Enemas during labour

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.