Enema During Labor - Everything You Need To Know

Enema During Labor

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A common embarrassing situation that many pregnant women talk about is the chance of an accidental ‘poop’ spill while pushing during labor.

Many women find that they begin labor with a slightly upset stomach which has them going to the loo several times. This is nature’s way of emptying the bowel ready for labor. If this doesn’t happen to you and you are concerned, make a point of emptying your bowels in early labor. When you get to hospital, if you feel that your bowels are full and uncomfortable, then you can opt for an enema.

What Is Enema During Labor?

Enema is a fluid injected into the rectum of pregnant women in order to clear out their bowels before the onset of labor.

The rectal area is easily influenced and stimulated by the force on the abdominal muscles and there is no telling what is going to happen if the bowels are not already cleared out.

Why Enema During Labor:

Though not very prevalent these days, enema in labor is still a common practice in many government and private hospitals. This is possibly because of the healthcare professionals who support use of enemas because they believe that:

Enema During Labor

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  • Enema helps in a clean delivery
  • The infection rates are reduced with the reduced risk of contamination with feces.
  • Earlier it was believed that the mother would have more room for the baby to be born if the back passage is cleared.
  • Enema is believed to make labor shorter.
  • Passing a large bowel movement soon after delivery may cause discomfort or an episiotomy wound to start to come apart.
  • It’s a good thing to clean the bowels.
  • Enema before labor will reduce the bowel movement after birth.

However, most of these claims are not by scientific studies except that the mother does not accidentally pass stools during labor and that the digestive tract is cleared before delivery.

Some studies indicate that the use of an enema does not:

  • shorten labor
  • lessen or increase the infection rates for mothers or babies
  • ensure that an episiotomy wound doesn’t break when a large bowel movement happens after the delivery

A 2013 study published by the Cochrane Database of Systemic Review was aimed at evaluating whether giving enemas during the first stage of labor has any effect on infection rates of newborns or mothers, perineal pain, perineal wound dehiscence in the mother, and fecal soiling (1).

The review authors compared two groups of women subject to four trials of enema versus no enema.

  • There was no different found between the two groups with respect to umbilical infection, meningitis, sepsis or respiratory infections.
  • The enema group showed fewer instance of fecal soiling.
  • There was no difference in the satisfaction level with procedure among women in labor. However, labor attendants, perineorrhaphy operators and accoucheurs expressed greater satisfaction with the procedure.
  • Higher intrapartum infections rates was reported among women who received enema than those who did not.

Is Enema During Labor A Compulsion Or A Choice?

Enema During Labor

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No, you don’t have to have an enema during early labor.

So, if you prefer not to have an enema, make sure you tell your doctor during one of your antenatal appointments. State your preference in your birth plan (after discussing it with your obstetrician). If you don’t have a birth plan, see if your obstetrician can prepare a letter for you to show to the labor and delivery ward staff. This is important as you are opting out of what is a routine procedure in some hospitals, so the nurses and midwives on duty need to know that your doctor has viewed your plan.

When Is Enema Recommended:

Usually, enema is given under the below circumstances:

  • You are not able to clear the bowels before labor.
  • You experience constipation before labor.
  • There are nil or less contractions and you need enema to induce labor. If you are due after a full term and still devoid of strong contractions, your doctor or mid wife will suggest inducing a labor by administering enema. The pressure on the rectum while passing out bowels stimulates the abdominal muscles, thereby kick starting labor.
  • You have a history of rough bowel movements or indigestion.
  • If you have already prepared yourself completely to tackle the labor, your doctor will not insist on enema.

What Could Make Grounds For Refusing an Enema:

Do not be surprised if your doctor, too, views the use of enemas as part of routine care. However, a good doctor will always take her patient’s wishes and preferences into account. To help make your case, perhaps present a list of reasons why you would rather not have an enema. These could include:

  • The effectiveness of enema is not substantiated by scientific proof.
  • Chances of watery feces which is more difficult to control and which can lead to potential infections for both mothers and babies.
  • Enemas when used in the first stage of labor cause pain or discomfort to women.
  • Also, the Ministry of Health in a directive issued in 2005 states that an enema should be given only if there is a need, such as when a woman complains of constipation. It can also be given if the woman wishes to have an enema.

Measures For Accidental Spill:

You may still experience a little poop coming out of your rectum while pushing during labor.

It is quite possible that you would have cleared your bowels very well or opted for enema before labor.

  • Do not be embarrassed as there are multiple disposable supplies available at the labor wards where any spill can be immediately wiped away.
  • You can check with the medical staff or make your own arrangements by buying these supplies from the market and keeping them handy during labor.
  • The nurse, the midwife or the doctor would have wiped away the feces by keeping a cotton wool or tissue handy even before you realize that you have passed stools.

Bowel movements during delivery is normal. As the baby comes down the birth canal, the bowel is squashed and the contents often tend to come out.

Since labor lasts for several hours in most women, you could have the urge to empty the bowels during labor. Don’t force the bowel to empty. It might also be that your baby is putting pressure on the rectum for you to feel so. So long as you don’t strain much on emptying the bowels, you can visit the washroom during early labor. Never visit the bathroom during active labor or the transition!

A vast majority of women poop during delivery. In fact your body will cleanse itself out during pre-labor as indicated by mild diarrhea or loose stools. The chances are you will still pass stools during delivery despite the pre-labor diarrhea.

Some women also seem to reduce their food intake during labor because they are afraid they will pass the stools. But starving is not the solution as your baby will need the energy to endure the successful vaginal birth. Many recommend a ‘nothing by mouth’ or liquid diet only around this period. Moreover it is exactly the same motion when they are asked to push. More often women do not push correctly because they are overcome by embarrassment that they may pass stools.

If you are stressed trying to bring in strong contractions while in labor, understand that nature takes its own course to get things started. It is important to be relaxed, happy and prepared before delivering your baby. A little spill, even if that happens despite all the preparations, should not dampen your spirit.

Happy Motherhood!

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