's no longer routine doesn't mean that you shouldn't have one if you think you want one.
My mother's story from birthing me was that she planned to do natural childbirth (Lamaz) but that she was in quite a bit of pain until the enema. During the pain part, the nurse said "oh, you're not going to be another one of those Lamaz patients who tries to go with out drugs and whimps out in the end, are you?" My mother was intimidated enough into agreeing to drugs after the enema was over. After the enema she said she felt so much better that she didn't want the drugs anymore, but they still gave them to her. So while you shouldn't be required to have one, in some cases it helps.
As for eating, I had a full meal before heading to the hospital (about noon) and delivered at 10:17 pm. I ate red popsicles nearly continuously the whole time. My hospital subscribed to the "only clear liquids" theory, but if popsicles counted, I was happy and didn't see a need to challenge it. I think in many cases the reasons they'll give now for "only clear liquids" are not the aspiration under anestesia reasons, but that "you might throw it up". Let them know you'll be happy to throw it up, and just be willing to only eat things that will be ok going up again. OJ is particularly unpleasant the second time round I've found. I'm willing to give ice cream with chocolate a second go.
If you do eat and puke, make sure you smile and say "I'm still glad I ate that" to help the next poor woman who wants to make the same choice.
I'd note that at hospitals where they let you take nothing by mouth, they also don't keep a hospital staff member with you 24/7. You get stretches of half an hour to an hour with only your own labor support (i.e. husband/mother/doula) while hooked up to a heartbeat monitor (belt around your waist.) If your hospital says "no" but doesn't provide you with clear medical reasons not to eat, do it any way if you want to. Just don't lie to them about whether or not you've eaten if you do need an emergency C-section. (And make sure your partners know not to lie either.)
You don't need to wait extra-long to go to the hospital just to avoid their policies. I personally would rather sneak food in the hospital at 3-4 minutes apart, than be at home eating food unabashaedly until 2 minutes apart. This is because 2 mins apart means transition in many cases, and that means maximum pain -- i.e. you don't want to be riding in the car with a seat belt where you can't do hands & knees position during transition.
--Beth
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Date: 2006-10-14 12:43 am (UTC)I know my OB is a fascist about sushi, but honestly, I like her. She answers my questions and gets my jokes and has been very responsive to those concerns I have expressed. Unfortunately, I do a lot of going into her office and forgetting to ask stuff, so there's a lot of gaps. Also unfortunately, she only sees patients on Tuesdays, so my next appointment (scheduled so that
Her policy, and the policy of the practice, is to do episiotomies only in emergencies (must ask what constitutes emergency). I haven't asked about IVs, fetal monitoring, induction, labor clocks, rooming in, breastfeeding support, birth plans, support people or much of anything else. I also haven't had a tour of the L&D facilities, and I have no idea what they're like.
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Date: 2006-10-14 01:27 am (UTC)no subject
Date: 2006-10-19 11:54 am (UTC)My water broke, and I had weak contractions, so I spent three days in first natural and then induced labour, and I couldn't eat for half that time. When it was necessary to have a c-section, I was extrememly weak.