Death by Cheeseburger?

So when I met with T. the other day, she told me about her meeting with the OB. The most outrageous comment he made was   “Just make sure you don’t eat a cheeseburger on the way to the hospital.  The number one cause of death during birth is aspiration!”

Ok, that one just left me flabbergasted.  He had been warning her to be careful about where she is getting her information from.  Even though I am not an Ivy League trained OB, I knew right away that what he said is wrong! It isn’t common sense for one thing and also I know a lot about childbirth and that just isn’t true!

I also saw it as a challenge.  I love to research things.  My friends call me when they want something researched.  They know I will send them a nice Excel Spreadsheet with gathered information for them, to help them in their decision making process.  So to have him warn her about me, like I just made these questions up for fun and there was no reasoning behind them, was offensive.  But then to top it off with a comment like that, which was completely NOT Evidence Based.  I had to research it.  I guess to prove him wrong.  You can decide who is right.

So while this is Enjoy Birth and I typically try to focus on happy birth topics, here is what I learned about the causes of maternal deaths.

First the enjoyable news, maternal death is very rare in developed countries.  Since you have the internet and are reading this, I figure you are in a developed country. So luckily this isn’t something you need to really worry about.  But in case you are now scared to eat a cheeseburger on the way to the hospital, let me reassure you…

The World Health Organization who has statistics from all over the world doesn’t have aspiration listed anywhere as a cause of maternal death.  Maybe they don’t have cheeseburgers in Africa?

So I continued on and searched high and low for USA statistics.  Surprisingly this is not widely advertised topic, so not easy to find information on.  There were some scholarly papers, which I don’t have access to.  But I did find this article Maternal Mortality during Hospital Admission for Delivery, which is about 10 years old.  But it is all I found, so it will have to do.

The only reference I found that could be aspiration related was here…

An anesthesia-related complication was one of the pregnancy-related diagnoses associated with maternal mortality among African-American women. Death caused by anesthesia-related complications, specifically problems associated with the airway, is the sixth leading cause of pregnancy-related mortality (13,34). Nagaya et al. (35) concluded from a two-year review of maternal death certificates and chart review in Japan that inadequate anesthesia services were associated with maternal mortality. Continued efforts to review and analyze anesthesia-related maternal deaths are warranted to formulate preventative measures for future care.

But apparently it didn’t make the list for Caucasian women:

The most common pregnancy-related diagnoses associated with mortality in Caucasian women included preeclampsia/eclampsia (15.9%), postpartum hemorrhage/obstetric shock (13.6%), blood clot embolism (9.1%), cardiac arrest/cerebral anoxia (9.1%), and cerebrovascular event (9.1%).

There were limitations to the study and they said this regarding this topic

the UHDDS did not include the type of anesthesia (regional versus general versus IV sedation) for labor and delivery, making it difficult to determine the incidence of anesthesia-related complications based on anesthesia technique (16).

So, while aspiration is a very, very, very small risk***

for Jane Doe, it could happen

If she needs an emergency cesarean

with general anesthesia

and if her anesthesiologist doesn’t intubate well

and she vomits

she may aspirate some vomit

which could cause complications

one of them potentially being death.

It is certainly NOT the number one reason for maternal morbidity. In fact it is very LOW on the list.

***** I am not a number person, I really have to think when I do this.  So please let me know if I am wrong.  I woke up early in the morning and thought, what if someone reads this and then gets confused and thinks they have a 6% chance of dying from eating a cheeseburger?  That would be bad!

So I had to wake up and do the math.  This is how much I love to research, I get up early to do math, which I don’t like.  So about 10 in 100,000 moms die due to childbirth in the US.  (I found stats ranging from 9.3 to 11, but to make the math easier, I chose 10.)  Which is the same as 100 in 1 million moms.  So the only statistic I found that could be aspiration related said 6%.  SO –

6 in 1 million moms, who die due to birth related causes, could be due to aspiration.

Which equals 0.000006% chance of dying from aspiration.  Which numerically speaking is a very, very, very small risk.

So this brings us to the question – How serious is this Death by Cheeseburger threat?  Or better yet, “Is it safe to eat and drink during your birthing time?

Well, I say it is probably worth the risk if you are hungry and low risk.  (If you are scheduled for a cesarean, then don’t eat, a planned cesarean is not low risk!)  If you are planning on a natural childbirth and all is well and you are hungry, then swing through In and Out and get a Double-Double with some Fries on the way to the hospital.    You’ll have some yummy protein and energy to continue your birth!  home_center_No_Text

Articles for your enjoyment. In a study of 78,000 mothers who ate and drank during labor, not one had any problems with aspiration. Even more recently in England they recently did a study that showed there is No risk from eating during labor.

Another great blog post on this topic over at The Unnecesearan.

Don’t eat a cheeseburger? Where’s the Research?!

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43 thoughts on “Death by Cheeseburger?”

  1. Because Dr.’s are scared that our bodies will do something during labor that they naturally do *puke!* or…gasp actually get a baby out of our vagina’s without help, so they starve us so we’ll be so tired and weak at the end of labor that they will HAVE to help us.

  2. This is hilarious and so ridiculous. I am not a die hard in and out fan, but that looks so dang good right now.

    One of my missionary companions lost her best friend to a stroke a few days ago. Her friend was 31 years old and had a 14 day old baby. I asked her if they know why she had a stroke and if it was pregnancy/birth related. She said she did not know. What do you think. I know Ina may is doing the mothers quilt and wonder if this is a case that is not reported as a maternal death because it was after the birth. Could birth cause a stroke a couple of weeks later? I don’t know if she had a c-section or not, but I would think the risk would be higher if she had a c-section. I don’t want to ask my companion many questions right now because she is in mourning, but I am interested to see if there is a correlation. Such a tragedy. She left behind 4 children. I can’t imagine what her poor family is going through.

  3. Bri,

    Actually “maternal mortality” covers maternal deaths during pregnancy and up to either 42 days or 365 (either 6 weeks or 1 year, depending on who’s counting) after the end of the pregnancy (whether by miscarriage, abortion, stillbirth, live birth), so 14 days is well within range. There are numerous ways to count “maternal mortality”, which can get a little confusing, so her death may or may not have been true “Maternal mortality.” The broadest category is “pregnancy-related mortality” which includes a pregnant woman or new mom’s death for any reason (including things like car wreck, homicide, allergic reaction), so her death would certainly be included in that; then there is one that is more restricted, requiring the death to be due to some indirect or direct obstetric cause (PIH or complications from a C-section or whatever). It’s possible for a stroke to be due to the pregnancy or childbirth – for instance, preeclampsia typically strikes during later pregnancy, but sometimes it can strike after birth; since stroke is a possibility of p-e, that is one possibility. Of course, it may be that she simply had some sort of previously undiagnosed brain aneurysm which happened to break right after birth, in which case it would not technically be “maternal mortality” unless perhaps her being pregnant exacerbated the situation.

    Re: cheeseburgers in labor — I would recommend going with something lighter and less fatty. My first labor began just after eating a large heavy meal and I threw it up a few hours later. It would have been preferable throwing up something different. I could imagine the same thing could be said about hamburgers & french fries. It seems that eating something so fatty and heavy might cause nausea.

    BUT, I would rather eat cheeseburgers in labor if I’m hungry than nothing at all!!! I wonder how many C-sections are *caused* (at least partially) by moms laboring on an empty stomach, hungry, with their muscles becoming weak due to unnatural fasting. Now how would *that* be for a research question?! 🙂

  4. Thank you for this post, and the articles linked. I have a few MDs that I work with that are die hard believers of NPO (not even ice chips!) during labor. Of course, being the rebel that I am, I sneak ice/liquids and even some crackers (oh the horror!) to the moms.

  5. This made me laugh. I have to share. I am the oldest of 7 children. When I was 16 I was with my mom and dad when the 7th child was born. My mom’s water broke that morning, she went into the hospital and said her water had broken, but she was not in active labor. During the check-in process she mentioned she was hungry. They said, “if you want to eat, then don’t check in” so we all left and went to Hires (a great hamburger place) and had lunch (probably cheeseburgers:) ) , then went back to the hospital and checked in. Then had a healthy baby boy that night. When I told her about this blog post this morning we had a good laugh. I’m so glad she’s still with us. 😉

  6. Bri,
    I am so sorry for your friends loss. As Kathy said it would fall in that window, so it could be pregnancy/birth related. How very sad. Prayers going out for her family!

  7. Here I thought this was going to be one of those posts about nutrition and fast food restaurants…you probably have a better chance of death by cheeseburger that way (assuming it’s the fried fast food kind, not the lean home cooked kind) than you do by aspirating it during your birth! Makes me wonder if he’s trying to say he or whomever does the intubating is incompetent…because if they’re competent, this should’t be a risk, am I right?

    Thanks for the amusing post. I read the interview with the OB too…I would run far and fast.

  8. OOOO I so like your ‘get to the bottom of it!’ research! To me that translates into LOVE …of women, your clients, babies, etc.. Something this doc probably wouldn’t understand. Did he stop and think, “Hm what is the most loving thing I could do for this pregnant woman?”

    I hope T. moves on….and any other women that read this and feel the nuge.

    I see birth as a celebration. And what is the one common denominator across the world when it comes to celebrations? Food!

    Bon Appétit!

  9. If that OB was telling the truth my cause of death could have been, “Yoplait kills mother of four”. Too too funny!

  10. I do know of a woman who died of aspiration during surgery — a tonsillectomy or something like that. Planned, so NPO for however many hours before. Obviously didn’t help in the face of improper (or no) intubation. She inhaled her own vomit (most likely almost straight gastric juices), was eventually declared brain-dead and taken off life support a few days later. This isn’t a scare story (unless you are planning on using that hospital; although it happened probably 15-20 years ago now) — just kind of a realistic perspective. It’s so rare that nobody hears about it — and with good reason! With proper anesthetic technique, it should be absolutely zero risk for aspiration. How many times do victims of car wrecks or other accidents or emergencies have to be operated on with an indeterminate amount of food in their stomachs, or perhaps they had a heart attack right after lunch? No need to invite trouble unnecessarily, of course, but if you’re not planning a C-section under general anesthesia (and I’d like to see the stats on how many C/s are performed under general, as a percentage of all births and of all C/s), then this is really a moot point. Proper technique for general anesthesia should be followed, no matter how much or how little you’ve eaten.

    I would RUN away from such a doctor. If he knows he’s lying, then what else would he lie about? If he doesn’t know he’s lying, then how can I trust him to know the right thing to do about anything else?

  11. I had fast food a few hours before my emergency c/s… I never did throw up…or die.
    I then went on to have milk and oreos an hour before my hbac… didn’t throw up, or die that time either.

  12. I think the risk of aspirating during your C-section might as well not exist when compared to the risk of NOT eating and nourishing yuorself during what is surely the most physically tasking time of your life. But of course you know that. 😉

    I mean, it’s no wonder my first birth crashed and burned when they wouldn’t even let me have a DRINK OF WATER. I labored for 46 hours and all I could think of during pushes was the big mug of ice water I would chug at the end. Not the baby. The water. I’m thirsty just thinking about that torture.

  13. realityrounds

    That OB certainly is an alarmist. Yuck.

    I sneaked food into my first delivery. When the staff would leave I would snack on bananas and power bars. Low and behold I needed a C-Section. My hubby was freaking out, asking if we should tell them I was a bad girl and ate during labor. NO. If I barf, I barf. Have seen it happen a million times in the OR, NPO or not, with no complications other than a messy floor.

  14. That is so sad… it is ridiculous. They should have given you water. But to be SO thirsty and working so hard. No wonder all you could think about was the water!

    I remember being at a birth and the mom was thirsty. I wanted to get her juice. The nurse snapped, “No juice allowed…. but she can have a popsicle.”

    HMMMMM, won’t the popsicle turn into juice as it melts????

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  16. I don’t remember where I read it, but I remember reading something about it actually being better to have food in the stomach if something were to come up and get in the lungs rather than having pure stomach acid get in your lungs. I mean, I would rather have less caustic stuff getting in my lungs than pH 2 stomach acid, on the slim chance that a super emergency c-section had to happen and I had to get general anesthesia.

  17. I have heard the same thing, but couldn’t find any good research to link to, so I didn’t mention it. But maybe I will search again, because it is a great point!

  18. Sheridan,

    Henci Goer discusses this in chap. 4 of “Thinking Woman’s Guide.” She says, “Less than 2/1,000,000 pregnant women in the US between ’88-90 died of *any* anesthesia-related complication — not just aspiration — during delivery,” and continues to discuss intubation and other improvements in anesthesia technique. Then on p.77 she writes, “Doctors know that ‘nothing by mouth’ is a futile exercise. The threshold of risk should aspiration occur is generally agreed to be about two tablespoons (25 ml) of stomach fluid. However, as studies attest, no time interval since the last oral intake guarantees a stomach volume below this amount in a pregnant woman. In fact, no time interval guarantees a volume of less than 100 ml…” Then on p.82, she writes under “ways to minimize the chance of aspiration” that women should “Maintain some form of oral intake. The most dangerous form of aspiration is aspiration of undiluted stomach acid because it chemically burns the airways.”

    In the “literature summaries” for this section she has three studies on the level of stomach fluid after overnight fasting; but nothing on inhaling stomach acid.

  19. For typical birthing moms this would be good advice.

    For my Hypnobabies moms many of my moms never get this. They go to the hospital happy and calm and are 8 cm.

  20. This is why I “sneak” food to laboring women in the hospital! Shh, don’t tell!
    I have to say though, if you have the appetite to eat a hamburger, you should not be on your way to the hospital. Stay home until you’re vomitting and shaking, and going through the drive thru is SO not a possibility!

  21. Thanks for posting this Sheridan!

    Since people are rushed into emergency surgery all the time with varying degrees of food in their stomachs, if there are aspiration problems, it is likely due to a fault in the administration of the anesthesia. Thanks to all who have corraborated this.

    I myself am happy that T. had this discussion with her doctor, since he made it very clear that considering transferring from his “care” is most likely a very viable and desirable option.

    If T. does that, perhaps she can sign off by telling her ex- OB to go home and try to find his missing chromosome.

    😉 Kerry
    Founder/Director of Hypnobabies

  22. My water broke almost immediately after eating: 1/2 of an IHOP Colorado Omelette, a full order of hashbrowns, and 3 large pancakes. I needed an immediately c-sec due to a footling breach baby. And, it turned out I needed to be under general anesthetic due to low platelets. And I woke up after the c-sec with plenty of energy to nurse my perfectly healthy twins. If I had to do it again, I’d still eat the IHOP!

  23. Absolutely her stroke can be related to her birth process. In fact, this poor woman’s death was most likely caused by an embolism, which is a clot that forms in an artery or vein, then releases and can travel to the brain, heart, or lungs. The formation of clots, known as deep vein thrombosis (DVT) is associated with pregnancy and birth.

    Unfortunately, the US does not properly report maternal mortality. Your friend’s friend’s death may or may not be reported or assessed correctly, depending on the laws of her State.

    Fortunately, Ina May welcomes names and quilt pieces. If you know the name and story of a woman who has died from pregnancy and birth related complications, please consider making a quilt piece or offering the information to Ina May, so that woman is honored and remembered.

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