SANTA ANA, Calif. —
James and Mary were the most popular baby names in the 1940s
when hospitals began forbidding laboring mothers to eat or
drink in case they needed an emergency Caesarean section.
But like trends in names, much has changed
in anesthesia techniques since then, and more hospitals are
loosening their restrictions.
A medical review of five studies of 3,130
pregnant women published last month recommended allowing
low-risk patients to eat and drink as they wish. The review
noted that most C-sections are no longer done with general
anesthesia and "poor nutritional balance" may be
associated with longer, more painful labors.
Debbie Ward of Tustin, Calif., remembers her
parched mouth, along with the pain of labor, when she
delivered her first two babies. Nurses offered her nothing
more than ice chips, the standard practice for roughly the
past 70 years because of concern of aspiration if the mother
had to be put under.
"Ice chips can only do so much,"
Ward recalled.
Ward, a history teacher, gave birth to her
third child four months ago, again at St. Joseph Hospital in
Orange, Calif. This time, her nurse, Caroline Price, served
her water and juices, holding the straw to her mouth when she
couldn't lift her head off the pillow.
The cool liquids refreshed her, boosted her
energy and settled her nausea.
"It just kind of helps ease
everything," said Ward, 36. "It was a source of
comfort. It made the whole situation not so medical."
Price, who is studying to become a midwife,
succeeded more than a year ago in reversing a long-standing
ban on drinking during labor. She presented research to the
hospital's anesthesia committee, which then changed the rules.
Saddleback Memorial Medical Center in Laguna
Hills, Calif., gives patients drinks, plus Jell-O and Italian
ice. Hoag Hospital in Newport Beach, Calif., which offers
women in labor a Popsicle once an hour, likely will begin
allowing liquids this month.
"One of the things that had always
bugged me is that we just relegate these women to ice chips
and some of them are in labor for 24 or 36 hours," Price
said. "I still get complaints about them being hungry and
wanting to eat food, but you can pacify them a lot if they can
have liquids."
In the 1940s, Dr. Curtis Mendelson
rigorously studied potentially fatal complications of
anesthesia in pregnant women. He recommended withholding food
and water because the contents of their stomachs could be
drawn into their lungs. It wasn't until the 1970s that
regional anesthesia became common practice for C-sections.
"I think a lot of what is done out
there is the old school and the old thinking because of
studies in the 1940s when anesthesia was very different,"
said Dr. Lisa Karamardian, who chairs Hoag's
obstetrics-gynecology department. "I think we do realize
with regional anesthesia and better spinals and epidurals that
women are at much lower risk."
In August, the American College of
Obstetricians and Gynecologists changed its recommendation
that women only consume ice chips. The group advised that
women with normal, uncomplicated labors be allowed to drink
modest amounts of clear liquids, including juice and sports
drinks.
Karamardian tells her patients to eat a
light meal if they wish before arriving at the hospital. She
said laboring women stay hydrated through an IV, but the
benefits of drinking also might be psychological. She expects
Hoag's ban on drinks to be lifted later this month.
"Just knowing they could have liquids
if they wanted it is going to make some women feel
comfortable," she said. "I think it's a good
change."
Dr. David Lagrew, director of Saddleback
Memorial's Women's Hospital, said beverages have been allowed
for years, although some very conservative doctors don't
approve them for their patients. He said no more than 2
percent of the hospital's C-sections are performed under
general anesthesia.
He said change can come slowly because of
malpractice lawsuits and memory of the days when aspiration
was one of the top causes of maternal deaths.
"I think they maybe went a little
overboard with prevention," Lagrew said.
Not every hospital has eased the
restrictions. The University of California Irvine Medical
Center, which sees a large number of high-risk pregnancies, is
sticking with ice chips.
Price, the St. Joseph nurse, said she
sometimes notices cups of ice at bedsides because not all
nurses are in the habit of offering drinks.
"In a hospital environment, sometimes
you have to take little steps," she said.