Enemas during labour

 

Abstract

Background

The 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.

Objectives

To 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 methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2010), the Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effectiveness (The Cochrane Library 2010, Issue 1), PubMed (1966 to 16 February 2010), clinical trials registers (February 2010) and reference lists of articles.

Selection criteria

Randomized 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 assessed studies for inclusion independently. 

Main results

Four RCTs (1917 women) met the inclusion criteria; one was judged as having a low risk of bias. We conducted a meta-analysis and found no significant differences for infection rates in puerperal women (two RCTs; 594 women; risk ratio (RR) 0.66, 95% CI 0.42 to 1.04) or newborn children (one 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 neonatal lower or upper respiratory tract infections. One RCT described labour to be significantly shorter with enema versus no enema (one RCT, 1027 women; 409.4 minutes versus 459.8 minutes; mean difference (MD) -50.40, CI 95% -75.68 to -25.12; P < 0.001). A second RCT found that the mean times to delivery were 504.7 minutes and 392.7 minutes for enema and no enema respectively (152 women; MD 112, 95% CI 48.13 to 175.87). However, no significant differences in the duration of labour were found in the third RCT that scored as having a low risk of bias and was adjusted for parity (median 515 minutes with enemas versus 585 minutes without enemas, P = 0.24). We found no significant differences in neonatal umbilical infection (two RCTs; 592 newborns; RR 3.16, 95% CI 0.50 to 19.82). The one RCT that researched women's views found no significant differences in satisfaction between groups.

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.

 

Plain language summary

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 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.

 

摘要

背景

生產時灌腸

生產時使用灌腸，一般反映出的是健康照護提供者的偏好，不過，灌腸可能會引起不適，且增加生產之費用

目標

評估第1階段產程時灌腸，對於母親和新生兒感染之、產程之時間、母親會陰傷口裂開、會陰疼痛和糞便污染的影響

搜尋策略

我們搜尋 Cochrane Pregnancy和Childbirth Group's Trials Register (2007年3月)、 PubMed (1966年2006年12月)、Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effectiveness (The Cochrane Library 2006, Issue 4)、clinical trials registers (2006年12月)和文獻的參考資料

選擇標準

第1階段產程時灌腸、評估可能會導致新生兒或產婦的罹病或死亡的隨機控制試驗(Randomized controlled trials (RCTs))

資料收集與分析

2位回顧作者獨立評估納入的研究

主要結論

納入3篇隨機控制試驗(1765名婦女)。統合分析發現，追蹤1個月之後，分娩所致的母親感染率(2篇隨機控制試驗；594名婦女；RR為0.66, 95% CI為0.42 – 1.04)或新生兒感染率(1篇隨機控制試驗；370名新生兒；RR為1.12, 95% CI為0.76 – 1.67)都沒有顯著差異。上呼吸道或下呼吸道感染也沒有顯著差異。有一篇試驗提及，灌腸組的產程比無灌腸組顯著縮短(1篇隨機控制試驗；1027名婦女；409.4分鐘相較於459.8分鐘；加權平均差異(weighted mean difference (WMD))為 −50,40 CI 為95% −75.68 至 −25.12; P < 0.001)，但是另一篇試驗加以校正類比後，未能確認此差異(灌腸組中位數為515分鐘、無灌腸組為585分鐘， 0.24)。2篇試驗發現，新生兒肚臍感染沒有顯著差異(2篇隨機控制試驗；592名新生兒；RR為3.1 5% CI 為0.50 – 19.82)。1篇研究探討母親的觀點，發現滿意度之間沒有顯著差異

作者結論

3篇隨機控制試驗的證據顯示，灌腸對感染率沒有顯著影響，例如會陰傷口或其他新生兒感染，婦女的滿意度也是。證據並不支持生產時例行性使用灌腸；因此，不應鼓勵這類實務

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

證據並不支持生產時使用灌腸。在許多國家，生產時使用灌腸已經行之有年。偶爾，婦女在生產時會解便，因此認為在生產前灌腸可以減少此一污染，以及減輕婦女的困窘。也有人認為先解便排空有助於增加胎兒的生產時的空間，進而可減少產程和減少母嬰感染機會。還有人認為，灌腸會減少產後腸道蠕動，這是產婦經常會關心的。灌腸的缺點可能包括，這是相當不悅的過程，會增加婦女生產時的疼痛，而且，灌腸會在生產時造成水便污染，可能會增加感染風險。本回顧納入了3篇研究、1765名婦女。證據顯示，對母親和嬰兒來說，評估的結果都沒有顯著差異，不過，並無試驗評估婦女在生產時的疼痛，也沒有足夠資料評估罕見的副作用。因此，證據並不支持生產時例行性使用灌腸