Return of bowel function is a major determinant of length of hospital stay and morbidity following cesarean delivery. Traditionally, mothers are given nothing by mouth for up to 24 hours following cesarean delivery, then a clear liquid diet for at least one day, followed by a full liquid diet for at least one day. Because most cesarean deliveries now take place under regional anesthesia and involve little intestinal manipulation, earlier feeding may be appropriate. Patolia and colleagues studied early feeding in patients following cesarean delivery.
The authors studied 120 women scheduled for elective cesarean delivery under regional anesthesia. Exclusions included history of bowel disease or surgery, use of magnesium sulfate, or any medical condition that could influence feeding following surgery. The patients were randomly assigned to an early feeding or a traditional feeding protocol following surgery. Patients in the early feeding group were given solid food within eight hours of surgery. Those in the traditional feeding group were not given anything by mouth for up to 24 hours, and they advanced to clear liquids on day 1 and a regular diet on day 2 if they reported passage of flatus or stool. All patients were examined at least twice daily and questioned about intake and bowel symptoms.
The 60 participants in each group were comparable in all important characteristics. Mothers in the early feeding group were given solid food, on average, five hours after surgery compared with 40 hours after surgery for mothers in the traditional feeding group. The rate of mild ileus symptoms was not significantly different (31.7 percent of early feeders and 26.7 percent of the traditional group), and the only mother who developed severe ileus was in the traditional feeding group. In the early feeding group, the duration of surgery was associated with ileus symptoms. Significantly more mothers experienced symptoms when surgery time exceeded 40 minutes, but this effect did not occur in the traditional-feeding mothers. Average total hospital stay was significantly reduced in the early-feeding group (49.5 compared to 75.0 hours), and this reduction remained significant after multiple regression analysis.
The authors conclude that early introduction of solid food after cesarean delivery is well tolerated and results in prompt return of bowel function and decreased hospital stay. Mothers who experienced ileus symptoms were more likely to have had surgeries that lasted 40 minutes or longer.