Routine use of enema during labor discouraged

NEW YORK (Reuters Health) - The use of an enema during labor does not reduce the rate of wound infections in the mother or infections in the infant, and also does not appear to result in a better labor experience for the mother, the findings from a new study review indicate.

In the mother, the area most likely to be damaged is the perineum, the space between the opening of the vagina and the anus. During labor it may be torn or the physician can perform an episiotomy, a surgical cut to widen the outlet of the birth canal to avoid tearing as the baby is delivered.

Despite being a common medical practice, the actual benefits of using an enema during labor are unclear and it may increase the mother's discomfort as well as medical costs, according to a report published online in The Cochrane Library.

Dr. Ludovic Reveiz, from the Research Institute of the Fundacion Universitaria Sanitas in Bogota, Columbia, and colleagues searched various databases, including the Cochrane childbirth registry, PubMed, and other sources to identify studies that evaluated the benefits of enema use during the first stage of labor. Three studies that used control measures and randomized methods, involving a total of 1,765 women, were included in the meta-analysis.

As noted, no significant differences in the rates of perineal wound infections and infant infections were seen between women who were given enemas and those who were not, the report indicates. Likewise, enema use had no impact on the rate of respiratory tract infections in the infant.

The data from one trial suggested that enema use may shorten the duration of labor, but another study, which considered whether it was the woman's first delivery or if she had given birth before, refuted that finding.

One of the studies evaluated the impact of an enema on a woman's satisfaction with the labor process; no apparent benefit was seen.

"This evidence does not support the routine use of enemas during labor, and consequently the practice of routinely giving them should be discouraged," Reveiz concluded in statement.

SOURCE: The Cochrane Library, October 17, 2007.