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Women in labor now allowed more than ice

SANTA ANA, Calif. (MCT) — 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.

(c) 2010, The Orange County Register (Santa Ana, Calif.).