Women's First Gastrointestinal Activation Post-elective Cesarean Birth During Post-partum Hospitalization:A Comparison of Paula Method (the Circular Exercises Method) to Standard Care
Phase: NA
Conditions: Bowel Dysfunction
Sponsor: Hadassah Medical Organization

 
 
 
 
 
 
 
 
 
 
 
Women's First Gastrointestinal Activation Post-elective Cesarean Birth During Post-
partum Hospitalization: A Comparison of Paula Method (the Circular Exercises 
Method) to Standard Care   
 
NCT03761147 
 
Document Date: August 7, 2017 
 

Protocol 
Caesarean section births constitute a significant percentage of all births in the 
western world and since the 1980s, there has been a constant rise. Caesarean 
section births can be associated with various post-operative complications, including 
poor peristalsis. In the hospital where this study was performed, the main treatment 
to accelerate post-operative bowel movement include early water drinking, early 
ambulation, and the use of laxatives. In this study these modalities are defined as 
the standard therapy. 
Since the standard methods are not always effective and not suitable for all women 
who underwent a Caesarean delivery, there is a need for finding alternative 
treatments to accelerate bowel function. The method examined in this study is 
called ''the Paula method for the training of ring muscles''. According to this method, 
the contracting and releasing of the one ring muscle causes other involuntary ring 
muscles to be activated as well, including intestinal system muscles.  
The purpose of this study is to examine the effectiveness of the Paula Method 
compared with the standard treatment offered to women after elective Caesarean 
delivery. In our study, gastrointestinal activation was defined as the initial 
appearance of intestinal sounds, first flatus passage and first defecation after the 
surgery.  
This is randomized controlled clinical study examined the effectiveness of 
performing training according to the “Paula Method” to accelerate gastrointestinal 
activity in women after elective Caesarean section, compared with the standard 
treatment. The study included 64 women following elective Caesarean section 

performed under regional anesthesia. The participants were randomized on a 1:1 
basis into a training group and a control group after signing the informed consent 
document. The women in the training group performed ring muscle training 
according to the Paula Method five minutes of exercise six times a day and those in 
the control group were treated with the standard protocol. During the experiment, 
data was collected on the timing of appearing the first bowel sounds, first flatus 
passage and first defecation after surgery. In addition, demographic data as well 
information regarding pain medications used during the hospitalization and course 
of the admission were collected. 
All data collected during the study were analyzed using SPSS software. With the help 
of the software, an analysis of the demographics and health of the sample was 
performed. In addition, the mean time and standard deviations of first bowel 
sounds, first flatus passage and first defecation after surgery were obtained from the 
analysis, as well as frequency of postoperative complications in each group and 
other data. Based on these data, conclusions were drawn about the efficacy of the 
two intervention methods studied in this study in the operation of the 
gastrointestinal tract after cesarean section. The effect of taking different types of 
pain medication on the duration of hospitalization in both groups was examined 
using the Pearson correlation and the results were confirmed by T-test. 
 
 
 

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