Priorities

[radegund]

Yesterday morning I (more or less) sorted out something I've been tussling with the hospital about for the last couple of weeks. Not entirely satisfactory, but a compromise I can live with.

Hospital policy (as is common in this part of the world) is to prohibit labouring women from ingesting anything other than ice and water once they've been admitted. For some people, that may be no big deal, but I have what amounts to a raging phobia about what I'll neutrally term NotBeingAllowedToEatAaaaaarrrrgggghhhhhh. If I'm hungry, know I can't eat and (the crucial factor) don't know when I'll next be able to eat, I get panicky, twitchy, uncoordinated, nauseous, irritable and generally not fun to be around. Not a position I ever willingly put myself in, because it's deeply unpleasant for me and those around me, and certainly not something I wish to add to the stress of being in labour. The fact that (as I've been told countless times) women in labour rarely feel like eating is irrelevant - it's the prohibition and the unlimitedness of it that freaks me out.

So I went in to discuss my birth plan with a midwife, and I knew this would most likely be an issue. (The policy has been standard in the US, the UK and Ireland for the last ages, and although many hospitals have relaxed it in recent years, the established wisdom is tenacious. The risk - that under general anaesthetic you'll vomit and aspirate acidic stomach contents, causing lung damage and possibly even death - is tiny (one US study estimates 7 in 10 million), but anaesthetists are cautious people.)

And I was right. "That's the policy," said the midwife. Such is the power of the bastard hormones that next thing I knew I was huffling and gulping and sobbing, which disconcerted the poor woman no end. She said she'd talk to some people and see what she could do. That was a Tuesday, and we agreed that I'd ring her the following Monday. I spent much of the next 24 hours fretting and obsessively looking up "eating in labo[u]r" and "fasting in labo[u]r" on d'Internet.

Cut to Thursday of the same week, when niallm and I went in to watch the Scary Childbirth Video (optional, you may be relieved to note ... and let me just say that the whole thing was rather squirtier than I'd imagined). Afterwards, fearing that my inhabitant might take matters into its own hands before my problem was resolved, I asked another midwife for clarification on the implementation of the policy. Again, embarrassingly, I found myself in tears within seconds, which evoked much clucking and soothing. This time, I was told that the policy referred to "fluids", which could include fruit juices, smoothies, tea, clear soup - all, natch, music to my ears. So I calmed down a lot and went home.

On Monday, the original midwife rang me to say that she'd checked with the authorities, and there was no leeway in the rule: it was ice and water only. (When I later rang the person who'd told me other fluids would be allowed, the gist of what she said was, "You were upset, and I was trying to calm you down." By lying to me. Yes. Way to go.) All for my own good, explained the unfortunate spokeswoman, again and again. Best interests at heart. I said I understood that, but still wasn't happy and wanted to talk to someone who could sanction a relaxation of the rule in my case. In the end she made me an appointment to see a consultant anaesthetist.

Midway through this conversation, I asked if the policy on oral intake was written down anywhere.

"Ah, yeah, it would be a written policy all right," said the midwife.
"Where could I get hold of a copy of it?" I asked.
Nervous pause. "Oh, well, you could try the Master's office - but I don't know if they'd just give out the policy like that."
"Why not?"
Flustered now - "Oh, I'm not saying they wouldn't, but they mightn't..."
"But you're a publicly funded institution - surely your policies are available somewhere."
"I don't know, now, but if you ring the Master's secretary she might be able to help you."

The woman was clearly at sea - had never been asked such a question. May never have thought that such a question might be relevant. It was all a bit bizarre.

Stranger still was when I rang the switch next day and asked to be put through to the Master's secretary. "Oh, yes," said this luminary, as soon as I'd outlined what I was ringing about. "I was told you'd be ringing. I'm afraid the Master is away from the office this afternoon, but would it be all right if he rang you tomorrow?" Her tone was deferent.

"Oh, yes, that would be most helpful", I said, but I was thinking How can this question be such a big deal for them? Could I possibly be the first person to take it this far? (For what it's worth, glitzfrau thought so: she pointed out that any normal Irish person would just say "oh, yes, thank you, that's fine" and then smuggle in whatever they felt like on the day. That's not my style at all.)

So there I am on the Wednesday morning, sitting with my feet up, when the Master of Holles Street Hospital rings me up and explains, once again, that the ice-and-water policy has been in place for forty years, is in my best interests and is well supported by research and clinical practice. I counter that I've read up a little on the subject and am aware of the risks involved, but am still asking for a concession. We bat statistics on caesarean section back and forth - because obviously, the risk comes into play only if I have an emergency caesarean under general anaesthetic, which happens in about 1-2% of cases in this particular hospital - and I'm surprised and encouraged by the extent to which this man is not patronising me. It was actually quite a pleasant conversation, and left me with some hope that my meeting with the anaesthetist would bear fruit. (Or fruit juice, perhaps.)

Finally, yesterday morning I saw the anaesthetist. He was rather more patronising than the Master, but he began by noting from my chart that I work as an academic editor, and thereafter did not attempt to simplify his language, which helped. After much discussion, we came to an arrangement whereby I can have isotonic drinks and herbal tea (without milk or sugar). I have this in writing. It will do.

So Lucozade Sport it is, then. Disgusting stuff, in my opinion - and furthermore, full of nasty aspartame, acesulfame, beta carotene, phenylalanene... - but better than nothing. Much better, in this man's doctorly view, than something like fresh fruit juice or honey dissolved in hot water. These - and here his eye took on a fanatic glint - homemade brews would be right out, because there is no telling what would be in them. Nice safe chemical sweeteners, on the other hand, are to be welcomed with open arms.

It's all about priorities. To the anaesthetist, the fact that I'll be eating and drinking whatever the hell I feel like until I go to the hospital, and that he may thus have no clue what's in my stomach if I do require a general anaesthetic, is irrelevant when it comes to the implementation of his precious policy. So is the fact that I am weighing a truly minute risk of death (far less than I face by, for instance, travelling to the hospital in a car) against a more or less 100% risk of being (as I see it) unnecessarily stressed during what will already be one of the most demanding experiences of my life. So is the fact that stress has been shown to slow the progress of labour, which would raise the chances of my requiring intervention in the first place. But because he is the Great Man (and I note in passing that all the midwives are Kathleen and Gertie and Maureen; all the doctors are Dr Keane and Dr Gallagher and Dr Kennedy), his priorities trump mine.

Maternity hospitals, I conclude, are deeply weird places.

Comments

[dreamvirus.livejournal.com]

Hmm, OK well I'll try to keep my soda-is-evil attitude in check. To be honest I always thought that those ads for Lucozade sport and "isotonic" drinks in general were based on bullshit non-science and never considered the possibility that they were anything other than soft drinks with a different marketing campaign. Maybe that was closeminded of me :-)