Enemas during labour

RHL Summary

19 May 2014
In the labor ward of a hospital in Bangladesh, a doctor examines a pregnant woman before her delivery.
Photoshare/Ismail Ferdous

Findings of the review: This review aimed to evaluate whether giving enemas during the first stage of labour has any effect on infection rates (in mothers and newborns), the duration of labour, perineal wound dehiscence in the mother, perineal pain and faecal soiling. The review authors included four trials (1917 women) that had compared outcomes of administering enema versus no enema. All the trials were judged by the review authors to be of moderate quality. No difference was found between the two groups for neonatal infection (umbilical infection, respiratory infections, meningitis or sepsis), degree of perineal tear, puerperal infection rates, and mean duration of labour. There were fewer episodes of faecal soiling in the enema group. Although there was no difference in the satisfaction level with the procedure among the women in labour, labour attendants, accoucheurs and perineorrhaphy operators expressed greater satisfaction with the procedure. There were higher intrapartum infection rates in women who received an enema than those who did not.

Implementation: Giving enema during labour does not appear to improve maternal or neonatal outcomes and may not be used.


Cochrane review

Citation: Reveiz L, Gaitán HG, Cuervo LG. Enemas during labour. Cochrane Database of Systematic Review 2013, Issue 7. Art. No.: CD000330. DOI: 10.1002/14651858.CD000330.pub4.

Abstract

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 methods

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.

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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