It might have happened — what then?

Women are often told not to eat when they’re in labor. In fact, I heard one story in which a woman was having some early labor, and called the hospital to see if it was “real labor” or not, and while they didn’t say that it was or wasn’t, they told her that if she thought she was in labor not to eat. It was Thanksgiving Day. She had looked forward to the sumptuous spread all year, and she had to spend the day smelling the delicious food being prepared, but was not allowed to eat a bite. Why?

The rationale is that you might need general anesthesia at some point (for an emergency C-section and/or hysterectomy), and you might vomit the contents of your stomach when you’re unconscious, and it might be inhaled, and it might cause aspiration pneumonia or even death. The risk is slight, but real. A relative of a friend died because of this several years ago, when she had a tonsillectomy. They have anesthesia procedures that when followed properly almost entirely eliminate this possibility, but doctors are human too so there is always a tiny possibility that something could go wrong.

According to this article, the likelihood of a first-time mom giving birth vaginally having a hysterectomy is 1 in 30,000, but the risk increases dramatically if you’ve had a prior C-section. Emergency hysterectomies are usually performed for uncontrolled bleeding after birth, if other measures to stop the bleeding have failed. Obviously, it’s rare. Up to 30% of U.S. women now give birth via abdominal surgery, but C-sections under general anesthesia are rare, because even most unplanned C-sections are not true emergencies, and there is time to place or strengthen epidural anesthesia. So, the likelihood of you needing general anesthesia is very slight. Also, according to Henci Goer’s The Thinking Woman’s Guide to a Better Birth, p. 77, studies show that “no time interval since the last oral intake guarantees a stomach volume below [25 ml — the “threshold of risk”] in a pregnant woman. In fact, no time interval guarantees a volume of less than 100 ml.”

Now on to the “what if.”

When I had my first baby, my water broke before I had any contractions. There was no warning that labor was going to start that day, as opposed to a week before. Although I was very tired of being pregnant, there was no way to know when labor would begin–it was just “business as usual.” So, that night we ordered in Chinese, and I ate my fill. About an hour or so later, my water broke.

The umbilical cord, of course, did not prolapse, and I went on to have a normal and completely unmedicated birth, but what if it had? What if I had needed an emergency C-section? My stomach was extremely full — what then? Simple — the anesthesiologist would just need to follow modern standard anesthesia techniques, stick a tube down my throat to maintain my airway so that even if I vomited, I could not inhale it.

Anesthesiologists have to deal with this all the time. Do you think that every person who needs emergency surgery — victims of heart attacks, strokes, car wrecks, skiing accidents, etc. — has an empty stomach?

When there is a scheduled surgery under general anesthesia, it makes sense to try to minimize the risk by fasting for a few hours beforehand, even as slight as the risk already is. But for a 1/30,000 chance that you might need general anesthesia? And since a lot of C-sections are done because mothers are just too exhausted to go on, quite possibly because they haven’t eaten in several hours and their energy stores are depleted, doesn’t it make more sense to let women eat in labor if they wish so that they can withstand the hard work of bringing forth their babies?

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