Almost 20% of pregnant women will have a caesarean section in the Netherlands. So the chances of you getting a caesarean section are quite high - even though that may not be great to hear. We know from other research on surgeries that having enough carbohydrates in your body can help your recovery. Sugar, a simple carbohydrate, is absorbed quickly, so you can take it just before an operation. Yes you read correctly, sugar helps to prepare your body for a caesarean section!
Should you fast before your c-section?
The general advice is not to eat anything for 8 hours before an operation. Between 8 and 2 hours, clear liquids are allowed. Such as water and lemonade (according to my hospital leaflet). If there is food in your stomach, you have a chance of it entering your lungs during the operation. This is called aspiration and leads to a nasty pneumonia that can even kill you. Aspiration is a particular risk if you are given a general anaesthetic. You will then be on a ventilator. But most caesarean sections are done with an epidural, where the risk of aspiration is almost zero.
What exactly is the risk of aspiration? In a study where 50% of caesarean sections were done under general anaesthesia (a bizarrely high number), only 1 in 11,345 women had aspiration pneumonia[1]. Very rare, in other words. In fact, in a recent scientific review article, there is no evidence at all that fasting prevents aspiration[2]! In recent years, changes in practice have also ensured that the risk of aspiration pneumonia has decreased tremendously.
"Fasting has disadvantages for your recovery and breastfeeding"
Fasting has its drawbacks. You go into surgery hungry, resulting in low blood sugar. This in turn can cause nausea, an increase in anxiousness and it affects your recovery and the start of breastfeeding. Often, you may have to wait even longer. After all, an emergency caesarean section takes priority. That happened to Lisa. She was due for surgery at 8 am and had been fasting all night. In the morning, she had only drunk a glass of water. It took until 3pm before it was her turn. In the meantime, she was only allowed to suck on ice cubes.
So you can see how strictly clinical practice deals with this extremely rare risk. For years, women were even advised not to eat anything during childbirth because of the risk of an unplanned caesarean section. A chance that may be increased precisely because you are not allowed to eat anything. Picture it this way: you are not allowed to eat anything, your energy reserves run out, you are exhausted and then the Caesarean section comes around the corner. How convenient that you didn't eat anything! Thankfully, this advice has been abandoned.
The benefits of sugar in preparing your body for a caesarean section
In recent years, most women have been told by anaesthetists to have a sugary drink two hours before the Caesarean section. Researchers have figured out that if you drink a drink containing 100 grams of sugar 8 hours before a major operation and another drink containing 50 grams of sugar 2 hours before, you can go home a day earlier[3]. So you recover a lot faster!
You absorb sugar much faster than carbohydrates like bread or potatoes. After half an hour, it is usually completely out of your stomach. In pregnant women, this is no different. Less research has been done in caesarean sections, but there is evidence that these so-called 'pre-operative carbohydrates' help with[4]:
- Less hunger and thirst before surgery
- It's easier to keep warm during surgery
- You produce colostrum sooner
- Your baby will be breastfed earlier, more often and longer (read here more on nutrition and breastfeeding)
- You have less blood loss
- You can go home earlier
- You have less insulin resistance (Yes really! How that works? Probably because eating sugar lowers stress hormones)
My experience with sugar in preparation for a caesarean section
Why choose an artificial sugar drink when you can also choose fruit juice, with vitamins, minerals and flavonoids? For my caesarean section (which I had because of a placenta praevia), I chose grape juice. Grape juice contains a whopping 18 grams of sugar per 100 ml. The night before the operation, I drank 600 ml of dark grape juice (108 grams of sugar). In the morning, I took another 400 ml of white grape juice (72 grams of sugar).
I did not experience any hunger or thirst at all, I felt calm leading up to the caesarean section and I had a cesarean section that went well with little blood loss. Breastfeeding also came on incredibly well, despite missing the golden hour. The only downside to this large amount of juice was that it gave me heartburn. Incidentally, that disappeared immediately after I was given Zofran (ondansetron), a standard anti-nausea medicine you get during a caesarean section.
If the planned caesarean runs out...
Suppose you are fasting, but the planned caesarean section is postponed. Another woman before you, often means waiting an hour or more. If juice is usually out of your stomach within half an hour, you might reason that you can have another glass of juice at that point. Discuss it with the anaesthesiologist!
Conclusion
- Consider drinking two glasses of juice (grape juice or apple juice, for example) 2 hours before the caesarean section and optionally also 3 glasses the night before the caesarean section.
- If your labour starts naturally, you can drink juice between contractions. The popular coconut water has only 5g of sugar per 100ml, which is low.
- This is not medical advice; discuss it with your gynaecologist and anaesthesiologist.
Want to read more? Then check out my other articles.
References
[1] Binyamin Y, Orbach-Zinger S, Ioscovich A, Reina YY, Bichovsky Y, Gruzman I, Zlotnik A, Brotfain E. Incidence and clinical impact of aspiration during cesarean delivery: A multi-centre retrospective study. Anaesth Crit Care Pain Med. 2024 Apr;43(2):101347. doi: 10.1016/j.accpm.2024.101347. Epub 2024 Jan 24. PMID: 38278356.
[2] Lam S, Cannesson MP, Osuna-Garcia A, Livingston EH. No association between preprocedural fasting and witnessed pulmonary aspiration: A systematic review and meta-analysis. Surgery. 2025 Aug;184:109483. doi: 10.1016/j.surg.2025.109483. Epub 2025 Jun 11. PMID: 40505193.
[3] Sebestyén AR, Turan C, Szemere A, Virág M, Ocskay K, Dembrovszky F, Szabó L, Hegyi P, Engh MA, Molnár Z. Preoperative carbohydrate loading reduces length of stay after major elective, non-cardiac surgery when compared to fasting: a systematic review and meta-analysis. Sci Rep. 2025 May 31;15(1):19119. doi: 10.1038/s41598-025-00767-z. PMID: 40450020; PMCID: PMC12126546.
[4] Cheng Y, Lu Y, Liu H, Yang C. The effect of preoperative oral carbohydrate on the time to colostrum and amount of vaginal bleeding after elective cesarean section. J Obstet Gynaecol Res. 2022 Oct;48(10):2534-2540. doi: 10.1111/jog.15375. Epub 2022 Jul 26. PMID: 35882375.
