What does your hospital do post-c-section?

[justme1972]

I just finished a very uneventful OB rotation in a hospital.

What I saw, surprised me and I am wondering if what I thought was the correct procedure, is.

When I had my c-section, the hospital had a very, very clear policy of putting me on clear liquids until I had my first bowel movement post-op.

Then they put me on a regular diet, so I was on the liquid diet for about 2 days. When I asked why they said, "If you start eating food immediately after post-op, it can cause your bowel to back up and you could be off to another surgery."

Made perfect sense to me (this was before I started nursing school).

When I did my OB rotation, these women came straight back from the OR to a regular diet on their very next meal.

Needless to say, we were giving out stool softeners AND enemas to the same patient, and these women complained of alot of deep, internal pain that seemed to be c-section unrelated.

Which procedure is correct? I just thought it was unnecessary that these women had to go through that b/c making that transition was easy for me and these women were miserable! I took no enemas, no stool softeners, and I had two friends that gave birth at the same hospital within a couple of months of me, and their experience was like mine.

[Jolie, BSN]

Because most C-section moms are healthy patients and general anesthesia is rarely used, it seems that some providers have gotten lax in adhering to clear liquid diets. (Heaven forbid, we don't want to say "No" to a patient's request for "real food". It's all about customer service.)

In my experience, most docs order clear liquids until bowel sounds are active and mom is passing gas. But there are some who cave in when a whiny patient starts to complain. Or some patients will simply ignore medical and nursing advice and have family members bring in food. McDonald's seems to be a favorite. Those are invariable the same moms who have horrendous gas pain a day or so later, to the point of tears and being unable to care for baby.

[maryloufu]

When I had my dd it was clear liquids until the passing of gas- but I snuck some cheez its in the middle of the night before they let me eat. I limited myself to 10- and they were the best crackers I have ever eaten.

[ladylabor]

We do diet as tolerated, immediate post op we start with ice chips or popsicles, then advance to clears for first meal and if that is tolerated we advance to soft (puddings, jellos) if tolerated then to regular diet. Nurses are listening for active bowel sounds during this process.

[JaneyW]

There was a Cochrane Review done last year regarding oral fluid and food intake after c-sections with both general and regional anesthesia. It was a limited review, but it found no reason to withhold fluid and food after c-sections. I think this is also a "rule" that is changing for other surgical patients as well. Evidence-based medicine is just not backing up what we were always told. I have had a lot of patients who recieved a regular diet soon after c-section and did great. A lot of it is getting them out of bed and moving soon.

Research is crazy, though, maybe 10 years from now it will swing back to clears and withholding food--who knows?

[shortstuff31117]

We do advance as tolerated. I start my pts. immediately on ice chips, and if they arent nauseous, juice. Then go to crackers and if they tolerate that fine, they can move on to real food. I rarely see a problem with gas at my work, I dont know why. It helps to get them on real food, because then they go to oral pain meds and get off those awful morphine pcas.

All this being said, when I had my section, it was at 2:45 am and I ate a real breakfast at 8am. I had horrible gas pains. Maybe it has more to do with the surgery and how much pulling?? Just a thought, or maybe some people are just unlucky.

[klone, MSN, RN]

If we waited until they had their first bowel movement, 95% of the women would not be eating anything but clears when discharged.

We wait until we hear active bowel sounds, then we slowly advance as tolerated - starting with maybe some ice cream and crackers and see how she does.

When I recover a fresh section, I immediately give her access to water, ice, juice, jello and chicken broth (I really encourage the chicken broth because warm liquids encourage bowel motility), as long as she's not actively vomiting. Usually by 12 hours, I'll have her try some crackers.

How quickly and how often you ambulate them also has a lot to do with when their bodies are ready to handle solids. Frequent and early is my motto, whenever possible.

[AllThingsPink]

Patients are on clear liquid diets until they pass gas. Usually it's 24 hours, could be more could be less.

[Elvish, BSN, DNP, RN, NP]

Our order say CL x 24 hours and then diet as tolerated.

In reality, once they have bowel sounds & don't have n/v, we start them on full liquids & crackers if they ask/want to. The docs are ok with this.

[jenrninmi, MSN, RN]

Because most C-section moms are healthy patients and general anesthesia is rarely used, it seems that some providers have gotten lax in adhering to clear liquid diets. (Heaven forbid, we don't want to say "No" to a patient's request for "real food". It's all about customer service.)

In my experience, most docs order clear liquids until bowel sounds are active and mom is passing gas.

This is how it is where I work.

[The Little Greek]

There was a Cochrane Review done last year regarding oral fluid and food intake after c-sections with both general and regional anesthesia. It was a limited review, but it found no reason to withhold fluid and food after c-sections. I think this is also a "rule" that is changing for other surgical patients as well. Evidence-based medicine is just not backing up what we were always told. I have had a lot of patients who recieved a regular diet soon after c-section and did great. A lot of it is getting them out of bed and moving soon.

Research is crazy, though, maybe 10 years from now it will swing back to clears and withholding food--who knows?

I have seen the Cochrane review too. When I was in grad school two of my classmates and I did a presentation about this subject. The hospital where I worked at the time switched from clr liquids following surgery to feeding pt's right away. In addition to Cochrane we also found some very interesting CE offerings that reiterated that in healthy pt's that have not undergone general can be fed right away. In fact, the reports even stated that assessing bowel sounds following surgery was an inadequate assessment of bowel movement. The authors stated that initial (no time frame was given) bowel sounds are often the result of electrical impulses and not a working bowel.

All that said, at my current job we withhold food for what seems like forever. Some of the docs withhold food until +BM. In my opinion that's ridiculous.

[cherokeesummer]

When I had my c-section 2 years ago, they said I could have solids that evening if I wanted them which of course I did but I went very slow and had previous experience with surgeries and what not, I'm also type I diabetic so that may have been part of it not sure.

But our policy is usually clears for 24 hours and bowel sounds must be present. We don't require a bowel movement, some moms do not even have them while in the hospital, that would be hard to enforce for our regular deliveries anyway, but some c-section moms don't have bm's that soon either. I usually start them out on crackers if they have tolerated the liquids well, then if bowel sounds are present and they are asking for food I will try the crackers and ask them to start slow. But yeah like an above poster said, if they really want food they'll send a family member out to get it!