Would you ever buy a car because the press release from Ford said it was a pleasure to drive, has incredible gas mileage and never needs repairs?
Then you shouldn’t accept the claim of a scientific researcher based on a press release that said it was awesome, ground breaking and relevant to current medical practice.
Mainstream media and natural childbirth advocates are trumpeting a press release from a poster presented by two medical students at the American Society of Anesthesiologists (ASA) 2015 annual conference.
[pullquote align=”right” color=”#d24623″]Since a policy of fasting in labor was instituted, deaths from aspiration have dropped dramatically.[/pullquote]
Most healthy women can skip the fasting and, in fact, would benefit from eating a light meal during labor, suggests research being presented at the ANESTHESIOLOGY® 2015 annual meeting. Improvements in anesthesia care have made pain control during labor safer, reducing risks related to eating, researchers note.
Women traditionally have been told to avoid eating or drinking during labor due to concerns they may aspirate, or inhale liquid or food into their lungs, which can cause pneumonia. But advances in anesthesia care means most healthy women are highly unlikely to have this problem today and when researchers reviewed the literature of hundreds of studies on the topic, they determined that withholding food and liquids may be unnecessary for many women in labor.
Really? How did two medical students reach that determination? It’s not easy to tell since there is virtually nothing available for other physicians to read and analyze.
Here’s what they said in their poster presentation:
Declining rates of parturient aspiration mortality have been indicated in the UK with no reported cases from 2000-2005 when compared with rates of 1.499 per 1000 parturients during the 1940s
Wait, let me get this straight: Since a policy of fasting in labor was instituted, deaths from aspiration have dropped dramatically?
And that’s supposed to mean that aspiration is no longer a risk.
But a dramatic drop in the incidence of maternal aspiration doesn’t mean that the risk has disappeared. There’s also been very few cases of polio in the UK since 1990 (because of vaccination). That doesn’t mean that polio has disappeared.
Here’s what the authors of the the poster say it means:
This review suggests that in low-risk patients with no risk factors, fasting does not appear warranted.
Here’s what it is more likely to mean:
Fasting in labor prevents aspiration deaths.
Why did the ASA issue a press release on the findings of two medical students? For the same reason any scientific organization issues a press release, to garner media attention.
What is the impact of such press releases?
According to a 2014 BMJ paper, The association between exaggeration in health related science news and academic press releases: retrospective observational study:
The framing of health related information in the national and international media, and the way in which audiences decode it, has complex and potentially powerful impacts on healthcare utilisation and other health related behaviour in many countries. The media also demonstrably influences the behaviour of scientists and doctors.3 4 Such impacts may often be beneficial, but misleading messages can have adverse effects (even if these effects may be difficult to predict and prove because the responses of audiences are complex and multiply determined).6 This problem is not restricted to rare dramatic cases such as vaccination scares7 8; the cumulative effect of everyday misreporting can confuse and erode public trust in science and medicine, with detrimental consequences.
How accurate are such press releases?
For our analysis of advice we found that 40% of the press releases contained more direct or explicit advice than did the journal article (bootstrapped 95% confidence interval 33% to 46%). For our analysis of statements based on correlational results (cross sectional or longitudinal) we found that 33% of primary claims in press releases were more strongly deterministic than those present in the associated journal article (bootstrapped 95% confidence interval 26% to 40%).
That’s precisely what has happened here. The medical students noted a finding, maternal aspiration now occurs rarely compared to more frequent incidents of aspiration in the 1940’s. This correlated with the development of anesthesia techniques designed to minimize aspiration. They concluded (with no evidence to support that conclusion) that the new anesthesia techniques prevent nearly all cases of aspiration.
But there was one anesthesia “technique” that seems to have escaped their notice, the strict enforcement of fasting during labor.
It is very likely that the fasting in labor is a major factor in the decrease in aspiration deaths. Certainly the authors presented no data to indicate otherwise.
Anesthesia colleagues, help me out here:
Have UK hospitals been allowing women to eat in labor since the 1940’s or did they have a strict fasting policy?
Is there something that I am missing that allowed the researchers to isolate the impact of new anesthesia techniques from the impact of fasting itself?
If not, then the authors drew a conclusion from the data that is not supported by existing scientific evidence.
If not, then the authors are advocating stopping the fasting policy that was responsible for the decrease in deaths.
If not, then the ASA has issued a thoroughly irresponsible press release that contains advice that isn’t merely unsupported by the evidence, but advice that could be deadly.
I saw this the other day. I puked during my labor and felt no hunger whatsoever. I’m not sure what the fetish is for needing to eat during labor. Can these women not go a few hours without eating?
Of course they also want to labor uninterrupted for days, instead of under 24 hours, so maybe that is part of their problem…
They’re not arguing for a freaking banquet, Amy. They are arguing for Gatorade and perhaps some crackers and toast. There *is* actually evidence that patients who consume Gatorade the morning of GI surgery (for instance) have better outcomes in terms of return of bowel function, length of stay, and acute kidney injury.
The students reviewed the literature & made a poster. Here is some of the evidence. Come on Amy, check your facts before you dis others. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003930.pub3/abstract
This was the same logic the MTF (military treatment facility) in Korea used to suggest I was a looney in requesting my children be vaccinated for Japanese encephalitis whilst living (across from rice fields) in Korea. “We don’t see any cases of this locally anymore, hence, it is not necessary for all the US families who come to live here.” Hmmm… the vaccine is part of regular vaccine schedule for all Koreans, so, that might be why they don’t see it. From what I could find in articles, most of the mosquitoes there do carry the virus. It got straightened out and now the vaccine is offered to families there, but, anyway- great logic, lol.
Heads up: the Guardian is doing a story on British midwives. Anyone here want to step up and participate?
http://www.theguardian.com/society/2015/oct/27/what-is-it-really-like-being-a-midwife
We haven’t had fasting restrictions for low risk pregnancies/ labours for at least 10 years. Some anesthesia techniques has changed – there was a time around the 1980s when there was a lot of concern about transient neuro praxias and cauda equina syndrome related to local anesthetics in the intramural place and spinals fell out of favour until non-preservative local anesthetic became available. That meant we relied on epidurals which are not as reliable as a spinal block which meant more failures durin cs and a higher conversion rate to ga. The other thing that has changed is a much higher rate of epidural placement for labour analgesia which has allowed cs, even very urgent ones, to be done with an epidural top up rather than GA.
The other thing that has dramatically revolutionized anesthesia was the invention of video laryngoscopes, particularly the Glidescope (invented by a general surgeon from Burnaby BC Canada) which can improve a dodgy laryngoscopes view by 1-2 grades. This has improved the management of difficult airways in a way that is hard to describe to anyone who doesn’t manage airways. Also fibre optic tools like bronchoscopes are available and the skill set to use them is widespread amongst anesthesia. So airway management has markedly improved.
We have now gone so far as to carbohydrate load all our patients who are low aspiration risk 2-4 hours before surgery (Apple or cranberry juice or commercially available glucose drinks) because it improves recovery and shortens ileus time after surgery…this includes scheduled CS.
I don’t agree with all the conclusions of the medical students but healthy term women who appear low risk – I assume they all eat and only worry about it if to have to urgently give them a GA. Then I plan and execute a GA knowing they have a “full stomach.” Thankfully we have the tools to do so.
Actually if you go back to 1920ish and read the original paper on Loefflers syndrome – the aspiration syndrome, the women that aspirated and died under ether during delivery all aspirated large chunks (in one case it was steak) while the ones that recovered aspirated liquids. Which is an argument to limiting intake to non- chunky, easily digested things like crackers, toast, and my fav, gummy bears.
Thank you for this.
In my first labor, 16 years ago, I wasn’t allowed anything but ice chips. In subsequent labors, 5 and 2 years ago now, I was allowed light snacks like you suggest and liquids. All I ever wanted during labor was water to moisten my dry mouth so I was incredibly grateful for that change! I know IV keeps you from dehydrating but honestly there really isn’t anything like a sip of cold water to help you feel better when you’re working really hard and breathing to match.
Women in the UK can eat or drink in labour, but we’re talking light food: toast, cereal bars, trail mix etc, not a three course meal, and few want to eat anything after 6cm anyway.
The pre-op fasting protocol prior to planned CS has changed in the last five years too.
With my first, I was told no food or fluids from midnight, with an admission time of 8am (CS at 11), with my second, no food from midnight but water allowed until 8am, with surgery at 11am.
After the CS it was the traditional NHS offering of tea and toast, followed by tea and toast, with yet more tea and toast.
and then you get to the post-natal ward to discover there is no kettle… or any other form of tea making facilities. I bet I wouldn’t have had a breakdown if they had provided kettles.
Health and safety- no kettles. Sometimes not even for the staff.
I worked in an ER in a hospital where the canteen was on the top floor and the ER was on the bottom. We got one 20 minute break in an 8hr shift.
Our choices, as per management:
Vending machine food and hot drinks from the patient waiting room. Nope, not walking into a full waiting room at 3am with drunk people who have been waiting for 6 hours. More than one staff member was physically assaulted doing that.
Or
Spend the entirety of the break in the lifts and the canteen queue.
Our choices really:
A secret kettle, fridge and microwave that were unknown to management.
Or
Deliveries from local takeaways (we weren’t supposed to order in food, because some patients complained if they thought we were eating instead of seeing them, but you try working a 5pm to 2am shift without food or fluids.)
Sunday breakfasts of eggs, bacon and coffee made by the charge nurse in the secret kitchen were what made Saturday night shifts bearable.
Of course.. should have thought of that. When I worked for the Civil Service we weren’t allowed kettles either, although our electrics were so old that any extra load ran the risk of blowing the whole lot. Had colleagues who would risk life and limb plugging kettles/radios in on Friday afternoons to try and get home earlier. Unfortunately we shared a building with the local Social Security at the time and as “punishment” for the computers / printers going down, my team spent more than one Friday afternoon & evening hand writing giros to help our poor colleagues out before a riot started. Was slightly funny the first time.. but got old fast.
I remember when I did my week on the labour ward during med school, getting the tea and toast after birth was my job. At least I was being useful!
Allowing women to eat and drink in labour is normal in UK and has been like this for a long time. Cochrane review on the topic: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003930.pub3/abstract;jsessionid=9640D6254023EB018568C21702ECA7AC.f04t01
I gave birth two years ago in the UK. I wasn’t offered any food during labour (16 hours), but I’d taken a few snacks with me, simply because nobody had told me otherwise. I hadn’t a clue that it was not the best idea.
It was a moot point in the end, as I *TMI* projectile vomited any time I tried to eat or drink anything.
I almost choked on a piece of toast after the birth though. My husband really appreciated the speed of response of the nurses he called. Lots of risks for mothers during birth, but I hadn’t appreciated toast as being one of them!
I’m a bit ambivalent about fasting for procedures in general – the evidence for fasting and aspiration for general anaesthesia is much weaker than was previously thought. Cricoid pressure has been found to be useless for preventing aspiration – it was based on a very old study done on post-mortem patients. There is good evidence that fasting is not required for procedural sedation in EDs (for example, for reducing dislocated shoulders).
Having said that, this study makes little sense. As Dr Amy says, it’s illogical to say that, with routine fasting, aspiration is rare, so we don’t need the routine fasting. The only useful evidence here would be the aspiration rate in casemix-matched and similar maternity care systems that DO NOT employ routine fasting during labor.
Here is a relatively recent paper about oral intake and gastric emptying, from ANZJOG 2013:
Maternal outcomes in women supplemented with a high-protein drink in labour
http://onlinelibrary.wiley.com/doi/10.1111/ajo.12079/abstract;jsessionid=BA0FE522730D5BA811F98B8B613F98F2.f01t01?userIsAuthenticated=false&deniedAccessCustomisedMessage=
I couldn’t find any papers that reported aspiration rates, with or without fasting.
I’m not ambivalent about it at all. Of course, seeing frank regurgitation of stomach contents during direct laryngoscopy will do that to you. Recently there has been a move to reduce fasting for adults to 6 hrs for solids and 2 hours for clear liquids prior to elective surgery. When patients are free to drink they arrive euvolemic and with less CHO debt. The guts recover faster and it’s all good. Until that policy, meant for low risk patients, is mistakenly applied to a sick high risk patient. Then you get an aspiration with induction in the thoracic surgery room and a totally avoidable ICU stay. For the first time the older anesthesiologist a in my department can remember, patients are aspirating on induction again. The majority of aspirations are clinically silent but some of them result in pneumonitis. We are going to see more and with a rate of approx 1/17000 with strict fasting the CHO load/ free drinking studies were likely underpowered to detect aspiration events.
I was deep into the woo and planned on DEMANDING food if I was hungry. Then, surprise surprise, I wasn’t the least little bit hungry! The nurses kept getting me cranberry juice with lots of ice, but I barely touched it.
Is it common for women to even want to eat or drink during labor? I sure couldn’t. When I was probably about 5-6 cm and still at home, I tried to take a little tea and it did not stay down. That’s one of the ways I knew things were getting serious. It strikes me that for some people having a meal during labor might be another check-box for a “natural birth experience.” What did you have for your “push meal?” “Oh, a bacon-wrapped filet mignon. You?” “Coq au vin, of course.” Then again, what stage of labor are they talking about? During the very early stage, I had lasagna and BBQ ribs : )
In early labor I had pulled pork and rice and a smoothie 🙂 At four centimeters I had some tea and finally after 6 cm I only wanted a few sips of water here and there.
Amy you are a bit out of date. Women in the UK are encouraged to eat and drink as they wish during labour, if they are at low risk if complications. This has been the case for at least the last 10 years.
This last time, I was told to eat a light breakfast before leaving for my induction. After they started the pitocin, I could have all the jello, juice, and popsicles I wanted. Even after I got the epidural. I don’t remember being particularly hungry during labor, but I was ravenous after I have birth. I ordered grilled salmon for my after birth dinner. Delicious.
Our unit allows women to eat and drink normally during early labour (i.e. when they’re at home), and allows clear fluids during active labour. Most women are only having small sips, anyway. And for high risk women (VBAC) we keep women NPO and hydrate with IV fluids as necessary.
Good golly, who supervised those students? And who reviewed their poster? And who decided to make a press release out of it?! What a travesty!
Not that medical students can’t conduct or present quality research, just that this ISN’T it!
I thought I heard something about fasting and surgery generally here in the media a few weeks ago?
The fasting can be tough on skinny minnies whose surgery runs late, particularly if there aren’t any fluids being run in either. Not as tough as aspiration, I’m sure, but a lightweight who has had no food or fluid for 18 hours is in a pretty ordinary way at hour 19 or 20.
I’ve never been in labor, so who knows how this would have turned out. However, my OB (American, generally not particularly woo-y) would have been fine with my drinking small amounts of juice or Gatorade while in labor. One of my concerns was that if my blood sugar gets too low, then it can often trigger a migraine, and I figured (probably not incorrectly) that labor plus a migraine wouldn’t exactly be fun and games.
This is a really dumb question but does anybody know what they do with diabetic women? My understanding is that for diabetics it is important to keep your blood sugar level and fasting doesn’t intuitively feel like a great idea. It isn’t like one day is going to make your foot fall off, but it still seems like it would be a big deal for the woman and the medical team.
Small amounts of juice and glucose tabs can be used to regulate blood sugar during labor. Mostly you stick to checking a lot, correcting highs and treating lows with juice or glucose tabs (which I was told by my OB were ok to use even during my 12hr fast prior to my c-section)
Thanks, that does make sense! I don’t have a medical background and I was having a hard time thinking it through.
Being diabetic can cause problems with all surgical procedures which require prolonged fasting prior to the op. I had a definite problem when I had my hip replacement for a couple of days.
I only have the “been there once” to say. With decent control and a good basal, a 12hour fast is not problematic if undertaken carefully (we also did some lowered insulin and some patterning to account for my known bs glitches that I would have solved with, say, lunch on a normal day).
General anesthesia tends to be a killer on blood sugar regulation though.
Diabetics are given an IV of dextrose and normal saline. Blood glucose is checked hourly and IV insulin is administered & adjusted as needed until delivery.
Actually, some diabetics manage their own through labor. Especially those on pumps. Usually have an endocrinologist approve the plan.
Because most of the diabetics I know cast vile aspersions upon the IV dextrose. Serious expletives are hurled.
My doc let me eat or not eat depending on if I felt like it or not. She did encourage me to drink fluids since I ionly had a heplock. Early on, I felt as hungry as usual but by 6cm or so, I wasn’t that interested in anything other than a pudding or a spoooful of peanut butter. Then again, I never made it past 8 cm before I needed a CS, so I can’t really comment on transition.
I, like Angharad below, was under the impression that recent studies found eating in labor not to be problematic but I can’t say it’s something I’ve researched extensively since I no longer do OB. I’m happy to learn if the evidence shows otherwise though.
Not an anaesthetist, and nor does my memory stretch back to the 40s. But in my two pregnancies and births (2011-12 and 2014-15) in the UK, I never once heard anything about not eating or drinking in labour. In the antenatal classes they even mentioned bringing snacks. I drank water in both delivery rooms, and ate a light meal during early labour on both occasions (to be fair, the PROM with the first one was well over 24 hours). If there is a ‘ban’, it isn’t one my Trust are taking very seriously. I seriously never heard anything about the issue until reading it here.
How weird, I ate in labour, what is dangerous about it?
My mouth was far too firmly clamped over the gas & air to waste precious inhalation time eating. The buttered toast afterwards was the best meal I’ve ever eaten though.
Me too!
I had the Sunday Roast that came past on the trolley after the second, the midwife told me the worst that could happen was that I’d throw it back up again, which I didn’t.
I drank water a little bit during my labors, but food itself was the farthest thing from my mind. Like some others have said, after the baby was born I was starving.
DD was born by CS, but I was the same way. Maybe it was partly the fast from the night before, but I don’t think I’ve ever tasted anything as delicious as the quesadilla I had a few hours later.
We were taught that peristalsis stops during labor, and so, with the exception of sugar and carbs, which are absorbed directly from the stomach, what you eat in labor just sits there, more or less.
It is a well-known phenomenon that many women, when they reach 7 cm dilatation, have an irresistible urge to turn on their left sides — and vomit.
I would offer clear liquids in labor as I found most women tolerated this well, and it was a way of getting both fluids and some easily absorbed calories, but never thought eating anything heavy was a good idea.
I felt like I was about to vomit with each contraction by the time I was 3 cm. 🙁
That’s how I knew I’d hit transition.
Well, if the all-out ban on eating in labor is lifted, the prudent thing to do would be to fully inform all laboring women of the risks of eating during labor and have them sign a form like all the other informed-consent paperwork. With that in place, and the natural tendency of women to puke a lot during labor, I wonder how many would even want to eat?
I wasn’t especially interested in food during labor, but I was very thirsty. They let me have a bit of apple juice, or ice chips. After the babies were born, I did feel hungry, and the nurses brought me a sandwich, but I wasn’t able to eat much until the next morning because eating made me feel nauseated.
I was hungry. My hospital allowed me to eat any liquids, so I had some soup and pudding and so forth while in early labor. After reading this, I was curious if that was an anomaly. I found a study about eating during labor that says it’s pretty widely allowed in the Netherlands (not that we necessarily want to emulate them) and allowed by quite a few hospitals in the UK. The study found no difference in any outcomes for eating vs not eating. If someone who knows more than I do about interpreting medical studies has any criticisms, I’d be interested to hear them because it looks well-designed to me.
http://www.bmj.com/content/338/bmj.b784
Do women often get hungry during labor? I didn’t want to eat for something like 24 hours; labor started a couple hours after dinner, lasted 18, and still didn’t get hungry until at least a couple hours post-partum.
Well I got hungry and I ate during labor though I could eat very little (without eating I would have been more exhausted as labor was long). My initial plan was to bring energy gel or drink used in sports but I never got around to it. Fasting is not enforced in our hospitals (but then again many hospitals offer waterbirths too so they are not very much into risk aversion).
I was induced and just before the pitocin was started the nurses offered me a little bit of toast. I could barely choke it down (anxiety may have been playing a role), but by the time labor was underway the LAST thing I wanted to do was eat. I eventually threw up (while waiting for my epidural), and wanted nothing more to eat until labor was over. That’s when I discovered to my great displeasure that the acid reflux and heartburn I’d suffered from most of the pregnancy had not resolved at delivery.
I was eating nuts and Oreos (I know, an anesthesiologist’s nightmare) during all of my labors. I also never felt nauseated or vomited. Yeah, I was a bad girl…
It’s true. Oreos are the devil. At least they are vegan. Mmmmmmm. Yum.
Have you had Newman-O’s? The hippie equivalent? They’re amazing.
I was mostly thirsty in labor. I was ravenous by the time I was allowed to eat though, but I had a C-section and had to wait to pass gas before I got more than a liquid diet.
I remember having to do that with my first. I don’t remember having to wait for the gas with the second. After my first cs I didn’t like the idea of calling the nurses station to announce to everyone that I had just passed gas, but by the time it finally happened I was so hungry I would have yelled down the hallway if I had to.
I was so thirsty after 24 h of labor that I begged for water. The nurses said I would probably just throw it up, and I ignored them and drank it anyway. I promptly threw it up. Those nurses…they know what’s up.
I still think fondly of the nurse who let me have a few sips of water instead of ice chips. I hate ice in my mouth. Makes my teeth hurt.
I wasn’t hungry but I was dying for a drink of water. As we were waiting for me to progress, my wonderful nurse allowed my popsicles. After it was time to push, it was ice chips all the way. I couldn’t get enough because I was so thirsty. Once my daughter was born and everything stitched and cleaned I was ravenous and desperately wanted root beer.
tea for me, fully caffeinated, and as big a size as my sister could find.
When I first heard that they don’t let laboring women eat I thought that it sounded barbaric and it actually kind of freaked me out. I get super panicky when I want to eat and can’t, and I was actually pretty happy to hear that most women don’t want to eat during labor.
With my first I was induced, so no food after midnight (basically they let me have dinner shortly after starting the cervadil, but wanted my stomach empty before starting the pit in the morning). The pit worked fast, and while I missed my am coffee and was rather thirsty, I really wasn’t ever hungry. I did get nauseous at transition, but did not vomit. With my other three children I went into labor spontaneously, so I was at home for the majority of my labors, and so I ate and drank as I saw fit. My labors all started with weak, early ctx that lasted about 24 hours before the real deal began. During that time I ate normal meals; my appetite was unaffected. Once active labor began I still drank water and/or Gatorade, and switched to easier to digest foods (bananas, applesauce, pudding, toast…. Basically just carbs). By the time I got to the hospital (8 cm, 6 cm, and 10 cm respectively with each child) I wasn’t interested I food at all (actually that was one of the things that tipped me off that it was “go time”… It takes a lot to kill my appetite, lol). With those deliveries not only did I not vomit, but I never felt the slightest bit nauseous. I do understand why they had me on ice chips only with my induction (first baby, no cervical dilation or effacement going in, past due date, etc, so I’m sure I was a pretty high c-section risk), but I think having my stomach too empty might have been the reason for the nausea. That happens to me outside of labor too.
I knew that things were getting serious when I suddenly lost my appetite completely mid-meal. But I was also ready to puke by the time I reached 3 cm (in a hospital where they won’t admit you until you hit 4 cm). The anesthesia fixed the nausea, but I still wasn’t interested in eating anything.
I was hungry *before* induction, having spent the previous four hours sitting around triage waiting for the doctors to decide to induce me. If I’d been laboring at home prior to coming to the hospital at the usual recommended time, I certainly would have eaten – I’ve never heard anyone recommend not eating in early labor – so it struck me as massively unfair to withhold food all that time. Unfair because a woman pregnant with twins is HUNGRY ALL THE TIME (I wasn’t so far along that my stomach was crowded). And I get migraines when I don’t eat.
I was not hungry in active labor, but I was thankful for the apple and granola bar I snuck before they hooked up the pitocin. My US hospital permitted any clear fluids or popsicles, but said no red. When asked why, the nurse doing the l&d tour said it was because patients freak out when they throw up red food and think it’s blood. And that’s the kind of policy I have a problem with: If I want red Gatorade and it’s not medically contraindicated, don’t treat me like I’m stupid. If you want to warn women that throwing up red Gatorade looks like blood (which, no, it doesn’t if you no what vomited blood actually looks like) then just tell them that – don’t say red liquids are not allowed. Or if there is some other reason for it, then just say that and don’t make up something about how it looks like blood. Stupid rules like that are why women don’t take the rules seriously.
Barfing red can be pretty alarming. I had blueberry oatmeal one morning and got wicked sick not long after. It was red. My 14 month old was screaming in terror.
I’m sure it can be, but if it isn’t medically harmful a ban is just infantilizing women in labor. Warn against red food, sure. But act like it’s not allowed?
True enough. I was just running on a tangent
Providers also freak out when a woman in labor vomits red fluid.
Right. I suspect they don’t want to have to waste time and money running tests to make sure it wasn’t blood. If mom can deal with apple juice instead of cranberry, lemon jello instead of cherry, etc., then nobody has to freak out.
Then they can say so when they ask that we not drink red Gatorade, but frankly I don’t trust a health care provider who doesn’t know the difference between artificial red coloring and blood.