Friday, December 12, 2014

Honey for Cesarean Wound Healing?

We've discussed honey for wound healing before, and specifically for cesarean wound healing.

We talked about the mechanics of how honey (medical grade honey, not supermarket honeymight help healing and what studies there were on the topic.

As one review notes:
Honey has anti-oxidant, anti-bacterial and anti-inflammatory properties. It can be used as a wound dressing to promote rapid and improved healing. These effects are due to honey's anti-bacterial action, secondary to its high acidity, osmotic effect, anti-oxidant content and hydrogen peroxide content. The use of honey leads to improved wound healing in acute cases, pain relief in burn patients and decreased inflammatory response in such patients...There is biological plausibility.
Mixed Results

While honey has "biological plausibility" as a healing agent, results from use of medical grade honey have been encouraging in some situations and discouraging in others. Results were not very good for venous ulcers, for example, but on some wounds there are better results.

A recent Cochrane review found decidedly mixed results, depending on what type of wound was being studied, and cautioned against its routine use until more data is available. So it's hard to know just how useful medical grade honey really is, and how much is just hype.

The problem is that much of the honey-based research is sponsored by the companies that make medical-grade honey, so the results are at high risk for bias.

Bottom line.....better data is needed. But given the positive results in some studies and its relatively low cost, why haven't there been more well-controlled studies done by independent groups by now?

Medical-Grade Honey for Cesarean Healing

Sadly, there's not a lot of data on using honey for cesarean wound healing. There are a couple of older studies done in third-world countries, but they had small data sets and uncontrolled conditions. As a result, using medical honey on a cesarean wound has not been been embraced in Western countries.

Now there's a new study on the use of honey for abdominal wound healing after cesarean. The data set is still very small and still from a third-world country, but at least the study design is randomized and blinded. The results from this study were encouraging.

This doesn't prove honey is a healing agent of choice for cesarean wounds, but it certainly points to the need for bigger and better studies to further examine the question. 

I would particularly like to see medical-grade honey investigated in the treatment of cesarean wound infections of "obese" women (who are substantially more at-risk for wound infection than other women).

About 15-30% of high-BMI women will experience a wound infection after a cesarean, and sometimes these infections last for months. Wound infections like this can be devastating to a new mother, can interfere with breastfeeding, and are costly to treat.

Many cesarean wound infections in obese women can likely be lowered by using more appropriate dosages of antibiotics, but medical grade honey might give another weapon in the arsenal against infections in this group of women.

Of course, the best treatment is prevention of the cesareans in the first place whenever possible, which is why the 40-80% cesarean rate in "morbidly" and "super obese" women is so completely unacceptable.

But sometimes cesareans truly are necessary. When cesareans do occur in this group of women, more tools are needed to help prevent or treat the wound infections that will result in some of them.

Medical-grade honey might be yet another tool in the toolbox for this situation. And it's past time for Western medicine to investigate this possibility more thoroughly.


Oman Med J. 2014 Jul;29(4):255-9. doi: 10.5001/omj.2014.68. The effect of honey gel on abdominal wound healing in cesarean section: a triple blind randomized clinical trial. Nikpour M1, Shirvani MA2, Azadbakht M3, Zanjani R4, Mousavi E5. PMID: 25170405
OBJECTIVE: To assess whether honey can accelerate the wound healing in women undergoing cesarean section. METHODS: This was a triple blinded randomized prospective clinical trial. Women with cesarean section were randomly designated as drug (37 cases) and placebo (38 cases) groups. The drug group received local honey gel 25% while the placebo group received similar free-honey gel on abdominal cesarean incision twice a day for 14 days. REEDA scale (Redness, Edema, Ecchymosis, Discharge and Approximation of wound edges) was used to assess wound healing. RESULTS: The mean REEDA was 2.27 ± 2.46 and 3.91 ± 2.74 (p=0.008) on the 7(th) day and 0.47 ± 0.84 and 1.59± 1.95 (p=0.002) on the 14(th) day for the drug and placebo groups, respectively. Redness, edema and hematoma in the drug group were significantly lower on the 7(th) and 14(th) days. CONCLUSION: Honey was effective in healing the cesarean section incision. Using topical honey is suggested as a natural product with rare side effects in order to reduce the complications of cesarean wounds.

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