Objective: To study the rate of ileus symptoms and hospital course of women who are offered solid food shortly after cesarean delivery. Methods: This study involved women delivered by cesarean under regional anesthesia. Exclusion criteria included general anesthesia, magnesium sulfate, intra-operative bowel injury or bowel surgery, or other conditions that precluded early feeding. Early-fed women were offered regular diets within 8 hours of surgery, and controls were given nothing by mouth for 12–24 hours, advanced to clear liquids on the first postoperative day, and then given solid food on the second or third postoperative day. Results: Sixty women were assigned randomly to each method. Early-fed women received solid food sooner after surgery, 5.0 ± 1.2 hours versus 40.0 ± 10.6 hours. The incidences of mild ileus symptoms and postoperative complications were similar in both groups; however, the study did not have an adequate sample size to definitively assess safety concerns. Women in the early-fed group had shorter hospital stays (49.5 ± 12.7 hours versus 75.0 ± 12.3 hours, P < .001), and shorter time intervals from surgery to bowel movement, 34.5 hours (interquartile range 25.3–48.8) versus 51.0 (43.3–62.0) hours, P < .001. In the early-fed group, women whose operative times exceeded 40 minutes were more likely to have symptoms of mild ileus. Conclusion: Early initiation of solid food after cesarean delivery appears to be well tolerated and may be associated with a shorter hospital stay. Early-fed women whose operations exceed 40 minutes may be more likely to have mild ileus symptoms.