M aternal feeding following cesarean section (CS) is controversial. The traditional regimen is no oral intake for the first 8 to 24 hours after surgery, until bowel sounds are heard, then clear fluids and solid foods are gradually permitted, the reasoning being that early ingestion can increase risk for gastrointestinal (GI) complications. To try to improve maternal satisfaction and shorten hospital stays, early maternal feeding, including clear fluids and solid food within 8 hours of surgery, has been proposed, on the basis that GI complications are not expected after an uncomplicated operation and that bowel function is basically preserved. In this prospective, randomized study, the authors evaluated the effect of early feeding on patient satisfaction, GI events, and initiation of breastfeeding after both simple and complicated CS.Subjects were women who underwent CS from June 2004 to April 2005 and who had not had prior bowel disease or GI surgery. Women were recruited either the night before elective CS or at the time the decision was made to perform emergency CS. The subjects were randomized into 2 groups: early feeding or traditional feeding. Women in the early group were given clear fluids and solid foods within 8 hours of surgery, according to their request. The traditional group received clear fluids 8 to 12 hours after CS, subsequent to the confirmation of peristaltic sounds, and solid food was served only after the first bowel movement. The complexity of the operation was defined by the surgeon's report. After surgery, all women were asked to complete a questionnaire regarding satisfaction with the feeding protocol, GI symptoms, and when she started to breastfeed. Multivariate logistic regression identified independent risk factors associated with complications.A total of 179 women were enrolled: 82 in the traditional feeding group and 97 in the early group. The groups had similar demographics and obstetric characteristics, and most CS were elective (86.6% in each group), with no significant differences regarding complexity or number of previous operations. Few women had postoperative complications, such as ileus, fever, and wound infection, and the complication rate was similar between groups (3.2% in the early group vs. 8.6% of women who initiated eating later than 8 h; P = 0.137). Maternal satisfaction was significantly higher among the early-fed women (94.4% vs. 78.4%; P = 0.008), who also would recommend their treatment regimen more often than the others (95.8% vs. 56.0%; P = 0.001). There also was a nonsignificant tendency toward earlier breastfeeding in the early feeding group.Although the majority of these cases were uncomplicated and more studies are warranted to evaluate the impact of early feeding after complicated CS, physicians should be aware that gradual early maternal feeding after uncomplicated CS is not associated with higher rates of GI complications and can lead to better patient satisfaction and comfort.
