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! 

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?!