Gum chewing stimulates early return of bowel motility after caesarean section

Abstract

It is true that we really do not know the safest way to manage labour and delivery after obstetric fistula repair, and I am sure that some women would be good candidates for a trial of vaginal delivery postobstetric fistula repair. As Dr Harrison notes, provision of a waiting hostel for pregnant women to enable them timely access to care during labour/delivery is key.It is interesting to note that of the patients from Dr Harrison's paper, the deliveries postobstetric fistula repair had the poorest outcomes with regards to (among other parameters) 'worst fetal results'. Even with care, the results from attempted delivery can be poor.Where we work in northern Ethiopia, the delivery care in the neighbouring hospital is stretched, being under-resourced and understaffed. After consultation with all parties involved in these patients' care, it seemed that the safest option for these women in this setting was to opt for a Caesarean delivery. This was in the hope of negating the risks of delivery in an understaffed delivery setting, a possible poor fetal outcome or a reopening of the repaired fistula.I entirely agree with Dr Harrison's comment that prevention of obstetric fistula is a priority. Many organisations have safe childbirth as their aim. To that end a new foundation is being established in Australia seeking to place volunteer obstetrician and midwife teams in hospitals in Ethiopia to train the local staff in safe emergency obstetric care. In areas where there is no access to health services, then to build a three-tiered obstetric care 'network'. The first tier being with trained and equipped birth attendants in the villages delivering low risk women to the second or third tier to await their deliveries. The second tier consists of waiting areas and delivery posts equipped to deal with intermediate deliveries but in radio and ambulance contact to the third tier, consisting of a fully functioning maternity hospital.Construction of a pilot network is underway and we hope to have it functioning early next year. We hope to have one such network for every 500 000 population, so that 1 day all women can have access to medical care during labour if needed. This of course has to be coupled with education for people to access these services, but the aim is hopefully 1 day to see obstetric fistula as a thing of the past. j Gum chewing stimulates early return of bowel motility after caesarean section Sir, Simple, obvious and cheap solutions to common problems are always welcome. However, despite this trial of chewing gum and bowel motility following caesarean section 1 being registered with the international database of clinical trials, no mention is made in the methodology as to the ingredients of the substance administered for medicinal purposes, which in this case is chewing gum. Many so-called 'sugar free' chewing gums contain substances such as sorbitol that are known to cause diarrhoea.2 The authors only briefly suggest that the beneficial effect of the gum resulted from a physiological 'cephalic-vagal mechanism', a...

The Effect of Gum Chewing, Early Oral Hydration, and Early Mobilization on Intestinal Motility After Cesarean Birth

“…Abd‐el Maeboud et al. () also investigated the effect of gum chewing after cesarean birth on intestinal functions and found no complication due to chewing gum, similar to our study. Malhotra et al.…”

“…Bowel sounds after cesarean section were heard 7.89 ± 1.20 hours later on average in the first group where all three interventions (gum chewing, early oral hydration, and early mobilization) were used and 16.00 ± 1.69 later in the control group in our study (Table , Figure ). Abd‐el Maeboud, Ibrahim, Shalaby, and Fikry () reported a duration of 10.9 hours in the gum chewing group and 15.6 hours in the control group for the return of intestinal motility sounds after cesarean section. Malhotra, Khanna, Pasrija, Jain, and Agarwala () reported intestinal motility sound to return 7.73 hours on average after cesarean section in the group provided early oral hydration although the time in the control group was 11.54 hours.…”

Effects of gum chewing on postoperative bowel motility after caesarean section: a meta‐analysis of randomised controlled trials

“…had overlapping populations; two of these studies were excluded from the meta‐analysis and only the remaining study, with the most extensive data, was used for this review. Finally, six RCTs including 939 women met the inclusion criteria for this review (455 women allocated to the gum chewing group and 484 allocated to no gum chewing). The characteristics of included RCTs are summarised in Table .…”

“…The method of randomisation was unclear in one trial . The randomisation allocation concealment was adequately stated in only two trials . Blinding was evaluated separately for women and outcome assessors.…”

Gum chewing promotes bowel motility after a radical retropubic prostatectomy

“…Gum chewing was found to be associated with the rapid resumption of intestinal motility and a short hospital stay after a cesarean section (a non‐bowel‐related surgery) . The data showed a beneficial effect of gum chewing in terms of passage of flatus (17.9 vs 24.4 h), first bowel movement (21.1 vs 30 h) and discharge from the hospital (40.8 vs 50.5 h), compared with the control.…”