A Randomized Controlled Trial of Paula Method Versus Gum Chewing for Gastrointestinal Reactivation After Cesarean Delivery

Background/Objective: Women after cesarean delivery (CD) may feel discomfort and pain until the gastrointestinal (GI) activation. Standard care approaches following an elective cesarean delivery often fail to address the needs of patients. Nurses care for women after CD, managing their symptoms and promoting GI activity to prevent ileus. Randomized controlled trials (RCTs) have shown that gum chewing is an effective method compared to standard care. Additionally, pilot RCTs have found Paula method exercises to be beneficial in comparison to standard care. This study aims to compare the time of first flatus and first defecation between the Paula method group and the gum-chewing group in women after an elective CD. Methods: A randomized controlled trial was conducted with 90 women; forty-four women were randomized to the Paula method exercises, and forty-six to gum chewing. Both groups received standard care. The primary outcomes were the time to the passage of the first flatus and the time to the first defecation from the delivery. Results: There was no significant difference between groups in time to flatus or time to defecation, yet there was a median 8.2 h shortening of time to flatus in the Paula group (19.7 h [IQR 15.7–28.3] in the Paula group versus 27.9 h [IQR 17.6–38.2] in the gum-chewing group). In an exploratory analysis of the first 16 h post-cesarean delivery, the gum-chewing group showed a shorter time to passage of the first flatus compared to the Paula group. Conclusions: Gum chewing is recommended as part of the current guidelines to enhance recovery after surgery, yet it is not suitable for all. While the Paula method appears safe and demonstrates promise, definitive conclusions require validation from larger, adequately powered trials.