Early Oral Intake After Cesarean Is Good for GI Function

The introduction of liquids and solids within 6 to 8 hours after cesarean delivery improves the return of GI function without increasing the occurrence of GI complications, according to the results of a systematic review and meta-analysis.¹ Although early oral intake is usual practice in the United States, these findings confirm that providing oral intake soon after cesarean delivery is beneficial to patients.
   
A total of 17 studies involving 2966 women were included; 14 were randomized controlled trials and 3 were nonrandomized trials. The sample size for each study ranged from 100 to 221 women. In all studies, the early intake groups were given liquids or food within 8 hours after cesarean delivery. Liquids, such as tea, juice, water, or coffee, were the most common nourishment provided in the early intake groups. In the delayed intake groups, nourishment was provided 8 hours to 48 hours after cesarean delivery or upon return of bowel sounds.
   
GI function returned significantly sooner in patients in the early oral intake groups. Bowel sounds returned an average of 9.2 hours sooner, passage of flatus occurred 10 hours sooner, and bowel evacuation occurred 14.6 hours sooner in the early oral intake groups compared with the delayed oral intake groups. In addition, there were no significant increases in the rates of GI complications, including ileus (intestinal blockage), vomiting, nausea, abdominal distention, and diarrhea, when oral intake was provided early.
   
Although the ideal timing of initiating oral intake after cesarean delivery is unknown, the available evidence supports oral intake between 6 and 8 hours after cesarean delivery to avoid stimulating the splanchnic nerve, the review authors suggested. They explained that the splanchnic nerve, which can trigger postoperative ileus, is activated during abdominal surgery and until 3 hours postsurgery and that delaying oral intake until after this period may help minimize this serious GI complication. However, the review authors stated that some included studies showed that providing oral intake as early as 1 to 2 hours after cesarean delivery was safe.
   
Although additional research is needed to determine the ideal timing of providing initial nourishment and food types for maximizing GI outcomes, clinicians should offer early oral intake to all patients after cesarean delivery.

Pertinent Points:
- Early oral intake after cesarean delivery does not increase the rate of GI complications.
- When patients are provided oral nutrition within 8 hours after cesarean delivery, GI function is improved.
 

References:

1. Hsu YY, Hung HY, Chang SC, Chang YJ. Early oral intake and gastrointestinal function after cesarean delivery. Obstet Gynecol. 2013;121:1327-1334.