I do believe ACOG must stand for American College of Obtuse Gynohaters. (Other suggestions from Twitter friends: Appalling Care, Obvious Garbage; Aberrant College of Greed; American College of Oppressive Gits*. Feel free to add your own suggestions in the comments!)
Unbeknownst to me, just days before I published Just like athletics: exploring a childbirth analogy, the American College of Obstetricians and Gynecologists was releasing a policy statement that “relaxes” restrictions on fluid intake during “normal, uncomplicated labor”, and would “allow” women in labor to
drink modest amounts of clear liquids such as water, fruit juice without pulp, carbonated beverages, clear tea, black coffee, and sports drinks
– as opposed to the even more unfathomable current policy which restricts women in labor to ice chips. Ice chips! (By the way, if more than 1% of American obstetricians have seen a truly physiologically normal labor that they haven’t managed to unnecessarily complicate somehow, I’ll eat The Man’s angora Stetson.)
Today The Big Push for Midwives released a sufficiently ridiculing reply to ACOG’s statement (which includes another comparison of birth to marathon!), though I wish they had gone into the evidence more.
The rationale for denying solids in labor goes something like: Once Upon a Time, long long ago, when OBs routinely knocked women out during labor (ok, so sort of at our own request) and anesthetics were in their infancy, aspiration of stomach contents was kind of a serious problem. And, of course, since women were knocked out anyway, they figured we didn’t need frivolous things like fuel or energy, so they might as well reduce the risks by dictating Nil Per Os (nothing by mouth), right?
Only, anesthetic techniques have gotten half a century better (see? I do have good things to say about ACOG. oh wait, that’s the responsibility of the American Society of Anesthesiologists. nevermind.), and only a small percentage of the large percentage (but still — for now — minority) of those who need cesarean or other surgery in labor actually go under general anesthesia (which, remember, is much safer), and there’s no evidence that withholding all food or drink actually makes the risks of aspiration and aspiration-related complications safer (though it does make it less messy for the anesthesiologist to clean up), so that’s pretty well an unsupportable policy.
When I talked with my friends in Canada, Australia, and the UK about the ice-chips-only restriction (and this “relaxation” of rules), the reaction was universally a variation on “wait, what? hospitals actually DO that?!” And yet, all three of those countries (and, oh, almost 40 others?) have better maternal mortality rates than we here in the good ol’ USA do.
So if not based on silly things like evidence, or reality, or actual maternal health, how do we explain these seemingly-inexplicable restrictions?
Oh, I am so glad you asked that.
The name of the game, ladies and gentlepersons, is control. About thirty or forty years ago in the US, women started going “Wait, wtf? I’m not sure I want to be knocked out for this childbirth thing. I think I’d like to try to just, y’know, do it. I don’t really need or want you to shave my snatch, stick a bag of soapy water up my ass, cut my cunt, or dope me up. In fact, I think I’d like my husband/lover/friend to be the first to touch my baby as s/he enters the world. So… What are we paying you for again?” And so, slowly, grudgingly, American OBs stopped requiring we be shaved, stopped ordering enemas, and welcomed all and sundry into the birth room (though they’ve yet to stop mutilating our genitals). And the epidural and cesarean rates skyrocketed. At the risk of sounding like a conspiracy theorist, this was not a coincidence.
In the face of women demanding concessions in some areas (enemas, atmosphere, attendants), ACOG had to regain control of birth somehow. The perfect way, when what women were trying for was “natural” labor? Sabotage: set up so many barriers in our way, deny us the fuel necessary for such a strenuous endeavor, that they’d be able to (we’d be demanding them to!) swoop in and “save” us. This is all about misogyny, all about undermining the strength and power of our bodies, undermining women, making sure that (usually white, rich, cis) men have control in the one area that those with functioning uteri and those without are simply, absolutely, different.
(This is probably a good time for the obligatory interlude in which I make clear that I am talking about organizations, and cultural forces that often go unrecognized. Individual obstetricians are generally perfectly decent people. Most OBs really do want to help women and babies, and think what they do is good for us. I have an anesthesiologist relative who, in addition to owning a house that would make Solomon blush, is quite a lovely person. The problem is that most evil is done by persons who are basically good. It only takes a few “we know best” people making decisions, legions of “just doing my job ma’am” pencil pushers — or episiotomy cutters — and a culture saturated in sexist beliefs and imagery and rules, to the point we can’t even see them anymore, to create a birth culture in which blatantly misogynistic unsupported-by-the-evidence practices can be near-universal and none of the intelligent, well-meaning people inside the institutions question it.)
So much for the history lesson: back to the present, in which we are offered this “relaxation” of restrictions, and told:
As for the continued restriction on food, the reality is that eating is the last thing most women are going to want to do since nausea and vomiting during labor is quite common.
Oh William H. Barth, Jr, MD, of Massachusetts General Hospital in Boston and chair of ACOG’s Committee on Obstetric Practice, how you make me laugh. While it’s true that most persons in labor would frown at a four course meal, and many of us do indeed upchuck quite frequently (if not copiously), most DO choose, when presented with the option, to consume something in labor, from toast to soup to pasta to pepperoni pizza (to name a few that were mentioned on Twitter). Further, the idea that because most do not want much means that none should be “allowed” any is… well, completely kyriarchal.
But hey, it’s a step forward, right? At least it’s something, right? A move in the right direction? From the policy release: “Allowing laboring women more than a plastic cup of ice is going to be welcome news for many.” That’s true enough, so this is sort of a little bit good… Right?
No.
What it is is a morsel, a scrap, a teeny tiny tidbit that is supposed to make us feel grateful, that serves only to tie us closer to them, like when a nurse or nurse-midwife slips us a sucker in the sly, and says “Shh, don’t tell, because you’re only supposed to have ice”, but we are so grateful to finally have something of substance in our mouths, something with energy, no matter how little, to get us through, something to settle our churning stomachs, we are so grateful… that we forget that it’s their fault we’re starving in the first place.
To my American hospital-birthing friends: you know this matters to you, whether you wanted food in labor or not, whether you were at an enlightened hospital or not; know also that it matters to me. To my American homebirthing- and birth-center-using-friends: it’s not enough to just escape the system. We aren’t all that lucky (approximately 12% of intended homebirths transfer in labor), and we don’t all want to. The system has to get better for when we need it, for when our sisters need it, for when our sisters want it. To my non-American or non-birthing friends: Birth rights are reproductive rights are human rights. What happens to one of us happens to all. As voz_latina says: “There can be no equality until all women have control over all aspects of our bodies. Birth, transition status, personhood.”
This may seem like such a small thing, a tiny drop, hardly worth getting bothered about; but in a million such drops we are drowning. ACOG wants to be seen as our benevolent allies, offering us tea and juice and soda, but they’re only pouring more on while we sputter for breath.
——————————
There are whole aspects to this I’m not addressing: the fatphobia slipped in toward the end of the policy statement (“Pregnant women who have additional risk factors for aspiration, such as morbid obesity… may need to be restricted from fluid intake on a case-by-case basis.”), and the undeniable racist disparity in maternal mortality rates, based largely but not wholly on the heartbreaking difference in quality of care based on class. And I hate to tag those intersections on at the end of a post like this, but I’m simply not up to juggling that many pieces today, and I beg your indulgence and forgiveness.
* “Git”, incidentally, is actually derived from “get” or “beget”, and refers to a person born out of wedlock. Thus, this will likely be the last time you’ll see it on this blog, as I do my best to refrain from misogynistic, kyriarchal language. (Which also happens to insult a group which includes my own child, though that shouldn’t matter. But it does.)
I gave birth at a German hospital, and the nurses gave me breakfast and everything I wanted. I’m not sure if this is the way it is handled in Germany in general, or only at this hospital, but I was hungry. And at a pre-birth check-up, I asked the doctors about food, and he explained that eating in labour is fine. His words (from my memory): “Every c-section after “normal” labour is an emergency situation. And even if there was a higher risk (which is not clear from the current research), it would not justify keeping food from women in labour – if we would do this, nobody would be allowed to eat anything, as he could have an accident and require surgery anytime, and that would be just bs. So go ahead and eat, if you are still hungry then.”.
After The Man read this comment, he turned to me and said “Can we send all our OBs to Germany for training?” So glad to know this particular piece of misogyny isn’t universal among obstetricians. Sad to know how entrenched it is in American OBs, but hey, saner countries give me hope.
Great post. I wish I had something meaningful to add but you’ve said it so well!
Also, apologies for the ‘git’ thing (as it was I who suggested it on Twitter). I had always thought it was derived from the Indo-European root of the word (‘ghend’) which means “to seize or take,” therefore implying an arrogant person or someone on a power trip. I didn’t learn about the alternative to the word’s origin until I did a search this morning.
No worries. :) I like the derivation you thought it was, and I’m sad to learn of the “beget” origin. I’m honestly bummed about the loss of “git”. It had been one of my favorites, with none of the obvious problems of sonuvabitch, asshole, etc. Ah well. Kyriarchy is everywhere. :-/
(At least we still have douchebag!)
I am Canadian. During my second labour I didn’t eat in hospital because there wasn’t time. I arrived at about 2:20 and gave birth at 3:11. But during my first labour I ate a tuna sandwich, which I threw up. But I totally didn’t care. I was nauseous my whole pregnancy, and I wasn’t in early labour. For the first time in months it felt good to eat.
While I was eating my lunch voraciously the nurse cautioned me and told me I’d likely throw it all up. But it so doesn’t matter. Either way I really think that having that food made a difference to my psychological and mental state, and helped me physically because it was all that I ate that day. It also underscored that I wasn’t sick or incapacitated, I was just undergoing a normal physiological process.
I think the new statement is pretty ridiculous. As if cream in coffee or pulp in juice is going to make the difference. As if anyone has the right to dictate the conditions of your birth.
Aww, thanks, ACOG, so lovely of you to cater to my hatred of pulp in orange juice. That means you must care about me now, and will train all your humble servant members to never ever write “generous episiotomy suggested” in my medical records ever again, right?
The fatphobic part is particularly distressing. Ick.
Their new restrictions is nothing more than a pat on the head and a “there, there, be a good girl and I’ll be a little nicer”.
I agree with Summer, they threw us a bone, and we are supposed to be grateful for it!! I am an American, and a homebirther. I gave birth once in a hospital, an 18 hour labor. After giving birth, spending about 12 hrs in the hospital with nothing to eat, I proceeded to eat the hospital supper they brought me, PLUS a big bacon classic value meal from Wendy’s fast food restaurant over the course of my daughter’s first 3 hours of life. Birth = marathon? You bet it does.
I had my “natural childbirth” and wasn’t vomiting, I ate yogurt, mixed nuts, drank Powerade and water… It was an amazing experience. Screw ACOG and make midwives more accessible to women.
While I’d be happy to see ACOG as an organization go up in flames, as I pointed out in the post, it’s not enough to just say “screw you guys, I’m going home” (to quote the ever enlightened Cartman). I mean, feel free to! I did, and I adored my homebirth. Choosing to step outside the system is a perfectly legitimate form of protest and revolution. But not everyone can or wants to, and it’s unacceptable that these troglodytes are still getting away with such blatant, unsupportable misogyny.
I can’t help but think that American obstetricians away from the influence of ACOG would be significantly nicer, safer doctors.
I had my first child two months ago and had a wonderful home birth with midwives. I’m in the U.S. and all the research I was doing about birth? yeah. Didn’t want anything to do with a hospital birth. I went into labor around 10pm and wasn’t able to get much sleep, it was nice to be able to eat when I was hungry. But you know I wasn’t really that hungry. I had eaten a big dinner around 8pm or so, and past about 5am I had NO interest in eating. around sunrise everything I had eaten got thrown up. But I drank a lot of juice. And water. I was SO thirsty.
But it was the freedom of being able to do whatever my body needed that was important to me. Which is why I chose to birth at home.
When a woman eats to her own taste in the early birthing hours, that food does not digest the way it does normally. However, the food provides energy (sugars) to the birthing woman/baby dyad. The reason that women vomit when nearing the pushing stage is that the body is automatically calibrating how much sugar should or shouldn’t be in her body and, at transition, the levels drop dramatically in order to protect the baby’s brain from a lactic acid buildup during the pushing. How do I know this? An amazing article pub’d in Scientific American. Not many ob/gyns read that magazine so I’ve never heard them discuss this phenomenum. There are so many things that are unknown about the birth process. We’re so much better to trust what Mother Nature has been perfecting for thousands of years than trust a flawed profession that has hurt and killed so many women and their babies.
That’s really interesting Gloria. I knew about altered digestion in labor (makes sense: all the body’s energy is going elsewhere!), but I hadn’t heard of a connection between vomiting, blood sugars, and lactic acid in the baby. I’d be really interested in seeing the article if you have a link (or the title, and I could look it up).
Thanks for this, Arwyn! I completely agree.
This link was posted on the FB page of a the woman attended my 3rd birth (2nd at home) whilst a midwifery student in Australia. She’s now a wonderful asset to the USA (her homeland). Anyway, I just love this the way this is written and I have little to add regarding access to fluids in Aussie hospitals. My first was hospital and I remember sipping water, and chewing ice. I don’t recall being hungry or thirsty though – or being denied but I certainly wasn’t offered anything else.
But in comparison, at home my midwife told me to have a hearty breakfast high in carbs (I chose porridge, ie. Oatmeal I think you call it) and drank sportsdrinks after that as I needed it. I didn’t need permission, I just did what I needed to do…..And that’s the point!
Why can’t they (or most of us) see this paternalistic behaviour is all about control?
Another factor to bring up is that these new guidelines will take forever to be actually implemented in hospitals, as I found when my baby had surgery and the hospital was using pre-anesthesia guidelines that were a decade old. It’s like episiotomies, too — they’re not recommended to be routine anymore, but that’s not stopping a lot of hospitals/doctors. So women are going to read about these new guidelines and go to hospitals thinking, “Well, at least I can drink a little water now” — and they’ll be shot down.
And, yes, it’s especially lovely to deny obese women liquids. That’ll learn ‘em to lose weight before going into labor…
Great post! I love how you’ve analysed the issue. I’m interested in developments in this area because I had a run-in with a Dublin maternity hospital weeks before giving birth to my elder son in 2004 – blogged about here, if you’re interested. Reading back over that post and my responses to comments, I note that my understanding of the kyriarchy has come on a lot in the last five years, which is encouraging.
Thanks you so much for writing such a kick ass article. Smart. The more we keep talking the better things will get.
Pingback: Raising My Boychick is now on Facebook « Raising My Boychick