The routine administration of a cleansing enema shortly before delivery was a common, standardized procedure in hospitals throughout the 20th century. This practice, known as an antepartum or pre-delivery enema, was deeply embedded in labor and delivery protocols in many countries. It was considered a necessary step in preparing the mother for childbirth, regardless of her individual medical needs.
The Historical Rationale for Routine Application
Medical professionals justified the routine use of enemas based on improving hygiene and facilitating the birth process. The primary concern was preventing infection, a far greater risk before the widespread use of modern antibiotics. It was thought that emptying the lower bowel would prevent fecal contamination during delivery, thereby lowering the risk of puerperal infection in the mother and infection in the newborn infant.
The practice was also supported by the theory that an empty rectum would benefit the mechanics of labor. Practitioners believed a full rectum could obstruct the natural descent of the fetal head, potentially prolonging the delivery process. Some also believed that the bowel stimulation from the enema might reflexively encourage stronger uterine contractions, shortening the overall duration of labor.
A significant cultural and social element also played a role in the routine application. Many women expressed concern about the potential embarrassment of involuntarily passing stool during the final pushing stage of delivery. Healthcare providers administered the enema to reduce this soiling, promoting a sense of “cleanliness” and comfort for the laboring mother.
The Lack of Supporting Medical Evidence
The routine nature of this intervention was questioned as medical research shifted toward evidence-based practices. Clinical trials and systematic reviews failed to provide scientific support for the historical beliefs. Studies found no statistically significant difference in the rates of maternal infection, such as puerperal or perineal wound infection, when comparing women who received a routine enema with those who did not.
The evidence did not support the idea that enemas shortened labor; pooling data showed no significant difference in the mean duration of labor between the two groups. Some research suggested that administering an enema in the first stage of labor could prolong the time to delivery. While enemas reduced visible soiling, this outcome did not translate into a measurable reduction in infection risk.
Researchers noted several potential drawbacks associated with the procedure that outweighed its unproven benefits. The enema was often unpleasant and uncomfortable for women already experiencing labor pain. The liquid nature of the resulting bowel movement could potentially spread fecal matter more widely, possibly increasing the risk of infection. The lack of proven benefits combined with discomfort led to the conclusion that routine use was not justified.
Current Obstetrics Practices Regarding Bowel Management
Today, the routine use of enemas during labor has been largely abandoned and is actively discouraged by major medical organizations. Current guidelines state there is no reliable scientific basis to recommend their routine use for all laboring women. The standard of care has shifted to minimizing unnecessary interventions and respecting the natural physiological process of birth.
Bowel management is now approached selectively, meaning an enema is only considered when a specific clinical need arises, such as severe constipation. If a laboring woman expresses a preference due to anxiety about soiling, a healthcare provider may discuss the lack of evidence and potential discomfort. The prevailing consensus is that routine enemas do not benefit the mother or the newborn and are not a necessary part of labor preparation.