Thursday, December 2, 2010

An enema during labor?

At my 36 week appointment, I was told that the medical group has a practice of giving an enema at the hospital. I was told this is in order to:

1. Stimulate labor
2. Prevent pooping
3. Make the baby's movement down easier.

The doctor said that in his experience, he sees less tearing when women have an enema because it allows more space for the baby to move. He said it's a lesson learned from midwives, who use castor oil. I was kind of surprised by this, having no discussion or use of enemas during my last labor.

But I did poop and I did tear. Though I don't like pooping while pushing, I can deal with that and wouldn't get an enema just for that reason. Nor do I see much need to stimulate labor if it has already begun or to endure any extra discomfort. Given the significant tearing I had last time, if an enema would reduce that, then perhaps it would be worth considering. I told him I’d look into it. I asked if I could reject it if I didn't want it and he said yes.

When I started googling, the information seemed dated. Many women wrote of hearing from their mothers that they had enemas, that it was terrible, and their mothers were glad their daughters didn’t have to experience that. It seemed it was often does for the comfort of the medical provider and had been rejected as an outdated practice. So why was my doctor recommending it?

The most compelling arguments were the possibility of reducing infection during delivery, the possibility of making the baby’s trip down easier, thus reducing tearing, and reducing the need to poop after delivery, when the area is fragile. I know I was terrified of pooping in the days after delivery, thinking that a bowel movement would rip out all the stitches and cause the toilet to fill with blood, as happened when I took my first pee.

When I looked for scientific evidence, this is what I found on the Cochrane Collaboration. In 1999 it was determined that research doesn’t show any benefit to getting an enema. But there is the risk of greater discomfort, of watery stools (which could increase infection) and of speeded up labor. This report was updated in 2010. I also found this page, which referred me to Cochrane, helpful.

So far, this is the most reliable information I can find. I discussed it with Mark and he thought there was no need to endure any additional discomfort. He was the one most bothered by seeing me poop last time, yet he thought it was better to poop again then to try to hold in an enema for 1-10 minutes while simultaneously dealing with contractions.

I wrote to my former doula, an expert who has been at well over 100 births, to request her opinion. She also did some searching and couldn’t find anything that would recommend its use. Out of all of her clients, only one used an enema, out of “a certain fastidiousness” as she described it. She said if the baby needs extra room to get out, then I will poop. She suggested having one on hand at home, in case I want to push labor along, and to bring it to the hospital for the same reason. But she didn’t see any other reason to get one, besides the doctor’s convenience.

So perhaps I’ll get one to have on hand at home. But I plan to opt out of getting one at the hospital. Since it seems the medical practice will put an enema on my chart for the hospital to carry out, I’ll have to add my opt-out to my birth plan and make sure the doctor is on board.

Now I’m starting to worry about my medical practice. One doctor of the three, the most senior, gets pretty bad reviews on bedside manner. He is the one I’m afraid of encountering. I’m imagining the policy probably comes from him.

Another non-patient-friendly policy I was just told about is that the practice doesn’t distribute the doctors’ schedules. My last practice did. I knew exactly who was on call on which days and I tried my best to not have to go to the hospital on the day when the doctor I was least comfortable with was on duty. I was also reassured when I did go into labor and I saw it was a doctor I was comfortable with on call.

The doctor explained that some people prefer one doctor over another, and so in order to not make it uncomfortable for the doctors, they don’t distribute the schedules. But whose comfort is paramount in this situation – the laboring woman or the doctor who is being paid for his or her services?

I told him that at a time that is stressful and painful, any additional uncertainly adds more difficulty to the situation. I told him how I find even not knowing the nurse ahead of time stresses me out, and is why we got a doula. We had one great nurse last time, and one horrible one. To also not know who the doctor will be is like walking helpless and in pain into a great abyss, where you don’t know if you will be aided and soothed, or treated roughly.

He did tell me the days he was on duty, and unfortunately, it looks like he’ll be off on the days immediately surrounding my due date. Given his willingness to violate the “policy,” I’m again suspecting that this comes from Mr. poor-bedside-manner, who seems to put the doctor’s comfort over the patient’s.

I asked my doula what to do if I get the doctor I’m afraid of and she said to take the support of the nurse and our student doula. I guess there is nothing more I can do.

Did you know who would be on duty when you went to the hospital? Did your doctor recommend an enema, or did you give one to yourself? Would you recommend doing it or avoiding it?

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