Posted by My OB said WHAT?!?.
Oct
1
Posted by My OB said WHAT?!?.
“…Your Poop Could Be Sucked Into The Vaginal Canal…”
“We don’t allow you to eat because your poop could be sucked into the vaginal canal and cause an infection.” -Triage nurse when mom asked why she couldn’t eat once admitted to L&D .
There are 148 comments to this post.
Not only that, but if you eat during labor, left-handed terrorists could win the lottery, thus ensuring a thousand-year reign of terror where no one is aloud to sing anything other than “Old Man River.” JUST DON’T DO IT!!!
–
But really–it takes what, 36 hours for food to make it through the digestive system? So what about the food the mom has been eating up UNTIL she went into labor? Should women past 36 weeks fast until delivery?
And the vagina is not a vacuum cleaner. (You’d think they’d cover that in medical school.)
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Aron Reply:
October 1st, 2010 at 4:55 am (Quote)
My thoughts exactly – except you always manage to say it in a way that makes me laugh! But really, why is the vagina vacuum only dangerous during labor? Does the baby flip some sort of “on” switch on his way out the birth canal? Can the switch be flipped by, say, making love? Sneezing? Now that I’ve learned this piece of wisdom you can just bet I’m NEVER EATING AGAIN! Why? WHY didn’t they teach me this in Anatomy & Physiology?
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Jane Reply:
October 1st, 2010 at 5:06 am (Quote)
And if it can vacuum up random stuff and cause infection, why do they insist on sticking their fingers up there every hour? It should be far, far too dangerous.
(I hope the OP mom said that to the nurse later: No, you can’t check for dilation! Your gloves might get sucked right up the vaginal canal and get trapped behind the placenta, causing infection! In fact, your whole arm could get ripped off. Better safe than sorry!”)
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cheeks023 Reply:
October 1st, 2010 at 9:38 am (Quote)
Oh My freakin’ word Jane. I am literally trying not to pee myself while laughing right now (35 weeks pregnant; makes it a difficult feat!)
JANE FTW!!!!!!
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Peyton-Leigh Reply:
October 2nd, 2010 at 6:45 am (Quote)
Hahahahahahahahaha!!!!!! I am loving this site!! I just found it this morning! I can’t get over the thought that a vagina can suck up anything. Boy, wouldn’t our husbands be extra happy!! 
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prochoicedoula Reply:
October 3rd, 2010 at 9:43 am (Quote)
LOL! Fortunately, this was just a temporary nurse. The one we got after this, after the shift change, was absolutely lovely. So we lucked out on that one… I was about to scream when the “sucking poop” nurse said her line!!
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Jane Reply:
October 3rd, 2010 at 10:07 am (Quote)
Prochoicedoula, would you mind replying to one of Dr. Fogelson’s comments on this page to indicate that you are a medical professional yourself and you heard this quote said AS IT IS, and not as he’s implying, that the nurse really said a woman might aspirate if she vomits while under anesthesia? Perhaps he’ll believe you as the earwitness.
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Sarah Dorrance-Minch Reply:
October 3rd, 2010 at 7:09 pm (Quote)
Although it’s sad that only the words of another birth professional would be considered plausible.
At least it *seems* that the birth professional can be anybody, and doesn’t need to be another obstetrician.
Sigh.
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Sarah Dorrance-Minch Reply:
October 3rd, 2010 at 7:22 pm (Quote)
PS. Although it’s a non sequitur, about the aspiration thing -
Mostly total bunkus.
In the minority of cases when the mother winds up needing general anaesthesia for her surgery, rather than the more common epidural or spinal, after she’s out cold, she gets intubated to prevent aspiration. (I was given general anaesthesia when it was discovered that the epidural only worked on my left side. It took my vocal cords weeks to fully recover from that tube. The first week home, I sounded like Tina Turner on a bad throat day. I was singing soprano in my church choir prior to that.) Correct me if I’m wrong, but isn’t stomach pumping part of the package deal?
Also, an empty stomach generates FAR more acid than a full stomach, which is why in a PLANNED surgery that involves general anaesthesia, patients are often given Mylanta beforehand. The stomach acid is what can corrode the lungs and cause pneumonia.
It is conceivable that a little food might come up with the stomach acid, but if the anaesthesiologist is competent, that wouldn’t happen.
Finally, I’m sure the Just In Case rebuttal has been issued several times over (You want to starve me during labour, Just In Case? Kind of like all the unnecessary routines such as monitoring me continuously with an electronic monitor, Just In Case, and putting a hep lock in my arm or hand, Just In Case. Well, then let’s all install hep locks before we drive or ride anywhere, Just In Case we’re in accidents and need to be rushed to the ER. Let’s all hire paediatric neurologists to babysit our children on date night, Just In Case they develop epileptic symptoms in our absence.)
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Sherrie Reply:
October 5th, 2010 at 4:55 pm (Quote)
Unfortunately my vocal chords never fully recovered. I had a beautiful singing voice until I had to be put under for my second child.
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Serene Reply:
October 29th, 2010 at 5:22 am (Quote)
Yes stomach pump is part of the deal with an emergency general, they also use a different anaesthetic to normal, and a double-ballooned airway. Less muscle relaxant is used, so the waking is more traumatic, hence the trauma to the vocal cords.
So yes, this mans story = BUNKUM
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I Care Reply:
March 31st, 2011 at 1:25 pm (Quote)
Your medicine is off on the majority of your post.
Yes, aspiration happens rarely when using general anesthesia, which obviously happens rarely with birth.
However, the food from the stomach is what causes pneumonia – that baked chicken serves as a nice feeding ground for bacteria – NOT the acid you speak of.
Second, a good anesthesiologist has nothing to do with aspiration – it is prevented by not eating.
Third – stomach pumping is NOT normal for general anesthesia – it may be done, but it is done after you are asleep – and look an an anatomy book – an NG tube doesn’t go near the vocal cords.
Emergency anesthesia – the same stuff they give you when having any other surgery to not be awake. It is not different – same muscle relaxer, same propofol. Waking up, etc is all the same as any other procedure in an OR. (including having sore vocal chords – sorry to hear that!)
Now – to the OP – come on, really? We all know that is bunk. But research your science before you spread incorrect facts around please =)
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LDnurse/pronatural Reply:
May 30th, 2011 at 7:50 pm (Quote)
I agree totally with everything you’ve said. I’ve assisted with thousands of C/S, and never once have seen someone’s stomach pumped out. I’ve also never known anyone who had permanent damage to their vocal cords from having general anesthesia during a C/S. Maybe in a surgery that lasted 12hrs, but not in a 45 min case. I guess it could happen, but it certainly would be extremely rare. I’m sorry that it happened to this lady who was a singer. Our hospital is like most….nothing to eat in labor. Clear liquids (SIPS) in early labor, ice chips in active labor.
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Just…wow. It makes me sad if the nurse actually beleives this, and angry if she was lying!
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erica Reply:
October 1st, 2010 at 10:36 am (Quote)
I think some nurses/docs have a really low opinion of the intelligence of their patients and say ridiculous things like this because they think it’s easier to understand than the real reason (which in this case is still a stupid reason). I know a woman with very little education who was having upper chest pain in her third trimester – almost certainly heartburn – and her doc told her it was from the baby being hungry and she needed to more frequent but smaller meals instead of three big meals so the baby would always have food, which is what you’d be told to do for heartburn. Why he didn’t just tell her it was heartburn I have no idea.
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sara Reply:
October 1st, 2010 at 11:21 am (Quote)
Wow….Pretty sure that goes against some ethics code- don’t doctors have to learn about those kinds of things? Or does a medical degree also give them license to make stuff up if they don’t think you’ll understand?
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prochoicedoula Reply:
October 3rd, 2010 at 9:36 am (Quote)
@Erica, you are exactly right about the intelligence thing. The woman this was said to was my client. She was 20 years old, having her second baby, single, African American, and on Medicaid. One wonders if the nurse would have said this ridiculous thing to a 30-something, white, college-educated woman with private insurance, you know?
In fact, I could probably make my own “My OB Said What?” page with the things said/done to this woman. I could write a book on this birth alone. The good thing, though, is that Mom had a lovely baby girl and was able to birth without an epi, and everyone was impressed by her strength since she was Pit-induced. I was impressed, too. This mama was *fierce*!!!
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Alyson Miers Reply:
October 3rd, 2010 at 10:18 am (Quote)
One wonders if the nurse would have said this ridiculous thing to a 30-something, white, college-educated woman with private insurance, you know?
*shakes Magic 8 Ball*
“Highly doubtful.”
Good for your client! That baby girl has a badass mama.
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Sarah Dorrance-Minch Reply:
October 3rd, 2010 at 7:29 pm (Quote)
Hey, I’m white, middle aged, married, and did my master’s work at Oxford (that’s Oxford, England, not Oxford, Ohio or Oxford, Mississippi) and I still get treated like that when I whip out my Medicaid card, for what it’s worth.
Because as all health professionals know, if you aren’t affluent enough to have private insurance, but instead have Medicaid or self-pay, you’re stupid (also probably a drinker, smoker, drug user, unhygienic, a child neglecter and/or abuser…)
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If my vagina was only a vacuum cleaner…think of how clean my house would be.
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Sarah Dorrance-Minch Reply:
October 3rd, 2010 at 7:32 pm (Quote)
But then you’d have to do the scrape-along-the-floor thing like dogs and cats do when they have a few leftovers to take care of after defecating.
Sounds uncomfortable.
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lisa had this to say,
Oct 1, 2010 @ 5:58 am (Quote)
So THAT’S where all the missing socks are!!
It’s ok nurse. We have twinkle lights and doulas who preform seanaces to fix that.
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Liz Chalmers Reply:
October 1st, 2010 at 7:57 am (Quote)
LOL! That sock comment made me spray coffee over my keyboard. The original quote made me almost throw up my breakfast there too!!! Messy times…
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Wow! Could you draw a diagram of how that works please?
Classic case of ‘I really have NO IDEA why you can’t eat. It’s just how things are done around here. No ones ever asked that before so I’m gonna say the first dumb thing that pops into my little mind….’
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Dumb dumb dumb. I like the hoover and socks comments.
I ate during labor, but it was mostly liquid type stuff so it sucked anyway (not literally). I plan on bringing my own food and hiding it this time. They can kiss my butt if they think I’m going to go 20+ hours on a liquid diet like I did last time.
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Jessa Reply:
October 1st, 2010 at 10:37 pm (Quote)
Yeah. It was 39ish horus before I got to eat. Ate @ 4pm Tuesday. Admitted to L&D @ 7pm Tuesday. Had HD @ 6:32pm Wednesday FINALLY GOT TO EAT @ 8am Thursday Morning. Why? After my csection (lets not go there lol) the nurse in the Recovery asked me if I was hungry and I SAID YES PLEASE. Got to my room at 8pm that night and my duty nurse was like “Oh NO! No one told me you could eat!” o.O?
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jespren had this to say,
Oct 1, 2010 @ 6:27 am (Quote)
“Really? Babies come with their own vaccuum cleaners? Where does the cord plug in? Oh, no, wait, it’s plugged right into my uterus, that’s what’s been sucking my energy for the last trimester! Oh, and by the way, if you don’t like me eating and drinking..don’t watch, I brought my own and don’t really care what you think!”
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I couldn’t drink during my 40 hour induction (except for a small pitocin break) and honestly, that was absolute TORTURE.
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Cmat Reply:
October 1st, 2010 at 9:05 am (Quote)
They didn’t want you even to drink water???? Crap! They gave me food/drink during my birth. I didn’t start out being induced, but was given pitocin. Nothing really changed.
That just sucks! Sorry you went through that 
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Rebecca Reply:
October 1st, 2010 at 9:18 am (Quote)
It was so hard because I take a medication that causes extreme thirst. During pregnancy I drank a liter an hour (when I was awake). Because I was very high risk, I was at a significant chance for c-section (which I did ultimately need), so I can kinda see their reasoning, but it sucked nonetheless. They weren’t jerks about it, they empathized with me and they tried to make up for it with extra fluids and extra ice chips at least.
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Holly Wilson Reply:
October 1st, 2010 at 11:10 am (Quote)
I didn’t get to eat or drink for over 60 hours when I had my daughter. Nothing but ice chips and I eventually pleaded my way into hard candy. Needless to say I will not be delivering at that hospital again.
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Melissa Reply:
October 1st, 2010 at 10:07 am (Quote)
But extra IV fluids have their OWN risks for both mother and baby (some of them rather scary) and, in my experience, don’t help you feel less thirsty. The “CS risk” thing as an excuse is pure bogus. The literature does NOT support women being denied food, much less DRINK out of fear that she may need a c-section.
About the worst parts of pregnancy for me was being told to come to the 3hr glucose fasting (no water!), drink the orange syrup (gaaah!), then not DRINK anything for those three hours. I drink the 6-10 glasses of water a day that we’re SUPPOSED to drink because it’s HEALTHY, and I can’t tell you how many times people took my water intake as a sign that I was unhealthy (uh oh, you must be diabetic!). I fainted once while pregnant, and what do they do after grilling me on what I ate/drank that day? Deny me ANYTHING for the next six hours.
So I do not know how you made it though 40 hours, especially with the meds you take that make you thirsty. But it makes me angry that they put you through that. Glad you made it through, though!
(40 hours without anything to drink IS torture. Gotta go check my Geneva Convention….)
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Rebecca Reply:
October 1st, 2010 at 1:36 pm (Quote)
The doctor actually confided to me that it was a decision made years ago and now almost exclusively held in place by the legal department. I did tell him that if I aspirated during surgery it was because the anesthesiologist was the problem, not the water, but that didn’t change the fact that he had rules to follow. I knew about the policy in advance and considered switching hospitals, but my perinatal team had been with me through a stillbirth and had cared for me between pregnancies just to make sure this pregnancy would go well, so I wanted to stay with them. And I figured why fight the system when I could have my husband sneak me water anyway. Much easier. Not a perfect solution because we didn’t want to get caught, but it worked to a degree. I cannot wait until all hospitals abandon this stupid rule. I remember the pain of labor fondly compared to the unbearable thirst.
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Linda Germany had this to say,
Oct 1, 2010 @ 7:38 am (Quote)
OK.. Correct me if I am wrong here.. The rectum/anus is BELOW the vagina….If old Newton was correct the “poop” would go down…. Right? I may be wrong, ya know, cuz I don’t have that awesome degree that says I know EVERYTHING about a woman’s body.. I just have one in art ed… Oh wait, maybe it is the magical floating poop…
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Liz Chalmers Reply:
October 1st, 2010 at 8:03 am (Quote)
…it’s only well below the vagina when mom is lying on her back. Which, of course, with a nurse like this opening the show, is where mom WILL be.
Which makes me realize that this particular line can be used in a variety of situations (“No, you can’t get on hands and knees, because….”, “No, you can’t have a waterbirth, because….”, “No, we have to suction the baby, because….”).
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While a baby and all the fluids etc are coming OUT of me? Really? Maybe if you’d keep my water intact, the bag of waters will come out with the baby and we’ll both be protected from infection longer. And then if you don’t cut an episiotomy, I’d possibly be even more likely not to get infection issues. If you let me birth in water, that might even be better…
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The Mommy Blawger had this to say,
Oct 1, 2010 @ 8:19 am (Quote)
That’s one of the most stupid things I’ve ever heard.
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The Deranged Housewife had this to say,
Oct 1, 2010 @ 8:57 am (Quote)
Seriously? SERIOUSLY?! Dear God, help us!
“Not only that, but if you eat during labor, left-handed terrorists could win the lottery, thus ensuring a thousand-year reign of terror where no one is aloud to sing anything other than “Old Man River.” JUST DON’T DO IT!!!”
I am laughing out loud at this – only Jane could come up with this one! LOL
I’m sure the nurse is really thinking, “If you eat and drink in labor, you just might have the energy to get through 36 hours of hard labor and push for another two all while the doctor really wants to cut you open, and WE WOULDN’T WANT THAT TO HAPPEN!?!” 
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Cmat Reply:
October 1st, 2010 at 9:04 am (Quote)
No kidding. I think I would have had just a little more energy had I eaten SOLID FOOD. Not saying hand me a big mac, but some fruit or something like that would be nice.
Btw I think I pooped because I was on a liquid diet. I know it happens and its common. It didn’t bother me. But after having my wisdom tooth pulled and going on soft/liquid diet for almost a week, I can honestly tell you that does some wicked things to my digestive system. Second I went back to solid food I felt better and my system wasn’t all wacky.
Like Judge Judy says- If it doesn’t make sense, its probably not true!
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This one is just too rediculous. During my first birth the nurse brought food “for my husband” My second birth I ate whatever the hell I wanted because I was at home. No poop got sucked up and if I got an infection it would have been from those stupid vaginal exams they insisted on.
Not to mention that when poop was coming out I also had a baby’s head stopping up my hoover.
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Riiiiiiiiiiiiiiiiiiiiight. As mentioned earlier, even if our vaginas DID turn into vacuum cleaners during labor, what we ate during our labors would pretty much be a moot point, because barring illness, WE HAVE POOP IN OUR BODIES ALL THE TIME. The poop that comes out during labor is not from food consumed during labor, unless the labor has been over 48 hours or so (which I’d doubt they’d “allow” in this hospital).
Seriously, I think the nurse needs a copy of this book, and to get over herself.
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Sarah--Well Rounded Birth Prep had this to say,
Oct 1, 2010 @ 9:56 am (Quote)
Just when you think you’ve heard it all.
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Jenny Islander had this to say,
Oct 1, 2010 @ 10:13 am (Quote)
If I had my support person nearby (probably my husband, he’s very good at looming) and could be sure that they wouldn’t isolate and punish me later, this is where I would look at the nurse and say, “Do you LISTEN to yourself?”
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WHAT! They honestly don’t even know why they have the regulations they do, so they’re forced to make shit up. And they can say whatever they want and make it ridiculously outlandish just for entertainment because the women are “under their control.” Pfshh.
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annnnnnddd “poop” is a medical term, right?
I tried to eat before going to the hospital while in labor with my daughter, but my body swiftly and violently rejected it, LOL.
I had a long labor with my son and ate a steak & cheese sub on my way home from Target (yes, I was in pretty serious labor in Target, LOL) and then went home labored a bit longer, packed up and had my son maybe 5 hours after eating that sub. No vagina vacuum incidents and I OMG had the energy to push him out with no medication. Sheez.
Let’s starve you and then make you run a marathon, ok? Nice.
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Someone ought to have mentioned this to my son because HE was the one who pooped… when he was half way out, no less. And guess what? My vagina didn’t magically suck it up, though I wouldn’t have complained if it did. It pushed it out along with all the rest of the leftovers.
Unreal. Seriously.
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Wow. I agree with whoever said that this sounds like the kids on the playground making shit up (ha ha).
So, I haven’t spend tons of money on nursing school and even I know that it’s based on an old study that deals with surgery under general anesthesia where the patient aspirates their vomit after throwing up. However, it was found that even on empty stomachs, patients still vomit and empty stomach contents are MORE dangerous from the acid burns inflicted upon the lungs (and for some reason, they now give citric acid to combat this?). Anesthesiologists are trained in removing vomit as it comes out now to prevent aspiration and they do it every day in actual surgical emergencies.
So, um, it’s just an outdated policy based on outdated technology and untrained anesthesiologists. I’m sorry, but if yours isn’t qualified for true emergency surgery, I don’t want them NEAR me.
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Dreamy Reply:
October 1st, 2010 at 2:03 pm (Quote)
Yup. Basically it’s a policy built on a fraction of a fraction of a fraction of a percent chance of something going wrong*, and is actually a WORSE policy than the alterative even in that rare event… Vs. treating a laboring woman like a human being– a human being with a special need to keep her energy up.
*IF a C/S is needed with almost no warning (rare) and IF there’s not enough time to place an epidural/spinal and it must be done under general (even rarer), and IF the patient vomits (not a given) and IF she aspirates (also not a given) and IF that aspiration is significant… And like you said, even then, it’s better to aspirate a tiny piece of chewed fruit than straight stomach acid. *sigh*
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Danielle Reply:
October 2nd, 2010 at 6:53 am (Quote)
I was curious as to why they give the citric acid as well but I ended up not having it.
Our hospitals here are filled with bullies and home births are practically illegal so I was bullied into 2 c-sections and chose to have another after there was a complication (the doctor gave me the “choice” but I didn’t think there was much of a decision to make since they couldn’t find his heartbeat…) but I got very lucky with the staff that I had this last time and I told them about how sick I get during the surgery so they actually DIDN’T give me the citric acid because they thought it would make it worse. The anesthesiologist’s nurse stayed up toward the head of the table and had some meds ready to go for me the minute I started gagging and I did vomit a little bit but she was awesome and cleaned me up immediately.
The eating thing is completely based on outdated policy though and I really, truly believe that all L&D staff need to be reeducated. The back is the worst position to birth in. Labor does NOT need to occur w/in 24 hours of water rupturing, vagina’s are not vacuums, food is not evil, pregnancy is not a medical condition and being informed does not make you the devil.
I think most L&D staff need to be pulled in and reeducated.
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“Well, my hubby tells me that I have a mouth like a Hoover… and now you’re telling me that my vagina is like one, too. Wow, I’m all kinds of freakin’ talented, aren’t I?!? YAY!!”.
lol sorry, but for a comment like this nurse’s, I couldn’t think of a better reply.
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Nicholas Fogelson, MD had this to say,
Oct 1, 2010 @ 6:14 pm (Quote)
If this is literally what she said, its obviously ridiculous…but it sounds so analagous to the real concern of vomit being sucked into the trachea if she aspirates that I wonder if that was what was really said. It is remarkable how what is said and what is heard often does not match up.
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Brenda Reply:
October 2nd, 2010 at 12:35 am (Quote)
I would have to agree with your statement that what is said by the health professional and what is heard often does not match. I also manage deliveries, and while I advise the mothers to be not to eat anything too substantial in established labour, they are certainly not routinely fasted. The reason for that advice is the propensity to vomit late in the labour. And in this part of the world, they can eat soon after a routine C-section.
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cheeks023 Reply:
October 2nd, 2010 at 7:51 am (Quote)
So, honestly what is wrong with vomiting in labour? Is it because it makes another mess for someone to clean up? Or is it because you are playing the “preventative medicine” game, and are banking on the fact that she may very well be in the OR having an unwanted/unplanned C/S. Either way, your reasoning SUCKS.
It is called LABOUR for a reason…it is HARD work, it is life draining, energy draining. How about we make all the doctors fast before and during a 24 hour shift and see how well they perform? After all, soon after their shift they will be more then welcome to eat.
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Brenda Reply:
October 2nd, 2010 at 12:47 pm (Quote)
I have seen many mothers vomiting in late labour and not one that enjoys the vomiting. That is behind my advice….which is an order.
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cheeks023 Reply:
October 2nd, 2010 at 1:07 pm (Quote)
Well of course nobody enjoys vomiting.
But having done both routes ie. vomiting in late labour, and being starved during a long labour where I didn’t vomit. Let me tell you that I much preferred having the energy during labour to work through what my body was doing despite the vomit, to having a long, vomitless labour with no energy, at which point I was SO exhausted, and so weak from hunger that I was crying and BEGGING for sustenance. I hadn’t eaten since supper the night before and it was about 10am. They ended up giving me a saline sugar solution (did nothing BTW) and after that I ended up with an epidural because I was so fatigued.
So sure, you can advise women all you want that it is not pleasant to vomit during labour, but please be sure to let them know the opposite side of the coin too, which is without real, honest sustenance, labour is incredibly more difficult. And don’t ever lie to a woman and tell her that pooping is the reason they are not allowed to eat, because unless she has a +24 hour labour, what she is eating in the hospital is NOT what is coming out. Digestive tracks take a minimum of 20 hours to run full through; I’m not a medical personnel, but that is simply grade 11 biology.
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Brenda Reply:
October 3rd, 2010 at 11:37 am (Quote)
That last comment of mine should have read “It is advice, not an order”…. Most women will do better with a light diet through most of labour and unless there are specific reasons for fasting (which are occasional not routine) the choice is left to them. I would caution against foods which are difficult to digest. And that is enough from me on this topic.
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Melissa Reply:
October 2nd, 2010 at 1:47 pm (Quote)
You advice may be “in order”–that is, an appropriate warning to laboring moms that they may want to limit their food to things that are easy on the stomach because of the possibility that it will be coming back up. But if it is “AN order”–it isn’t advice. And it isn’t appropriate.
I’m grateful when people give me the info–the real info, the real numbers, the real risks–and then remember that *I* am the only one that can really decide if the risks of what I do or what I allow to be done to me are worth it. I even welcome the “if it were ME…” advice from medical professionals who have a whole host of information and experience that I’m not personally privy to. It helps me make good decisions.
But *I* make the decisions for myself.
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Jane Reply:
October 3rd, 2010 at 10:01 am (Quote)
The only labor in which I vomited was the one in which I was told not to eat anything. Maybe a stomach full of stomach acid just isn’t the best thing to labor on?
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Knitted in the Womb Reply:
October 4th, 2010 at 7:57 am (Quote)
Yeah, a lot of women vomit in labor, and I don’t know any that LIKE to vomit.
But I don’t know any who like to be starved for a whole day either.
And, just for your little “anectodal evidence” file…you should know that I vomited in my first and 3rd labors. The 1st I had only had fluids and ONE French fry for about 10 hours prior to vomiting, though I had been eating normally in early labor (33 hours of labor). The 3rd it had also been about 10 hours since I had eaten–PRIOR to the onset of labor.
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helen blumner Reply:
October 2nd, 2010 at 5:58 am (Quote)
right, because a health care professional couldn’t possibly have said something as asinine as this? it must have been that the crazy laboring woman misheard it. i can totally see how she would mistake trachea for vagina and vomit for poop. im sure that’s what happened. ::rollseyes::
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Lauren Reply:
October 2nd, 2010 at 6:06 am (Quote)
You think we moms are THAT dumb, to mix up vomit and poop, vaginas and mouths??? Give it up. You’re being a troll.
You know what’s remarkable? How SO many women come forward with horror stories from their prenatal care or births, and are dismissed. It’s disgusting. I’m one of those women, and I will NOT be silenced!
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Rachel Reply:
October 2nd, 2010 at 6:34 am (Quote)
I completely agree with you Lauren. He masqueraded as trying to be helpful and informative but at this point he’s the definition of an internet troll.
Just like in life, you can find idiots everywhere. The medical community is most certainly not immune. You can have a super wonderful OB (like I did) or not, you can have a super supportive labor and delivery nurse or one who frankly shouldn’t be practicing. My mother in law is an icu nurse and the medical lunacy that comes out of her mouth is often astounding – she absolutely does not always know what she’s talking about. Just because they are a member of the medical community does not mean that they don’t say stupid things. Idiots are everywhere.
I just love that Dr. Troll automatically jumps to the conclusion that it’s the mother who is clueless as to what was going on and not the nurse.
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Nicholas Fogelson, MD Reply:
October 2nd, 2010 at 8:51 am (Quote)
I just love how many people that frequent this site can’t stand even a little disagreement without resorting to immature namecalling.
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Rachel Reply:
October 2nd, 2010 at 12:37 pm (Quote)
Ah yes but while you didn’t outright call the woman who submitted this comment a name, you did imply that she couldn’t possibly understand what a doctor was saying properly and honestly switched out “you can’t eat because you could aspirate on your vomit during surgery if you have to have it” for “You could poop during labor and your vagina would suck it up and cause an infection”. How is that any less insulting to the nameless woman who submitted this comment and most likely will be back and see what you said? It works both ways and there is a person with real feelings on the other side of her computer as well.
And you are, in fact, behaving like an internet troll. Lately you just come on here to stir up trouble. There was nothing helpful about that comment you made and only potentially hurtful.
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Alyson Miers Reply:
October 2nd, 2010 at 1:58 pm (Quote)
Dr. F, I don’t think your comment is trollish. I just can’t imagine how something non-stupid could have been misheard as “Your poop could be sucked into the vaginal canal.”
“You can’t eat because you might throw up, and the vomit could be sucked into your trachea”?
The motion is analogous, but the sound of the words is so different I really doubt that’s what was said.
“You can’t eat because your puke could be sucked into your blowhole”?
Now THAT could theoretically be misheard as something approaching, “Your poop could get sucked into [some word which is euphemism for vagina],” but if that was the nurse’s wording, it doesn’t help her case.
I think this nurse has to deal with a wide assortment of people in her job, and some of them are not too bright. She mistook the OP for one of those patients who can be persuaded to follow instructions based on nonsense like what was quoted above, but who probably won’t listen to her based on “You’re more likely to vomit during labor and if you choke on your vomit, that could cause serious problems.” When in fact the reason why mothers aren’t allowed to eat during labor is ultimately that the Legal department will hire thugs to round up the L&D staff and break their kneecaps. I think that, even if some mis-hearing did go on, the nurse treated the OP like a stupid person, and the OP felt accordingly insulted.
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Heidi RN Reply:
October 2nd, 2010 at 7:43 am (Quote)
Dr. Fogelson, I’m not trying to bait you, but are you actually defending the practice of restricting food for laboring women? Because of a study from decades ago where a few women aspirated? Anesthesia techniques have improved and very few women have general for labor. I just don’t see the logic in routinely starving ALL women when they are trying to push out a baby because of a risk that is almost nonexistent. Please point to me to the body of up-to-date research that supports this practice. I have yet to find it. If it’s out there, I’d love to see it.
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Nicholas Fogelson, mD Reply:
October 2nd, 2010 at 8:04 am (Quote)
Its based on a very theoretical risk that cannot be measured, because it is so rare. That being said, aspiration does really happen, and it really does cause a serious and potentially life threatening pneumonia.
There really isn’t any evidence to support restricting food, but it really can’t be studied because the risk is so low. If an aspiration did occur it would be pretty hard to defend in court given the general standard of care of restricting food in labor (in hospitals). That is ultimately a substantial driving force.
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cheeks023 Reply:
October 2nd, 2010 at 8:33 am (Quote)
So we’re being starved during some of the hardest work our bodies will ever do, all on an assumed, yet incredibly low risk with no evidence?
So why the lies?
Telling a woman “You are at risk of major abdominal surgery by delivering your child in this hospital. It prevents us from allowing you to eat anything due to our fear of you aspirating during said surgery. We have no proof, and no evidence, but that is our policy.”
(While completely asinine) At least would be the truth.
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Nicholas Fogelson, MD Reply:
October 2nd, 2010 at 8:41 am (Quote)
Not really a lie, just an opinion you don’t agree with.
A lot of what doctors believe is based on culture and anecdote, just like a lot of what midwives believe. Aspiration is sure rare, and we probably shouldn’t worry about it as much as we do. In reality it isn’t obstetricians that worry about it, its anesthesiologists. As they get to run the operating rooms, we tend to go with what they want.
Saying that we have no way of studying something is not the same as saying we have no evidence. Every anesthesiologist has dealt with aspirations, and every doctor has seen men and women sick from them, in some cases severely. They happen rarely, but they do happen. This rarity makes them impossible to study in any randomized way. The only way I think would be for a hospital to just change policies and then look retrospectively whether there were more aspirations over a time period after the change. Maybe this will happen. I also tend to think people should let women eat in labor, and I am more liberal with this than most.
There is a lot of interest in NPO rules changes in anesthesia, but things change slowly. The biggest changes have happened in pediatrics, where kids are generally allowed to drink clear liquids up until surgery now.
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Heidi RN Reply:
October 2nd, 2010 at 9:04 am (Quote)
“I also tend to think people should let women eat in labor, and I am more liberal with this than most.”
So does this mean that you order a regular diet for your laboring patients? Or if it’s against your hospital’s policy, do you tell your patients that you won’t stop them if they bring food?
If you do, then I respect you even more than I already did. Now how can we get the rest of the country’s OB’s to do the same?
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Nicholas Fogelson, MD Reply:
October 2nd, 2010 at 9:35 am (Quote)
If the woman is in active labor being induced, I go with NPO. I tend to let people eat in latent labor, even in inductions as long as there are no strip issues. If a woman is naturally laboring without pit, I don’t generally write for food but would probably look the other way if it were in the room.
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Susan Reply:
October 2nd, 2010 at 10:20 am (Quote)
It would be interesting to see what a retrospective study would turn up in such a case. I’m one of those who would have to have a general if I had a C-section, as I’m allergic to lidocaine (or any -caine drug), and since that’s the most common local, I’m out of luck. But even if I fasted during labour, it’s doubtful I’d have an empty stomach, since my last labour was all of 4 hours (well, could have been longer, I suppose; I woke up at midnight noticing regular contractions, went back to sleep until 1.00, so maybe I slept through more than I realised).
FWIW, I didn’t think you were being troll-like in your response earlier. It is common for people to mishear, or transpose words, especially in a situation where one may be a little more on edge. I know I liked having people with me at my pre-op appts (knee surgeries) so they could confirm what was said in case I mixed things up.
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Nicholas Fogelson, MD Reply:
October 2nd, 2010 at 8:49 am (Quote)
“You are at risk of major abdominal surgery by delivering your child in this hospital. It prevents us from allowing you to eat anything due to our fear of you aspirating during said surgery. We have no proof, and no evidence, but that is our policy.”
But yes, this would be accurate.
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Serene Reply:
October 29th, 2010 at 5:41 am (Quote)
OK I am currently working in Theatres. I have seen around 50 caesars to date (I do mostly gynae, not ob). Most have been with an epidural. Of the ones that were in active labour beforehand, those that ate aspirated no more than those that did not. Firstly because they are conscious during the procesure and able to warn the anaesthetist nurse and have it taken care of (as is the procedure – I have not actually SEEN a vomit), and second, none HAVE vomited. Of the 3 General Anaesthetic CS I have seen, none have aspirated. All had a Gastric Lauvage, and all had a double-lumen ET tube placed. Lower amounts of muscle relaxants were used to maintain oesophagaeal tone also.
This is standard practice in Australia, are things done significantly differently in the states?? Because from what I see, even though so many of these women ate, none aspirated and none were restricted because of risk of surgery. I would be interested to see the differences in your surgical procedures that make your processes so much more risky.
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Heidi RN Reply:
October 2nd, 2010 at 8:56 am (Quote)
Do you agree, though, that it is unethical to starve all laboring patients based on fear of litigation? Especially if they’re in labor for more than a few hours? This is obviously not based on safety, or we’d all need to fast 8 hours before crossing the street just in case we get hit by a car and need emergency surgery.
So why not change the standard of care? ACOG could change these recommendations but they’re still insisting on clear liquids only. If they were to change the standard of care to allow a laboring woman to eat when and what she desires, maybe no one would sue. What do you think of that? Would that solve the litigation problem while still allowing women to be treated humanely in labor?
In the meantime, I’ll just continue to tell all my friends to take their own food to the hospital and pretend not to notice when I see my patients sneaking food in 
By the way, I appreciate this polite dialogue. Looking forward to your response.
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Nicholas Fogelson, MD Reply:
October 2nd, 2010 at 9:11 am (Quote)
Ethical? Any times lawyers get involved, ethics seem to be irrelevant
I have made the same argument, word for word, that you have made here. We do not worry about people eating before they get hit by cars. But at the same time, we do not let people eat before elective surgery, because all anesthesiologist have experienced a patient retching partially digested food up the esophagus while they are trying to intubate, and it scares the crap out of them.
ACOG can say whatever they want, but really it would be the appropriate body for obstetrical anesthesia that would have to make a statement. As they don’t really have a lot of vested interest in the hungry stomachs of pregnant moms, this isn’t likely to happen. From their point of view its a lose-lose proposition.
I actually did a randomized study looking at a similar issue, between intubation and deep sedation for second trimester abortion, in the belief that not paralyzing and intubating a patient for a short procedure was better for everyone involved. Even though my paper showed that sedation led to shorter operating room times and fewer operative complications, the anesthesiologists didn’t care. They only cared about aspiration risk, which from a mediolegal point of view is like their shoulder dystocia. It seemed a bit perverse to me, given that paralysis seemed much more likely to lead to aspiration than sedation in a woman that is still awake enough to protect her own airway.
The thing is that when there is a standard of care, right or not, it takes bravery to step outside of it. Some would say foolishness. Clearly if a hospital decided to routinely allow regular meals during labor and there was an aspiration with a big complication, there would really be no defense to make at all.
Another thing people must realize is that while aspiration is fairly rare in a cesarean, vomiting is not so rare. We push pretty hard on the upper belly to squeeze the baby out of a small hole, and we are pushing stomach contents up at the same time. Its just not that uncommon for women to retch a bit. At this moment they are on their back and can’t sit up to spit out whatever comes up. Aspiration in this setting is not so hard to fathom.
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Aron Reply:
October 2nd, 2010 at 9:44 am (Quote)
But in the exceedingly unlikely event someone did happen to aspirate her own vomitus isn’t it safer for that fluid to be diluted rather than raw gastric acid in the bronchioles? Studies say yes. So does common sense. And, of course, there’s the simple fact that an empty stomach does NOTHING AT ALL to prevent vomitting. Some women actually experience more nausea on an empty stomach than if she is allowed to eat/drink according to her own comfort. I am definitely one such woman. NPO for laboring women is just a cure pretending to be attached to a disease.
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Nicholas Fogelson, MD Reply:
October 2nd, 2010 at 10:00 am (Quote)
Diluted with water, maybe. Diluted with a hamburger?
I’m not sure what studies you are referring to. Quote away.
You can’t vomit food if there is none in the stomach. When one hasn’t eaten or drank for awhile, there isn’t a great deal of fluid in the stomach. A little, yes, but stomach fluids are produced in response to eating.
There’s no doubt though that there isn’t strong evidence either way. Your common sense is different than the common sense of people who have watched people get sick or even die from aspiration pneumonia.
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Kit Reply:
October 2nd, 2010 at 10:15 am (Quote)
If stomach fluid is mainly produced in response to eating, then why is it that when I’m fasting and throw up, so much fluid comes up. (I mean a LOT. And it burns like heck. Made my lips bleed before my wisedom teeth were taken out it was so nasty.) Do diffrent people produce it diffrently?
Just my own weird curiosity.
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Nicholas Fogelson, MD Reply:
October 2nd, 2010 at 10:24 am (Quote)
I’m sure it is different for different folks to some extent, but you are right that there is something in the stomach.
The thing to point out is that there is a difference between aspirating stomach acid and bowel contents. Stomach acid aspiration causes a chemical pneumonitis, which while being not fun will generally resolve. Aspiration with bowel contents full of bowel contents and oral flora is more likely to cause a real bacterial pneumonia.
Bacterial aspiration pneumonia tends to be multibacterial, and involve a lot of oral flora that is fairly virulent.
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Kit Reply:
October 2nd, 2010 at 9:54 pm (Quote)
Ugh. That does sound really gross.
The worst my stomach acid has ever done to me was when I gasped while throwing up and breathed it in. I coughed blood, which was scary, until the doctor told me that it wasn’t dangerous, then it was funny. It lasted past the point that my IV meds wore off though, and stopped being funny about the fifth week of tasting blood in my throat.
And how would you asperate bowel contents? To put it delicately, my butt is pretty far from my my throat. Ort am i totally missing something here?
Thanks by the way for answering my questions. My PCP rolls his eyes at me when i ask him things.
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Aron Reply:
October 3rd, 2010 at 8:27 am (Quote)
I had a whole reply typed up till the website went wonky and lost it. Arg. Anyway, my point was to say that I LARGELY agree with you, Dr. F., except that even you admitted the chance of aspiration is remote, to say the least. And frankly, the consequences of laboring while malnourished are immediate and frequent. I don’t doubt aspiration DOES happen, but any care provider seeing it more often than a handful of times in a career has bigger problems (perhaps an anesthesiologist in need of a bit of retraining) than hungry patients. However, the choice is still the woman’s to make as to which risks SHE is most willing to work with. It stinks to have lawyers breathing down your neck, but that excuse is beyond worn out and only serves to add to the problems our country is experiencing in health care.
In a related scenario, amniotic fluid embolism is a life-threatening yet rare complication that has been strongly linked with aggressive induction/augmentation methods. How many care providers still have a cavelier attitude about the overuse of pitocin or cytotec? How many are penalized for over-aggressive induction methods that lead straight to fetal distress and worse? Why is this rare but serious risk tossed aside while the (at least as rare) risk of aspiration must be avoided regardless of how fasting negatively impacts a laboring woman? This sort of logical disconnect is at the heart of the mistrust between women and the obstetric community.
Heidi RN Reply:
October 2nd, 2010 at 10:09 am (Quote)
Thanks Dr. Fogelson.
I completely agree with what you said a few days ago about incentives. Any system driven by personal incentives is not going to provide what is best for the patient. So how could incentive be created for anesthesiologists to care about laboring moms being hungry? I do think a statement from ACOG could help, but you’re right, until some policy changes are made, there’s no vested interest in feeding moms for anesthesiologists.
I guess the most doctors and nurses can do at this point is to look the other way if patients eat. I just feel bad for the ones who don’t realize they can do that–who actually believe that eating in labor is dangerous because the doctor/nurse said so.
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cheeks023 Reply:
October 2nd, 2010 at 7:59 am (Quote)
I’m disappointed in you Dr. Fogelson. I only ever see you in here defending the funny ones. The really serious, dangerous, awful ones you seem to miss. You try to tell us you are different then other OB’s, more interested in helping us, but then you come in here and basically say that this woman mistakenly heard vagina for trachea and poop for vomit? Really? do you listen to yourself? Do you really think women to be so utterly stupid?
It’s remarkable how even when your words seem kind you can still come off like such an A$$.
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Nicholas Fogelson, MD Reply:
October 2nd, 2010 at 8:28 am (Quote)
I don’t bother to get into the dangerous, awful ones. What’s the point?
If it takes stupidity to mishear a comment, then everyone must be stupid. What is heard is often not was is said, and what is said is often not what is meant. The expectation that these three things will always match up is a true source of hurt in the world.
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cheeks023 Reply:
October 2nd, 2010 at 10:32 am (Quote)
mishearing information is one thing. I’ve misheard my husband say “yeah” when I ask him if he wants to do something…only to find out he actually said “nah”. I’ve misheard my children saying “The duck is in the drawer (WTH??)”, when really what they were saying is “the truck is around the corner”.
However there is just no way to make a jump from “you can’t eat in labour because if you poop, your vagina could vacuum it up and cause an infection” to “you can’t eat in labour because if we go into surgery you could vomit and aspirate on it.” I’m sorry, that is just too big a stretch.
There are countless examples on this site of CP’s lying to us (rather stupidly), instead of telling the truth, because the truth is often reflective of what is easiest for them, or based on a standard of care that lacks real, supportive evidence. In either case, it’s not something they want to deal with, so crap is made up.
For example, several of us have been told that the reason no one is allowed to birth in the hospital labour tubs is because the baby could drown. Now lets be honest, the real reason they don’t allow water births is because it is awkward, messy (docs and nurses tend to get real wet) and takes a lot more effort to clean and disinfect the tub. But instead of telling us that, they lay the dead baby card at our feet.
I agree that many, many instances of hurt are caused by misunderstandings, tone of voice, poor choice of words, someone in a completely separate space- mentally, can all contribute to misunderstandings. And often times we agree here, that while what the OB/midwife/nurse was trying to convey was sound, that maybe the timing, or the wording was off and misunderstood.
But don’t try and tell us that this is one of those cases…
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Melissa Reply:
October 2nd, 2010 at 1:29 pm (Quote)
“I don’t bother to get into the dangerous, awful ones. What’s the point?”
Dr. Fogelson, the problem is that silence can speak volumes. And I wonder, if you have to ask that question, if you’re missing the point of this website. We all KNOW that the “dangerous, awful ones” are dangerous and awful. This is not news to anyone here (except the occasional troll). But commiserating with the original poster, being angry with her that she received such “care,” encouraging and championing her attempts to get the care she deserved or her refusal to accept the garbage she was given–that serves a very important purpose. It’s good for her, it’s good for others like her, it’s good for moms or expectant moms who haven’t seen the ugly side of maternity care, it’s good for doctors, nurses, and others in the medical field.
I can’t imagine a professional, sitting in on a therapy/venting session for trauma victims, keeping silent on the cruelty, stupidity, etc. of the experiences being recounted, and only choosing to comment about the times when it might be possible to understand what the victim saw, felt, heard, etc. in some other, less horrible way. It’s good to remember that sometimes, it’s possible that what was said or done was not meant to hurt, that it might even be a simple case of mishearing or misremembering. But the fact remains: it did hurt. It is possible to gently raise the possibility without blaming the victim. We are pretty good at policing ourselves, and often point out that some of us might find a comment funny *while at the same time* commiserating that the experience was so distressing to the mom involved. You have sometimes helped us understand what has been said to us: I’m thinking of the time a mom, while in surgery, heard one of her doctors say something about “bowel coming at [him]” You explained what that meant, the mom was at least partially reassured, even though it didn’t negate the experience of being scared or embarrassed and not receiving an answer from her care providers.
You expect us to respect your medical knowledge. As you demonstrate that you generally know what you’re talking about, most of us do. We won’t trust you blindly, but that’s good for everyone involved. We’ve learned from you. But respect is a two-way street. As a human being, we would hope that hearing about mistreatment would arouse a sense of injustice and a desire to see women receive better care. As a doctor who cares about giving good medical care to women during their pregnancies, I don’t think it’s wrong to expect a certain level of outrage or frustration that some supposed professionals have misrepresented your chosen calling to the point that they have hurt women and their babies rather than help them, as you strive to.
We don’t expect you to chime in on every horror story (or at least I don’t). But if your are going to post as a doctor on this site, for good or ill, you represent the profession. So it matters very much that you are silent on the horrors and only comment on a select few women’s experiences in ways that attempt to explain away the problem. It is disturbing to me that you are silent on the rest of the comments. In fact, this is the only time I can remember you labeling some, at least, of these stories as “awful” and “dangerous.” And perhaps there have been other times that I have missed. But perceptions matter, especially when an individual represents a culturally powerful institution and the status quo. (You may not realize how heavy the weight is on us, from almost all directions, to go along with what the doctor tells us and “be a good little girl.”)
Please note that I’m not accusing you of anything, nor assuming how you feel about our experiences with OB/GYN care. I just want to help you understand why it might be important for us to hear, from a doctor who is one of the “good guys,” that these things were not okay. That it is not supposed to be that way.
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cheeks023 Reply:
October 2nd, 2010 at 3:27 pm (Quote)
Melissa,
That was incredibly articulate and so well written. Everything I wanted to convey but couldn’t! Thank you.
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Sarah Dorrance-Minch Reply:
October 2nd, 2010 at 5:31 pm (Quote)
Seconded.
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Nicholas Fogelson, MD Reply:
October 2nd, 2010 at 8:00 pm (Quote)
Here’s my feeling on these comments.
1) I have sat with so many patients who have told me comments that another doctor said, and immediately realized that they misunderstood what was said. How did I know this? Because I understand the language that the doctor was speaking, and could tell where the misunderstanding had occurred. Sometimes its like when a native speaker of one language speaks to someone who isn’t as fluent, and then that second person retells it to a third person who is fluent. In that retelling many things were garbled, but the third person can actually understand what the first person must have said because they have a better understanding of the language.
I truly believe that many of the comments that are posted on this site are exactly that. Sometimes docs and nurses say things in technical terms that are misunderstood. They shouldn’t do that, but they do. The patient may then be missing something they need to understand what was said, and so they fill in some other idea in there.
I have a feeling a lot of you will take that comment as some sort of insult, but it does happen, and it is not meant as an insult.
2) There are some comments on this site that are completely bonkers. Some are insensitive. Some are creepy. I realize this. My lack of comments on those posts doesn’t mean I don’t realize this.
However, I do feel a little more compassion for the folks being attacked here than many of the other readers, and generally don’t feel the need to attack the phantom people who said these things. I just don’t know enough about the situation to know what was going on when the comment was said, and I have no idea who these people actually are.
I have had so many times in my experience where I thought that something another doctor said or did was crazy or wrong or even unethical. In the brasher and earlier part of my career, I would launch into a diatribe about what I thought. Most of the time it ended up that I didn’t really have all the information at hand, and when all came to light it was I who looked like the idiot.
Doctors have a culture of not attacking other physicians, and I am part of that culture. We get attacked enough from the outside to want to attack ourselves from the inside. Sometimes this goes too far, but its a reasonable base to work from. So its going to take something pretty agregious and clearly documented to make me lash out at something another doctor said. Remember, my reputation as a physician is on the line here too. The internet is forever, and google can find anything.
Furthermore, if you go through thousands of comments I have written on most sites, you may notice a pattern that shows that I’m not much of an attacker. I’m just not an aggressive person by nature. I might point out another point of view on how something might be seen, but I really see no reason to just attack something that it wrong. When people attack me, 99% of the time I just respond to whatever portion of the comment is reasonable and ignore the attack.
3) While I realize that this site is a support group of sorts for people who feel that they are somewhat maligned in the traditional OB system, but it also serves as a big wedge between traditional OB and natural birth. In my opinion it is every bit as harsh and mean spirited as Skeptical OB. Many of you absolutely demonize Dr T, but I really don’t see the difference between what she does and what this site does. Both sites have positioned themselves as enemies of the other, and make the majority of their content about that attack. In my opinion both sites are destructive in nature. I truly believe that OB should move towards a less interventional practice, but don’t see any site that makes its core identity in attacking its perceived opposition as a positive step in that goal.
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Melissa Reply:
October 2nd, 2010 at 11:46 pm (Quote)
“While I realize that this site is a support group of sorts for people who feel that they are somewhat maligned in the traditional OB system, but it also serves as a big wedge between traditional OB and natural birth.”
I’d really like to help you understand something important. When even the “good guys” stand back, stay silent on the times something terrible has happened, and only jump in when there’s a chance it’s somehow the mom’s “fault” in misunderstanding or misreading the situation, the people that have been hurt by the system, whether through negligence, cruelty, or yes, even a misunderstanding—those people are the ones that get pushed farther away. We get hurt. Again.
Ironically, do you know what would really help us, heal the rift, give us reason to trust again? If the “good guys” would, upon hearing about negative experiences–from the silly to the frustrating to the inhumane–look us in the eye, tell us plainly that such was not the right way to treat a patient, and that you will respect us and tell us the truth. (Notice: that did not need to include a detailed accounting of blame, or a recreation of a scenario in which the doctor reconstructs facts not in evidence.)
An illustration, if I may? (And OP, please forgive us for sidetracking your post. I hope this discussion still feels pertinent to you.)
My first visit to a GYN was for a script for BC pills and the required pap, in an attempt to moderate an unusually heavy, painful period. I was a virgin at twenty years old. The doctor told me in no uncertain terms that I was lying, then mocked me for my sexual inexperience (at such an “advanced” age!) when it became physically apparent that I was, indeed, a virgin, then derided me for crying from the pain as she attempted to fit the speculum in me. I, the shy, modest, and very alone young woman, screamed at her to stop several times before she gave up in disgust and marched out of the room, leaving me to collect my clothes and sob.
Three years later, I saw my PCP for the same reason, only I was engaged this time. Still a virgin, I confided in her what my first experience with an exam had been. She stopped her preparations, came right up to me, and told me that what had happened was wrong, and that she wouldn’t be like that. And she wasn’t. When the smallest speculum didn’t go in easily, she immediately set it aside, told me not to worry, and offered information about what sex might be like for me, and details about how I could make it easier. She even offered to bring my fiance in and talk to him!
Do you know what the real turning point for me was? I could see the flash of anger in her at the idea that a doctor could act like that. She agreed with me that the treatment I had described was NOT appropriate. She didn’t feel the need to explain exactly what the doctor had done wrong, or call her names–and neither did she feel the need to invent an excuse as to how I could have misunderstood, or how the doctor was probably just run down from having so many young teenagers coming in and lying to her, etc., etc.
Her actions and her words just said: “I’m sorry that you were hurt. It shouldn’t have been like that. It won’t be like that with me.”
That, Dr. Fogelson, will do SO MUCH to heal the rift. We’ll finally be able to stop yelling (because someone has heard) and be able to extend a little more trust to the system, because we’re not longer being told (and silence is loud) that our bad experiences never happened.
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Mama Wears Combat Boots Reply:
October 3rd, 2010 at 5:29 am (Quote)
“We’ll finally be able to stop yelling (because someone has heard) and be able to extend a little more trust to the system, because we’re not longer being told (and silence is loud) that our bad experiences never happened.”
Very true and well said!
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Kat Reply:
October 4th, 2010 at 8:18 am (Quote)
I couldn’t read this and not say anything. Your comment brought tears to my eyes. I am so sorry you were treated like that. I too went to a gyn appointment before getting married, it was my first appointment ever, and I was also a virgin.
It was stressful enough, and the nurse-practitioner was gentle, kind, and helpful. I am glad you found a doctor who was kind to you.
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Claire Reply:
December 26th, 2010 at 1:29 pm (Quote)
I know this post is a little old now but I needed to reply.
I was 13 when I first went on the pill and was on it more or less constantly for the next ten years (I have a terrible cycle) and lost my virginity at 21 years. When I had a letter calling me for my first smear at 18 I spoke to my GP and she put on the system that a smear wasn’t required and told me to call them when I was married as I would need my first a year later.
I am shocked that in the US virgins and pregnant women are sujected to them!
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Sarah Dorrance-Minch Reply:
October 3rd, 2010 at 7:47 pm (Quote)
“While I realize that this site is a support group of sorts for people who feel that they are somewhat maligned in the traditional OB system, but it also serves as a big wedge between traditional OB and natural birth.”
I should certainly hope so!
You’re a SURGEON. Your job is to bail us out when we experience the rare obstetric emergency. We need your medical training and your surgical skill then.
Otherwise, you don’t belong at our births. Natural birth does not belong in the hospital, but at home or in freestanding birthing centres. If women weren’t told from their earliest days that birth is dangerous, deadly, and unbearably painful, we wouldn’t even think of going to the hospital to give birth… unless there were an obvious emergency.
There are obstetricians who think similarly, since I’m sure you don’t take the opinions of mere mothers (and other laypeople) seriously. If you haven’t yet read them, try reading the books written by Dr Michel Odent, or _Born In The USA_ by Dr Marsden Wagner.
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Melissa Reply:
October 4th, 2010 at 2:02 pm (Quote)
Dr. Fogelson, are individual doctor’s reputations and licenses at stake here? No. You say they’re being attacked. Who are “they,” specifically? The only individuals with anything at stake here are the women whose stories and comments are posted here. And they have a lot at stake. It is they you are, by turn, either ignoring or attacking (though you see your actions in more benevolent terms) by finding ways to explain away what they have experienced. (As counter examples, you have occasionally given some very helpful information–with regard to the mechanics of a cesarean and twin lung maturity–and you did it in a way that illuminated the woman’s experience rather than downplaying it.)
You insist on stepping into a group of women and defending people not present against the implications of our traumatic experiences. I cannot wrap my mind around why, in the (at least virtual) presence of real people with real concerns, YOUR concern lies elsewhere. Your priorities are disrespectful, and at variance with your posture (and our perception of you) as a doctor who cares about women and their health.
I agree with you that miscommunication is a problem and in some cases would go a long way (not all the way) toward mitigating the situation. But identifying a possibility or the occurrence of miscommunication does not erase the experience (though it may help rewrite it and give us more peace). It does NOTHING, however, for the times when we have understood all too clearly the ignorance, misogyny, sadism, resentment, etc. of the “care” we’ve received. We are not asking you to put your medical imprimatur on our recollections of mistreatment. We do expect you to respond as a human being and as a caregiver to the negative experiences and even trauma we have lived through.
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Jamie Reply:
October 11th, 2010 at 4:27 pm (Quote)
“…but it also serves as a big wedge between traditional OB and natural birth.”
But … this website isn’t threatening to sue anyone for imperfect posts, right? The best defense of modern obstetrics is litigation concern. Best stick with that, rather than trying to blame the dissatisfied customers for their dissatisfaction.
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Dreamy Reply:
October 2nd, 2010 at 9:39 pm (Quote)
It seems to me far more likely that it was this *triage nurse* who misheard (or rather misinterpreted/misunderstood) what she was told by someone in obstetrics about vomit aspiration. I can think of so many (non-medical) examples like this from my own real life that I’d be here all night if I started listing them. Most of them end up kind of like this one– humorous. But humorous or not (to those who understand the medical reality), this is some pretty appalling misinformation for the nurse to be repeating to a patient.
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Jane Reply:
October 3rd, 2010 at 10:25 am (Quote)
Prochoicedoula has two comments elsewhere on this page indicating she heard this while she was acting as doula to the laboring mom. Therefore as a medical professional herself (albeit without an MD) she should be considered a reliable witness. She herself wasn’t in labor, and as someone who has studied birth, she would have understood aspiration.
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Sarah Dorrance-Minch Reply:
October 3rd, 2010 at 7:50 pm (Quote)
A pity we don’t have another obstetrician who shares prochoicedoula’s opinions (and observations). It would be handy to be able to exploit the hierarchy of expertise here.
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Charity had this to say,
Oct 2, 2010 @ 3:58 pm (Quote)
No… THEY don’t want you to eat because they’re counting on you wanting an epidural… Epidural = intervention… Intervention = c-section in LOTS of cases. Has nothing to do with poop, unless you consider a possible intestinal knick during the section…
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Sarah Dorrance-Minch had this to say,
Oct 2, 2010 @ 5:29 pm (Quote)
Apparently I have the potential to become a giant vacuum. Better not put me in the lithotomy position, because then you’ll be in the suck zone.
So if I decide to get fitted for a diaphragm later, should I ask for the HEPA filter option?
This comment is so ridiculous that nothing I say could possibly, um, improve on it.
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laura Reply:
October 3rd, 2010 at 6:17 pm (Quote)
ROFLCOPTER
I actually snorted at HEPA filter.
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Serene Reply:
October 29th, 2010 at 5:52 am (Quote)
i read this out to my husband (Sarah, he LOVES your sense of humour!) and he is now telling me to suck him up! Dirty dirty man but hes having a ball!
His best comment so far?
“Honey, if nurses are that stupid, you’re in the wrong profession. Now get on your back and hoover!”
hahahahahahah! But I did get a compliment <3
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give birth in Britain! we encourage you to eat. Not fatty food though- there is a simple formula: fatty food+labouring stomach=vomit. I am sorry to insult your nation, but don’t your doctors and nurses actually learn anatomy and physiology when they train?
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Sarah Dorrance-Minch Reply:
October 4th, 2010 at 4:18 pm (Quote)
I also like the way the NHS encourages one to give birth at home with a midwife, provided there is a “flying crew” parked in the driveway just in case transport is needed. I know this has been described as a passive-aggressive way to make mothers feel guilty about being self-indulgent and causing inconvenience, but I see it as a wonderful compromise, to cut transport time in the event of a true emergency. (Well, hey. I’m a selfish American.)
Mind you, I like the way births are done in the Netherlands better. Lots and lots and lots of homebirths. Hospital birth still uses the midwifery model of care (unless the birth is an obvious medical emergency, treat it as healthy and normal and don’t intervene). Everybody gets a few visits from a postpartum doula afterward, paid for by taxes.
Sweden and Finland are supposed to be really good places to birth a baby, too.
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Sarah Dorrance-Minch Reply:
October 4th, 2010 at 4:24 pm (Quote)
PS. (I love blogs, they allow me to express l’esprit d’escalier)
I ate avoglemono soup for breakfast, lobster ravioli for lunch, and hot dogs and baked beans for dinner during my active labour the day before I gave birth (active labour took the day before that, too, judging by my sounds and so forth; when cramps made me swear or sound rather than just saying “oof” and making a weird face. But I can’t remember what I ate that day. Pizza, I think, but I’m not sure.)
And lots of snacks. Frozen fruit bars. Cheesecake.
Very fatty.
I didn’t barf, but having endured dry heaves, I’ll take a wet barf any day. It hurts less. And whether it’s dry or wet, heaving does help push the baby out.
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alice Reply:
October 4th, 2010 at 4:50 pm (Quote)
The NHS can sadly not afford an ambulance to be on the driveway throughout a labour, but they do generally arrive at an emergency within 10mins of being called.
The other sad thing is that in principle the NHS supports home birth, but local staffing levels (and staffing attitudes) are often a barrier. The way the community midwives cover homebirth in my area has changed recently. They cover a much bigger area and ususally have not met the woman before labour. Prior ro this, they worked in a small area and some would not offer, or discourage homebirths in that small area.
At the birth centre where I work we have had several ‘homebirths’ come in to us because ‘the midwives were having handover, so they though they wouldn’t make it out to me’. Or ‘it might snow’ WTF? Some individual midwives are not so supportive, usually because of their lack of skills/ confidence.
I am livid every time this happens. They’re given rubbish excuses when they feel they’re not in a position to argue. Often, they’re response is ‘oh well’ because they generally have a good experience on the birth centre, but I want to scream at them ‘Don’t you know what they’ve made you miss out on, and for NOTHING!’
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Susan Reply:
October 5th, 2010 at 12:00 am (Quote)
Thankfully the community midwives near me were good. They were afraid they wouldn’t make it to me in time, but I also live near a midwife, so I wasn’t worried (they made it in time, BTW). We don’t have a car, and it still wasn’t a problem to have a home birth.
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Sarah Dorrance-Minch Reply:
October 5th, 2010 at 6:49 am (Quote)
I read about the ambulance “flying crew” parked in the driveway in a womens’ magazine, when I was still over on your side of the pond. That was the late nineties, though. So policy changed?
I’ve also recently read diatribes on other fora from English mothers against those who homebirth – attacking the choice to give birth at home as self-indulgent, unsafe, and something that wastes the time of midwives who ought to be in the hospital, ordering pethidine and gas I guess. Never mind that a year or two ago the NHS was reported to have tentatively encouraged more mothers to birth at home due to the lower risk of complications and the lower cost. Apparently your midwife shortage is creating a feeling of dire scarcity, pitting hospital-oriented mums (the majority) against homebirth-oriented mums.
Many times a “compromise” was proposed in the conversation, in which mothers who insist on homebirth could be “allowed” to have one… if they paid for it, rather than having NHS cover it.
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Susan Reply:
October 5th, 2010 at 7:14 am (Quote)
I’m pretty sure it’s still on the NHS website that home birth is encouraged. Just looked and found this: http://www.nhs.uk/livewell/pregnancy/pages/wheretogivebirth.aspx So not discouraging of home birth. I’d thought before that they were actively encouraging home birth, but I could be mistaken.
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alice Reply:
October 5th, 2010 at 3:45 pm (Quote)
Yep, I’ve seen those comments too. I’ve seen women critised for wanting a midwife *to themselves* (God forbid!) I think it stems from them getting crap care at the hospital when they were lucky if they saw the midwife every 15 minutes to ausultate the fetal heart, and once the baby was born, well another 4 hours on your own (yes we can THAT busy) Why should some women get one to one care in the comfort of their own home? Its not fair! Thats a *luxury* so they should have to pay! They got better than me, damn it, they got 2 midwives, and I only got a quarter!
What they don’t realise is the low cost associated. Thay are staffed by community staff, who are paid for the hours they are ‘called out’. The 2nd midwife never made it to either of my births, was too quick! I cost the NHS about £70 for my first birth and £40 for my second.
The cost fo a hospital bed for the night?- approx £350, and epidural + drugs?- £450. Associated cesarean? £3000 Hospital aquired infection? etc etc
Certainly the comparatively low cost is an incentive for the NHS and the research supports it and womens experiences are better, but the maternity services are in crisis here. With the birth rate skyrocketing in some areas, staff shortages and severe NHS cutbacks I’m worried these services may be lost in the false belief that centralised care is cheaper.
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Inserwillian had this to say,
Feb 7, 2012 @ 3:54 am (Quote)
click to view coach bag tote at my estore to get new coupon
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What? Really? Nothing like blatant lies. . .
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