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Audit of an early feeding program after Cesarean delivery: patient wellbeing is increased

[Audit d’un programme d’alimentation précoce post-césarienne : bien-être accru des patientes]

Dan Benhamou, MD^*, Monika Técsy, MD^*, Nicholas Parry, MD^*, Fréderic J. Mercier, MD^* and Colette Burg

^* From the Department of Anesthesia Intensive Care and the Nutrition Service,
Assistance Publique- Hôpitaux de Paris Hôpital Antoine Béclère Clamart France.

Pr. Dan Benhamou, Department of Anesthesia and Intensive Care, Assistance Publique-Hôpitaux de Paris, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92141 Clamart cedex, France. Phone: 33-1-45-37-42-73 or 43-35; Fax: 33-1-45-37-49-85; E-mail: dan.benhamou{at}bct.ap-hop-paris.fr

Purpose: Early feeding is well tolerated after Cesarean delivery. However, patient wellbeing and nurses’ attitudes toward implementation of early feeding have rarely been investigated.

Methods: A quality-assurance program of 18 months duration was implemented because evaluation of traditional practice demonstrated significant deficiencies (phase I). Drinking was then allowed within one hour and feeding within six to eight hours after delivery. Gradual dietary expansion followed according to a detailed program. Three consecutive evaluations (phase II–IV) were performed: 1) to measure implementation by the ward nurses; 2) to record the type of food and the volume of water effectively received; 3) to evaluate patients’ gastrointestinal tolerance and patients’ levels of hunger and thirst and patients’ overall satisfaction.

Results: In phase I, 60% of patients received nothing by mouth and 28% received only water on the day of surgery (D0). Moderate or severe hunger and thirst were seen in a large portion of these patients (D0, hunger: 38%, thirst: 63%, D1, hunger: 40%, thirst: 28%). Introduction of the program significantly improved patient wellbeing as well as patient satisfaction. No side effects were encountered.

Conclusion: Hunger and thirst are frequently encountered after Cesarean delivery when patients are allowed to eat only after return of the first flatus. By using a quality-assurance program, it was possible to reduce the incidence and the severity of these distressing symptoms and to improve patients’ satisfaction while no side effects were encountered. These beneficial effects were maintained in phase IV suggesting a high acceptance rate from the nursing staff.