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Enemas during labourReveiz L, Gaitán HG, Cuervo LG
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SummaryEnemas during labourEvidence does not support use of enemas in labour. Giving women enemas during labour has been routine practice in many countries for a number of years. 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. Also that an enema could produce a watery faecal soiling whilst giving birth, which might increase the risk of infection. The review identified three studies involving 1765 women. The evidence showed 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 was insufficient data to assess rare adverse outcomes. Thus the evidence does not support the routine use of enemas during labour.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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January 25. 1999 AbstractBackgroundThe use of enemas during labour usually reflects the preference of the attending healthcare provider. However, enemas may cause discomfort for women and increase the costs of delivery. ObjectivesTo assess the effects of enemas applied during the first stage of labour on infection rates in mothers and newborns, duration of labour, perineal wound dehiscence in the mother, perineal pain and faecal soiling. Search strategyWe searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2007), PubMed (1966 to December 2006), the Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effectiveness (The Cochrane Library 2006, Issue 4), clinical trials registers (December 2006) and reference lists of articles. Selection criteriaRandomized 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 analysisTwo review authors assessed studies for inclusion independently. Main resultsThree RCTs (1765 women) met the inclusion criteria. Meta-analysis revealed no significant differences for infection rates in puerperal women (2 RCTs; 594 women; relative risk (RR) 0.66, 95% CI 0.42 to 1.04) or newborn children (1 RCT; 370 newborns; RR 1.12, 95% CI 0.76 to 1.67) after one month of follow up. No significant differences were found in the incidence of lower or upper respiratory tract infections. One trial described labour to be significantly shorter with enema versus no enema (1 RCT, 1027 women; 409.4 minutes versus 459.8 minutes; weighted mean difference (WMD) -50,40 CI 95% -75.68 to -25.12; P < 0.001), but another, adjusted for parity, did not confirm this (median 515 minutes with enemas versus 585 minutes without enemas, P = 0.24). Two trials found no significant differences in neonatal umbilical infection (2 RCTs; 592 newborns; RR 3.16 95% CI 0.50 to 19.82). The one trial that researched women's views found no significant differences in satisfaction between groups. Authors' conclusionsThe evidence provided by the three included RCTs shows that enemas do not have a significant effect on infection rates such as perineal wound infection or other neonatal infections and women's satisfaction. This evidence does not support the routine use of enemas during labour; therefore, such practice should be discouraged. |