Posted on February 20, 2017
Beverley’s blog ‘Chewing gum could be the key to a timely discharge home for mothers giving birth by caesarean section’ was the runner-up in our 2017 Cochrane UK & Ireland Symposium competition. See here for more information about what the entrants were asked to do. Her blog is written in the style of a Daily Mail news article.
The global chewing gum market has been a little ‘sticky’ over recent years with sales stagnating between 2010-2014. However due to the growth of sales in sugar free gum to prevent dental caries, the future for this socially ostracized stick is starting to brighten. To add to this change in fortune, new research suggests it’s not only dentists who proclaim the virtues of this minty chew, pregnant mothers are being advised to add a packet to their hospital bags.
Caesarean sections are reported to be the most common type of surgical procedure performed throughout the world. In England, just over one quarter of women have their babies delivered by this method. However, despite medical advances, many women undergoing caesarean section experience a temporary loss of bowel function, a side effect known as a paralytic ileus. Such loss of bowel function causes pain, increases the need for medication and prolongs hospital admission. Thus, both mothers and NHS managers would welcome an affordable and easy-to-use treatment.
According to a recent Cochrane publication, this easy treatment could already be available in a confectionary form. Edna Pereira Gomes Morais and colleagues in Sau Paulo, Brazil, examined 17 studies where chewing gum had been given to mothers who had delivered by caesarean section. The reviewers found that mothers, who chewed gum immediately and up to 12 hours following surgery, resumed normal bowel function around 9 hours sooner than their non-chewing counterparts. Consequently, the ‘chewing gum mums’ were discharged home significantly quicker than those who didn’t join the masticating masses. It is likely that the action of chewing causes the bowel to start moving. However, the evidence reviewed was graded as low quality since there was no way of producing a chewing gum placebo.
More positively, researchers did not identify any negative side effects to chewing gum post caesarean section. Additionally, researchers were unable to conclude how much chewing gum should be chewed, or when and for how long following surgery. Despite this, the benefits of a very low risk, low cost intervention such as chewing gum could be significant, since early restoration of bowel function enables new mothers to start eating earlier and spend less time in hospital, reducing infection risk and care cost.
A spokesperson for the Royal College of Midwives told the Daily Mail ‘we are excited to learn that a simple, low risk, low cost, therapeutic intervention such as chewing gum could have such positive effects. A safe and timely discharge is essential in the provision of high quality care for mothers and their newborn babies. The results of this review provide the basis and impetus for future research regarding bowel function recovery following caesarean section’.
Morais and colleagues undertook the review as part of a Cochrane Collaboration working group. The Cochrane Collaboration for Systematic Reviews is a revered, international organisation that sets strict standards and criteria for the collection and examination of research evidence from multiple medical trials, to assess effectiveness of treatments. Looking through Cochrane’s extensive Database, surprisingly, the Brazilian team was not the first to consider chewing gum as adjunct to medical therapy. Nineteen Cochrane Reviews evaluating the effectiveness of chewing gum have been published since 2008. These reviews suggest that chewing gum could be a ‘novel therapy’ for the current era. Amongst the studies published, chewing gum has been shown to aid digestive recovery following bowel surgery in adults; prevent ear infections in small children; support smoking cessation and prevent dental carries.
Whilst experts can’t agree on the amount and frequency of gum chewing required for therapeutic benefit, there is one thing we can be sure of: chewing gum sales will continue to rise throughout this decade and city council cleaning teams may rue the day the benefits of this rubbery menace were identified.