Enemas during labour

  • Review
  • Intervention

Authors

  • Ludovic Reveiz,

    Corresponding author
    1. Health Systems Based on Primary Health Care (HSS), Pan American Health Organization, Research Promotion and Development Team, Washington DC, USA
    • Ludovic Reveiz, Research Promotion and Development Team, Health Systems Based on Primary Health Care (HSS), Pan American Health Organization, 525, 23rd St, NW, Washington DC, 20037-2895, USA. mmreveiz@hotmail.com. lreveiz@yahoo.com.

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  • Hernando G Gaitán,

    1. National University of Colombia, Department of Obstetrics & Gynecology and Clinical Research Institute, Faculty of Medicine, Bogota, Colombia
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  • Luis Gabriel Cuervo

    1. Pan American Health Organization (PAHO/WHO), Research Promotion Team and Development, Washington DC, USA
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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 (17 May 2012), the Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effectiveness (The Cochrane Library 2012, Issue 5), PubMed (1966 to 17 May 2012), LILACS (17 May 2012), the Search Portal of the International Clinical Trials Registry Platform (ICTRP) (17 May 2012), Health Technology Assessment Program, UK (17 May 2012), Medical Research Council, UK (17 May 2012), The Wellcome Trust, UK (17 May 2012) 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.

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 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.

Laički sažetak

Klistir u porođaju

Znanstveni dokazi ne podupiru rutinsko korištenje klistira u prvom stadiju porođaja.

Davanje klistira ženama u prvim stadijima porođaja je rutinska procedura u rodilištima diljem svijeta. Povremeno žene otpuštaju stolicu dok rađaju te je zbog toga prevladalo mišljenje da bi klistir, u prvim stadijima porođaja, smanjio učestalost te pojave te neugodu žena kojima se to dogodi. Mišljenje je također bilo da pražnjenje crijeva daje djetetu više mjesta za porod te smanjuje mogućnost infekcije za majku i dijete. Nadalje, mišljenje je bilo da taj postupak smanjuje broj stolica nakon porođaja koje često ženama stvaraju poteškoće. Negativne strane klistira su činjenica da je to jako neugodan postupak koji uzrokuje bol ženama u trudovima te može uzrokovati vodenastu stolicu u porođaju, što može povećati rizik od infekcija. Ovaj pregled literature obuhvatio je četiri studije sa 1917 žena. Nije bilo znatnih razlika ni u kojem ishodu porođaja kako za žene tako i za djecu. No, ni jedna studija nije istraživala bol žene u trudovima te nije bilo dovoljno informacija kako bi se usporedili rijetki loši ishodi. Stoga dokazi govore protiv rutinskog korištenja klistira u porođaju.

Bilješke prijevoda

Prevoditelj:: Croatian Branch of the Italian Cochrane Centre
Prijevod financira:: Ministry of Education, Science and Sports

Ancillary