With ever-increasing pressure on the healthcare system, many are aware that the allotted times for hospital care do not always go to plan.
While long waits can be frustrating, fasting for hours in advance can make people very uncomfortable.
For elective caesareans, fasting prior to surgery can leave heavily pregnant women waiting without food or even fluids — sometimes several hours.
“Elective surgeries are often postponed because emergencies must take precedence,” said Tracy Donegan, midwife and author of the Irish caesarean section and VBAC guide.
“Women with a planned cesarean can go up to 10 hours without fluids – and some with gestational diabetes are forgotten and very unwell before being sent to the operating room.”
To combat this problem, Limerick Maternity Hospital has become the first facility in Ireland to introduce a new practice designed to alleviate the discomfort of expectant mothers.
Regarding the old guideline, one new mother said she had a cesarean section in late April and, after fasting from 8pm the night before, did not eat or drink anything before her 5pm procedure.
“I had been fasting since the night before and between emergencies, I wasn’t sent down until 5 p.m. and was muzzled by then,” she said.
“My friend who is a midwife told me to ask her to hang up a bag of liquid for me, but every time I wanted to they said ‘You’ll be up soon’ or ‘You won’. It will not take much longer.
“I ended up being so dehydrated that the anesthetist couldn’t get a line in the back of my hand and had to put it in my elbow, which was really uncomfortable.”
Michelle Roche, who recently had an elective C-section and said she found the element of fasting extremely difficult.
“I had no water or food from 9:30 a.m. to 9:45 p.m. and felt like I was going to pass out from thirst,” she said.
New mom Ciara Ryan of Newport, Co. Tipperary gave birth to a baby girl last week.
Ciara said she is acutely aware that emergencies could delay her cesarean and is grateful that she can comfortably drink while waiting.
Midwife Ms Donegan said such experiences are not only stressful but can also cause other problems.
“It (not consuming liquids) can have a knock-on effect that makes it harder for staff to insert an IV,” she said.
“In addition, women can suffer from low blood pressure, which makes them nauseous and makes it harder for them to recover, while breastfeeding can also be affected when the mother is so dehydrated.”
dr Nick Barrett, consultant anesthesiologist at UL Hospitals Group, said the longer a patient fasts, the “more dehydration, thirst, hunger, headaches and general malaise they experience.” “This can be accompanied by metabolic disorders and physiological stress responses that can impede recovery,” he said.
“We are also seeing higher rates of post-operative nausea and vomiting after prolonged fasting. Many improved recovery programs advocate a high-carb drink two hours before surgery — but the problem with a caesarean Elective List is that planning is subject to unexpected disruptions, a planned two-hour liquid fast can easily turn into eight hours or more.”
Now Limerick Maternity Hospital is the first in the country to launch a new practice, ‘Sip til Send’, allowing women awaiting caesareans to drink fluids until they go to the operating theatre
“Earlier this year I came across the Sip-til-Send initiative, set up by anesthesiologists at NHS Tayside and has been adopted by several other NHS trusts in the UK, and I contacted them,” said Dr. Barrett.
“It has the advantage of being incredibly easy, not dependent on theater schedule updates and with no risk of a patient missing their seat when given a drink.
“Essentially, the patient is drinking clear liquid, which can be refilled every hour until we get him out of the operating room. It can be water, liquor, Dioralyte, or even an isotonic drink or popsicle… a six-hour solid-food fasting rule is observed.
“Our local version of the policy was developed in April and May, the June period was used for testing and finally rolled out in early July.
“Feedback from both staff and patients has been extremely positive, with staff saying, ‘I can’t believe we haven’t done this before’, while patients report greater satisfaction and comfort.”
The anesthetist hopes other maternity hospitals across the country will follow suit.
Ms Donegan said this was a positive step forward.
“It’s great to see Limerick taking the experience of women into account and including them in this initiative,” she said.
https://www.independent.ie/irish-news/health/sip-til-send-limerick-hospital-leads-way-with-new-initiative-to-ease-discomfort-of-women-having-elective-c-section-41943587.html ‘Sip til Send’ – Limerick Hospital is leading the way with a new initiative to ease the discomfort of women who have had an elective Caesarean section