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The study in this edition of the BMJ showed no difference in outcomes
between women who were starved and those "allowed" light diet during
labour.
As the reason behind enforced starvation is the risk of Mendelson's
syndrome, surely these results add weight to the argument in favour of
starvation?
General Anaesthesia is now rare in this country for caesarian
section. And aspiration itself is a rare event. There is scanty
evidence, and common sense, to suggest that aspirating partially digested
food will have a worse clinical outcome than aspirating gastric fluids
alone. IE the patient is more likely to develop acute respiratory
distress syndrome.
There has never been any evidence, or suggestion that aspirating food
is better for the lungs than gastric fluid alone. Numbers needed to study
prospectively the effects of feeding on aspiration outcome (the key issue)
would be enormous. Much bigger than this study.
Starvation guidelines for elective operations have gradually reduced
the time of starvation for solids and particularly fluids, as there is
evidence for adverse effects resulting from prolonged starvation.
(Including on the acidity of stomach contents).
If, as this study seems to indicate, there are no adverse effects of
a starvation policy, and as bereaved relatives might put it "it could save
a single life", why not maintain the policy?
As mentioned in the editorial - the study didn't ask women whether
they wanted to eat or not.
The labour wards where I have worked have all had their own policies
(varying to some degree). So midwives, obstetricians and anaeshetists
simply state the protocol.
My personal view,is that labouring women (or any "patients") should
be able to choose freely. But I don't know the words to use when offering
the choice. "For the vast majority of women eating in labour is fine.
For those that go on to have a delivery in theatre, there is a small
chance of needing a general anaesthetic, and of those there is a tiny
chance that what's in their stomach may go into the lungs, and we think
that probably, if theres lots of food in the stomach, the chance of
developing a major lung inflammation, needing intensive care, and possibly
resulting in death or disability is higher than if you've not eaten. . .
But it's up to you." Somehow doesn't sound right. Especially to say to
someone who's trying to have a baby.
Competing interests:
I am an anaesthetist
Competing interests:
No competing interests
06 June 2009
Carl J Morris
specialist registrar anaesthetics
Heatherwood and Wexham Park Hospitals Foundation NHS Trust, Wexham Park, Slough SL2 4HL
A different interpretation of the results
The study in this edition of the BMJ showed no difference in outcomes
between women who were starved and those "allowed" light diet during
labour.
As the reason behind enforced starvation is the risk of Mendelson's
syndrome, surely these results add weight to the argument in favour of
starvation?
General Anaesthesia is now rare in this country for caesarian
section. And aspiration itself is a rare event. There is scanty
evidence, and common sense, to suggest that aspirating partially digested
food will have a worse clinical outcome than aspirating gastric fluids
alone. IE the patient is more likely to develop acute respiratory
distress syndrome.
There has never been any evidence, or suggestion that aspirating food
is better for the lungs than gastric fluid alone. Numbers needed to study
prospectively the effects of feeding on aspiration outcome (the key issue)
would be enormous. Much bigger than this study.
Starvation guidelines for elective operations have gradually reduced
the time of starvation for solids and particularly fluids, as there is
evidence for adverse effects resulting from prolonged starvation.
(Including on the acidity of stomach contents).
If, as this study seems to indicate, there are no adverse effects of
a starvation policy, and as bereaved relatives might put it "it could save
a single life", why not maintain the policy?
As mentioned in the editorial - the study didn't ask women whether
they wanted to eat or not.
The labour wards where I have worked have all had their own policies
(varying to some degree). So midwives, obstetricians and anaeshetists
simply state the protocol.
My personal view,is that labouring women (or any "patients") should
be able to choose freely. But I don't know the words to use when offering
the choice. "For the vast majority of women eating in labour is fine.
For those that go on to have a delivery in theatre, there is a small
chance of needing a general anaesthetic, and of those there is a tiny
chance that what's in their stomach may go into the lungs, and we think
that probably, if theres lots of food in the stomach, the chance of
developing a major lung inflammation, needing intensive care, and possibly
resulting in death or disability is higher than if you've not eaten. . .
But it's up to you." Somehow doesn't sound right. Especially to say to
someone who's trying to have a baby.
Competing interests:
I am an anaesthetist
Competing interests: No competing interests