Post c/section diet

[Elvish, BSN, DNP, RN, NP]

I have a question for you guys that was sparked by a discussion in another forum.

What are your diet orders for post c/section moms? And how often do you see ileus as a complication post c/s?

Our regular post c/section orders are clears x 24hrs, then as tolerated, but I often find moms that want to eat a regular diet sooner. Most of our docs will okay that, and some will even scratch out the CL order and write for 'diet as tolerated' immediately postop.

Most of our moms do really well, and I can count on one hand the number of times I've seen ileus pop up as a complication.

Curious to see what y'all do and experience....

[rn/writer, RN]

Most of our post-op orders are to advance as tolerated. If they have bowel sounds and are not nauseated, I'll start them on apple juice (water makes some sick to their stomachs). If that doesn't cause a problem, they get graham crackers or saltines. Onward to a box lunch if it's a long time till breakfast. Then whatever they want.

I have seen occasional n/v, for which we give zofran, but can't recall a true ileus ever.

I would be more on the lookout if the patient had a general, but that's really rare. Epidurals don't appear to cause the same kinds of problems generals did in the "olden" days.

[VivaLasViejas, ASN, RN]

Oooh, that brings back some bad memories!

I developed an ileus three days after my third C/sec, almost nineteen years ago. My OB was one of those strict ones who kept moms NPO for the first 24 hours post-op, then advanced very slowly from ice chips to clears to full liquids over the next 48 hours. Only on D/C day did he OK diet as tolerated, and that was when they brought you your celebration meal........imagine the pain caused by piling filet mignon, cheesecake, and champagne on top of a bowel that was still 'asleep'!

I think OBs are much more sensible nowadays, although I have seen some interesting reactions from moms who chowed down on Whoppers and fries only a couple of hours after their cesareans.

[LDRNMOMMY, BSN, RN]

Our orders are clears, advance as tolerated provided pt is not nauseous and has bowel sounds. I don't take care of c/s post partum past initial recovery unless they are staying in L&D on Mag, but the diet order is provider dependent.

I have been in L&D for almost 5 yrs. I have only heard of one patient that had an ileus. It was a couple of months ago where I currently work

[nursej22, MSN, RN]

From personal experience, early ambulation had more impact on gut motility than what I ate. C section #1 I was afraid to move, felt like my guts would fall out. Result: I bloated up like the Hindenburg. Babies #2 and #3 no problems gut problems 'cause I was up and at 'em as soon as I could. A little too soon with #3 as I got a spinal HA.

[NurseNora, BSN, RN]

Our orders are to advance as tolerated. Some will insist on a burger and fries first thing, and some do tolerate it.

I haven't seen an ileus since they improved post operative pain management. Epidural/spinal narcotics or PCA pumps ROCK!! When the patient moves around, she's so much less likely to have problems, and when she has good pain control, she moves.

[mommybess, BSN, RN]

Orders for us are NPO until tolerating clears, and then advanced to full liquids, and then advanced to regular once passing gas, and no N/V. I usually do chips and sips for several hours first, then if all goes well, offer apple juice and encourage more water, if the patient is passing gas and I hear good active bowel sounds then I offer chicken broth and saltines. For most of my c/s patient their first regualr meal is breakfast (I work nights) and I really encourage a light breakfast. I have not yet seen an ileus on our floor.

[NurseNora, BSN, RN]

How do you know they're tolerating clears if they're NPO?

I remember patients being on tea and tap water for the first 3 days. Boy have things changed!

[Conejita, BSN]

We only have two providers who do C/S where I work and they couldn't be more different with the post-op diet orders.

We have one provider who writes orders for advance as tolerated- and we usually start with clears for the first "meal" and then if no N&V we move on to full liquid and on and on as tolerated. Some of these patients will do fine on clears and then just go straight to the burger and fries without any problems at all.

The other provider (very old-school) writes orders for clears and then requires a BM before the patient can have a regular diet. He helps them along by writing a list of orders for meds (not prns) like dulcolax suppository, colace, and cytotec. Many of this provider's patients end up with the runs after this medication regimen, so usually they get to eat by 24hrs post op.

I haven't seen an ileus yet (but i only have 1.5yrs under my belt so far).

[jennylouwho]

OMG, if I had to wait 24 hours to eat after my emergent c/s with my first baby I likely would have either had someone sneak me food or I would have made a huge stink. I ate around 4 am the morning my water broke (because I knew I was going to get nothing after that) and ended up with a c/s around 8:30 that night. It was torture when my in-laws showed up that night with McDonald's for my husband. He still gets hell for eating in front of me. I finally ate the next day around noon - it was a left over tray and was cold but it tasted so good.

I'm so glad that my next two births have been VBACs. After all that hard work those turkey sandwiches on white bread (I never eat white bread) tasted pretty darn good!

[RNBelle]

One placed I worked it as advance as tolerated, I would start off with juice or broth, depending on what the pt wanted, then crackers, etc. Never saw anyone with problems. Where I work now it is clear for 24, then full liquid, then soft, then regular. I think it is cruel to make a person wait 2 full days before then can eat something with bulk and texture. I know I would eat my own arm if that happened to me.

[rn/writer, RN]

One placed I worked it as advance as tolerated, I would start off with juice or broth, depending on what the pt wanted, then crackers, etc. Never saw anyone with problems. Where I work now it is clear for 24, then full liquid, then soft, then regular. I think it is cruel to make a person wait 2 full days before then can eat something with bulk and texture. I know I would eat my own arm if that happened to me.

This order set reflects an absolute lack of trust in the ability of the nurses to assess and act accordingly. One patient in 100 might need something this drastic. And that's a high estimate. Almost all of my section patients are eating a general diet by day 2. I do encourage them to eat lightly to begin with and avoid things that are greasy, but other than that, I'm happy to see them eating.

Some of these women have labored for a full day before having a section. They're hungry. With good pain management they're up and moving. Bowel sounds usually start gurgling away. Anti-emetics take care of nausea and vomiting. To tell such a woman that she can only have soup just doesn't make sense.

It sounds like a holdover from the days when c-sections were all done under a general anesthetic, followed by IM morphine. Epidurals and PCAs have really changed things.

Maybe you could do an "evidence-based practice" comparison between the two groups of women and see if there is a difference in their outcomes. And their satisfaction. Then present your findings to the doc who doesn't let his patients eat. I'm sure he's only trying to be careful, but you have to change with the times.