Comments on: Restricting food and drink in labor is not justified

By: KALI update « Mom’s Tinfoil Hat

KALI update « Mom’s Tinfoil Hat — Wed, 03 Feb 2010 04:42:59 +0000

[...] Cochrane review on restricting food and liquid intake during labor. Thanks for posting about it, Amy. Tagged with: Birth, Cesarean Section, Fellowship, Medical School, Pregnancy, [...]

By: Kathy

Kathy — Fri, 29 Jan 2010 19:01:59 +0000

@Amy Tuteur, MD
“You just don’t get it” is not an acceptable debate response, just a way of avoiding a response. How about addressing the claim?
Which claim? That NCB’ers are just about defying authority? Or that NCB is just about “how we want to view ourselves”? All I can do is say, “No, it isn’t,” and you’ll rejoin, “Yes, it is” — it’s a pointless argument, not a debate. I’ve already given you examples of how it’s not about defying authority — if it were, I should have had a pinnacle experience with my unplanned UC, defying not just the authority of doctors such as yourself in having a homebirth with a midwife but in defying the authority of my midwife in not calling her when I was in labor. [Though the reason I did not call is that I had already called her for one false alarm, and with the ctx so widely spaced apart, I wanted to make sure it was "real" labor before I called her to come again.] And another example is that in my first labor which was an empowering birth (CNM-attended water-birth), I did whatever the mw asked me to do, without thought or hesitation — get in the tub, out of the tub, sip some juice (although I absolutely did not want it and knew I would throw up [but I remember thinking though not saying to the midwife, "It's your own fault if you have to clean up my vomit because you made me drink this when I don't want to!"]), take my bp, temp or listen to the baby’s heartbeat (with a Doptone, not even with a fetoscope!). You’d think that if I were getting off on defying authority, I’d have at least mentioned **something** when she thought my labor had stopped and was wanting to give me something to make the ctx stronger. You’d think that I would have said something along the lines of what I was thinking — “Stronger?? They’re supposed to be *stronger*??” or even, “I’m still having strong ctx, thankyouverymuch.” Instead, I meekly said, “Ok,” but before she got done with taking my vitals, I started spontaneously pushing. Oh, wait — maybe I defiantly caused my cervix to fully dilate in those few minutes so that I could defy my midwife’s wishes in giving me herbs or whatever to strengthen the ctx.

I was being sarcastic about “getting off on thumbing our noses at the doctors,” but that is what you believe about it, so there is no debate, and argument is fruitless, because it’s already come down to “Nuh-uh,” and “Yeh-huh!” Pointless.

I’ve come to realize something, though. Talking to you on this topic is like talking to an abused wife about how wonderful husbands are; or talking to a rape victim about how wonderful sex is. For whatever reason, regardless of how many stories you read about empowering births or good birth experiences, you just don’t believe it, so you say it can’t be… or if it is, it has “nothing to do with birth and babies,” but with something else — defying authority, or how women view themselves. [Although I have to wonder -- what's so wrong with women seeing themselves as powerful?]

By: Dr. Amy Tuteur's doppelganger

Dr. Amy Tuteur's doppelganger — Fri, 29 Jan 2010 03:50:40 +0000

“In our relentlessly competitive society, it is often difficult not to set goals for ourselves, even in the most intimate of circumstances. It is important to remember that childbirth is not an athletic event. No team of judges will award the perfect score to the woman who refused an episiotomy, or deduct points from the woman who requested an epidural.

Childbirth is a deeply personal experience. You should feel comfortable making the choices that are right for you; do not judge yourself by someone else’s standards.” (Tuteur, 1994)

Tuteur, Amy B.MD. How Your Baby is Born. Ziff Davis Press, Emeryville, 1994.

By: Amy Tuteur, MD

Amy Tuteur, MD — Fri, 29 Jan 2010 00:15:31 +0000

“that’s been established.”

No, it has NOT been established. There is no scientific evidence that shows that women need to eat DURING labor to have enough calories to complete labor. If you want to make that claim, you must provide proof.

By: Rachel

Rachel — Thu, 28 Jan 2010 22:39:52 +0000

So Amy, why shouldn’t we allow women to eat or drink if they want? Again, I’m not sure what your claims are. And no I don’t think we need to study that we need to eat for energy…that’s been established. These study showed that there are no bad outcomes…so what are you claiming Amy?

By: Amy Tuteur, MD

Amy Tuteur, MD — Thu, 28 Jan 2010 22:19:15 +0000

“Do we need to study this?”

That’s the rationale that they used when they first pumped high concentrations of oxygen into incubators. It never occurred to anyone that concentrations of oxygen that were perfectly safe, indeed beneficial, for adults could and would cause blindness in premature babies.

If you make a claim, you need scientific evidence to support it. So, yes, you do need to study whether adding calories through eating and drinking during labor promotes better outcomes. That’s just what the authors of this study were looking at … and they found not merely that eating in labor is not necessary for successful outcomes, they found that it has no benefit at all.

By: Rachel

Rachel — Thu, 28 Jan 2010 21:25:27 +0000

Amy, I’m confused. What is your claim?

That “the don’t “need” nutrition and calories for labor”? That “eating in labor has no medical benefit”? “The don’t “need” nutrition and calories for labor. “Natural” childbirth advocates simply made that up”

We need to eat to do anything. Do we need to study this? Do we really need a study to say that women in labor needs energy and calories. That’s just basic physiology. When a women is in labor she is burning calories, she is using energy. Her body is working. Even with an epidural, a woman’s body is using a lot of calories that should be replenished.

“The fact is that “natural” childbirth is all about defying authority.”

No evidence for this but antedotal.

“Doctors recommend pain relief;”

Some do, some don’t. In my experience, most are willing to do what the woman wants, but don’t always provide labor support.

“Doctors point out that eating in labor has no benefits”

I guess that depends on what your definition of what benefits are. This study did look at comfort, energy levels, level of exaustion, or desire to nurse or be with the infant afterwards.

By: Amy Tuteur, MD

Amy Tuteur, MD — Thu, 28 Jan 2010 18:03:33 +0000

“at least I can say with confidence, “you don’t get it”

“You just don’t get it” is not an acceptable debate response, just a way of avoiding a response. How about addressing the claim?

By: Kathy

Kathy — Thu, 28 Jan 2010 17:48:27 +0000

Well, at least I can say with confidence, “you don’t get it… you just don’t get it.” I’ve always suspected it, but now you’ve confirmed it.

By: Amy Tuteur, MD

Amy Tuteur, MD — Thu, 28 Jan 2010 16:43:09 +0000

“Maybe we’re just getting high on defiance when we think we’re getting high on oxytocin and endorphins. Maybe when we stand up and walk around in labor, working with the sensations of our body and being supported by those who care, hearing them tell us that we are strong and powerful, and pushing out our babies under our own strength, in whatever positions we choose, we’re not feeling empowered by those things — we’re really just getting off on thumbing our noses at the doctor.”

Exactly!. None of this is really about birth or babies. It’s all about how “natural” childbirth advocates want to view themselves.