Enemas during labour

Scientific research evidence does not support the routine use of enemas during the first stage of labour.

Giving women enemas during labour has been routine practice in delivery wards of many countries and settings. Occasionally women leak from their back passage whilst giving birth and it was thought an enema in early labour would reduce this soiling and the consequent embarrassment for women. It was also thought that emptying the back passage would give more room for the baby to be born, would reduce the length of labour and would reduce the chance of infection for both the mother and the baby. It was also suggested it would reduce bowel movements after birth which often cause women concern. The disadvantages suggested were that it is a very unpleasant procedure and causes increased pain for women during labour and because enemas could produce a watery faecal soiling whilst giving birth, they could potentially increase the risk of infections. The review identified four studies involving 1917 women. These studies found no significant differences in any of the outcomes assessed either for the woman or the baby. However, none of the trials assessed pain for the woman during labour and there were insufficient data to assess rare adverse outcomes. Thus the evidence speaks against the routine use of enemas during labour.

Authors' conclusions: 

The evidence provided by the four included RCTs shows that enemas do not have a significant beneficial effect on infection rates such as perineal wound infection or other neonatal infections and women's satisfaction. These findings speak against the routine use of enemas during labour, therefore, such practice should be discouraged.

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Background: 

Although the use of enemas during labour usually reflects the preference of the attending healthcare provider, enemas may cause discomfort for women.

Objectives: 

To assess the effects of enemas applied during the first stage of labour on maternal and neonatal outcomes.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2013), the Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effectiveness (The Cochrane Library 2013, Issue 5), PubMed (1966 to 31 May 2013), LILACS (31 May 2013), the Search Portal of the International Clinical Trials Registry Platform (ICTRP) (31 May 2013), Health Technology Assessment Program, UK (31 May 2013), Medical Research Council, UK (31 May 2013), The Wellcome Trust, UK (31 May 2013) and reference lists of retrieved articles.

Selection criteria: 

Randomised controlled trials (RCTs) in which an enema was administered during the first stage of labour and which included assessment of possible neonatal or puerperal morbidity or mortality.

Data collection and analysis: 

Two review authors independently assessed studies for inclusion. 

Main results: 

Four RCTs (1917 women) met the inclusion criteria. One study was judged as having a low risk of bias. In the meta-analysis we conducted of two trials, we found no significant difference in infection rates for puerperal women (two RCTs; 594 women; risk ratio (RR) 0.66, 95% confidence (CI) 0.42 to 1.04). No significant differences were found in neonatal umbilical infection rates (two RCTs; 592 women; RR 3.16, 95% CI 0.50 to 19.82; I² 0%. In addition, meta-analysis of two studies found that there were no significant differences in the degree of perineal tear between groups. Finally, meta-analysis of two trials found no significant differences in the mean duration of labour.

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