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Routine Enema in First Stage of Labor May Prolong Delivery


 

SAN DIEGO — Routine use of an enema during the first stage of labor significantly prolonged the time to delivery in a randomized trial conducted at the Carolinas Medical Center in Charlotte, N.C.

Although routine enemas have been abandoned in many hospitals, anecdotal beliefs persist that the procedure enhances uterine stimulation, makes for a “cleaner delivery,” and reduces neonatal wound infections, Dr. Noellee T. Clarke said.

Labor and delivery nurses in some regions hold to the notion that enemas for this purpose are best administered “high and hot and a hell of a lot,” she noted following the oral presentation of her study.

To see if enemas do reduce labor time, Dr. Clarke and coinvestigator Dr. Todd R. Jenkins conducted a trial that randomized 152 women in uncomplicated early labor at their institution either to undergo an enema or to have no enema on admission. At baseline, women in the two groups were similar in terms of parity, age, and other relevant variables.

Enemas were performed using a standard protocol (1 L water plus two packets of castile soap at a mean cervical dilatation of 3.6 cm). Mean time to delivery was 505 minutes in 75 women who received enemas, vs. 393 minutes in 77 women who did not receive an enema, for a highly statistically significant difference of 112 minutes.

Intrapartum infection rates were 12.3% among patients receiving enemas and 2.7% for those receiving no enema; however, this difference lost its significance when investigators controlled for differences in duration of membrane rupture.

No differences were seen between groups in epidural use, delivery mode, or presence of meconium, she said at the annual meeting of the American College of Obstetricians and Gynecologists.

Women who underwent a routine enema had less fecal soiling at delivery, observed in 8 of 75 (11%) in the enema group vs. 23 of 77 (30%) in the group that received no enema.

Dr. Clarke said the study results were accepted by some, but not all, labor and delivery nurses on her service. “I was unpopular a little bit,” she said in response to a question following her presentation.

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