Hot, high and horrible. Should routine enemas still be given to women in labour?

The effect of a soap enema on the progress of labour was studied in 160 women admitted for delivery in Esigodini District Hospital. The study was set up as a 1:1 randomised case control study in 200 women. It was changed to a 1:3 case control study after 82 subjects had been studied, when it became apparent that the midwives were no longer willing to follow the study protocol. Forty women received an enema and 120 did not. Two focus group discussions were held with 16 women who had an enema. The 12 hospital midwives were asked to give their opinion on enemas. Focus group discussions were also held with 28 traditional midwives. Dilation of the cervix was 2.19 cm/hour in the non-enema group (95pc confidence interval 1.86-2.52) and 2.00 cm/hour in the enema group (95pc confidence interval 1.38-2.62). The difference is not significant (t-test:p-value = 0.58). Pregnant women did not like enemas, midwives preferred not to administer them and were not concerned with contamination during delivery. Traditional midwives do not use enemas in labouring women and consider the possible contamination as normal. It is concluded that there is no benefit from routine enemas in labour.