title: Enemas during labour.
abstract: BACKGROUND
  Although the use of enemas during labour usually reflects the preference of the attending healthcare provider, enemas may cause discomfort for women.
  
  
  OBJECTIVE
  To assess the effects of enemas applied during the first stage of labour on maternal and neonatal outcomes.
  
  
  METHODS
  We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (17 May 2012), the Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effectiveness (The Cochrane Library 2012, Issue 5), PubMed (1966 to 17 May 2012), LILACS (17 May 2012), the Search Portal of the International Clinical Trials Registry Platform (ICTRP) (17 May 2012), Health Technology Assessment Program, UK (17 May 2012), Medical Research Council, UK (17 May 2012), The Wellcome Trust, UK (17 May 2012) and reference lists of retrieved articles.
  
  
  METHODS
  Randomised 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.
  
  
  METHODS
  Two review authors independently assessed studies for inclusion.
  
  
  RESULTS
  Four RCTs (1917 women) met the inclusion criteria. One study was judged as having a low risk of bias. In the meta-analysis we conducted of two trials, we found no significant difference in infection rates for puerperal women (two RCTs; 594 women; risk ratio (RR) 0.66, 95% confidence (CI) 0.42 to 1.04). No significant differences were found in neonatal umbilical infection rates (two RCTs; 592 women; RR 3.16, 95% CI 0.50 to 19.82; I² 0%. In addition, meta-analysis of two studies found that there were no significant differences in the degree of perineal tear between groups. Finally, meta-analysis of two trials found no significant differences in the mean duration of labour.
  
  
  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.
authors.affiliation: Research Promotion and Development Team, Health Systems Based on Primary Health Care (HSS), Pan American Health Organization,Washington DC, USA. mmreveiz@hotmail.com.lreveiz@yahoo.com
authors.forename: Ludovic
authors.initials: L
authors.lastname: Reveiz
authors.forename: Hernando G
authors.initials: HG
authors.lastname: Gaitán
authors.forename: Luis Gabriel
authors.initials: LG
authors.lastname: Cuervo
mesh_terms: D001424:Bacterial Infections / Q000453:epidemiology* / Q000517:prevention & control; D003672:Defecation; D004733:Enema / Q000009:adverse effects; D005260:Female; D006801:Humans; D007747:Labor Stage, First; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D011645:Puerperal Infection / Q000453:epidemiology* / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D014472:Umbilicus