Enema before delivery?! Apparently it's "standard" at my hospital

[gherkins]

Hi,

Just got back from my 2nd antenatal class, and we were told by the midwife leading the class that women delivering at our hospital will be given an enema when they arrive at hospital.

Is this usual? I've never heard of this happening before. Well, actually my Mum said she was given one before having me, but that was back in the 70s! I had no IDEA this was standard - first I'd heard about it

Is this really standard procedure? If so, what's it like?

I'm rather morbidly fascinated

I think that the message you have been given is confusing. The perineum has muscles - just they aren't the pelvic floor muscles AFAIK.

It sounds like they don't do routine episiotomies but ones based on some sort of clinical assessment (not sure if it is an evidence based approach). Whilst I don't love my episiotomy (my secondary repair is now healing) I wouldn't give them all bad press as I had a forceps birth which required one. The medio-lateral episiotomy tore further and I had 3 more tears, one going straight down (appeared to be the line of least resistance) and without my episiotomy I think that I would have had a 3rd or 4th degree tear and a significant risk of incontinence.

I have no idea if I pooed during labour - I do remember the pad under me being whisked away at one point, but with such little fuss that you wouldn't know why and DH had no idea if I had or hadn't.

sorry gherkin I didn't get back to this thread but it has all been said, re enemas and episiotomies- is there any chance of you coming home for the birth? if not then I would try to find a doula.

I wouldn't necessarily be totally opposed to an enema (as long as it's not compulsory of course). I get very constipated and I know for a fact that when I have my period being constipated significantly increases the pain of cramps, so I'd imagine in labour it would be the same. If I haven't been for a while when I go into labour I think I'll ask for one to help decrease my pain.

I think enemas were done back in the 60s/70s mainly so that the doctors would not see any poo and to keep everything nice and "tidy". No real benefit for mothers. Definitely not standard in the UK now.

I have no idea if I pooed during my two labours - if I did it was swiftly whisked away and I knew nothing about it, neither did my DH as he very studiously avoided the "business end"

Normally I'd say go for an enema. First labour - I too was in horrendous pain with every contraction down below and I 'evacuated' which I found humiliating (midwife was great at distracting hubby by giving him a job while she dealt with things). Second labour no pain but again the 'evacuation' - still found it humiliating and cursed myself that I hadn't had one. Somehow hubby unaware again - great midwives!

But it's certainly not going to help labour's progress and how many people tear that much? If you have a big baby (I did) the worst that will happen is you'll tear a bit, but your ligaments might become overstretched and you'll need to do pelvic floor exercises (and maybe have a corrective op). I don't think an episiotomy is going to prevent that, but I'm not a gynae.

It sounds to me like the hospital is stuck in a time warp.

Wow. I wish my hospital had that policy. I was in agony for 10 hours with a compacted bowel before they finally agreed to give me an enema. As soon as they did things were much less painful, I went into transition and my son was born a few hours later.

Unfortunately I had a very big blood loss after the delivery of the placenta which my community midwife believes was caused by the fact my cervix and the baby were ready for a long time but things were halted by my compacted bowel. She thinks this caused the stress and resulted in the harmhorrage (which is a word I just cannot spell!)

So obviously from my perspective an enema first would have been much better. Oh and the enema itself didn't hurt at all, it wasn't even particularly unpleasant.

at the op being #morbidly fascinated' at the thought of an enema.

I am also intrigued - would like one to see what it was like

It does seem incredibly out of date, I don't think this has been done in the UK for years.

I was induced with dd, spent the 6 boring hours waiting for the pessaries to work going to the loo every 10 minutes because I thought I needed a great big poo. Turns out it was dd's head having descended.

Didn't poo during labour, not everyone does.

Seriously, I would think strongly about coming home for the labour if that it as all feasible, they do sound like they are stuck in the 1950s.

Thanks to everyone who's posted. I'm a bit scared now!

While it's possible for me to come back to the UK to have the baby (and, given we are currently living overseas, I could go private ), DH and I decided it would be best for me to have the baby out here, as otherwise it would mean us spending several weeks apart, both in very late pregnancy and also in the early weeks after delivery before it's safe to fly home. Also there is the risk of him missing the birth if the baby comes early...

I have said to myself that if I develop major complications later on, that I'd definitely just come home, but if it looks like a 'normal' delivery, it's best to be here, at home, as it's just simplest all round.

However, am a bit alarmed by what everyone's saying now. I think this has given me food for thought - I will check with more women who've given birth here, enquire about doulas and also ask at next week's ante-natal class for the midwife to really clarify hospital policy on episiotomies and enemas, asking about what clinical research they base their interventions on.

Thanks for everyone's replies - it's been so helpful to hear from those with medical knowledge and also people who have had enemas etc, and that they weren't the end of the world. I suppose as long as one has the right to refuse, that would be ok.

But the option of saying no to an episiotomy, which would presumably happen at the most painful and chaotic part of labour, seems more limited. I know one woman here who specifically asked not to be cut, but her doctor cut her anyway. Of course, there may have been a medical reason, but the doctor just dived straight in there and cut her . There was no medical emergency - it was a straightforward birth - but maybe the doc felt she would tear .

No need for an enema usually. Your bowels will evacuate perfectly well during labour without one! But I don't really think it's a big deal either way unless you're unconfortable and want one. You really won't care too much about your dignity either at that stage!

"but the doctor just dived straight in there and cut her"
Well, there's the thing that would terrify me in your situation - not being able to trust the medical staff to do or not do what you specifically ask them. They should always have your express permission to do this kind of thing.

I don't think anyone has mentioned massaging your perineum with oil, to improve its pliability and make it easier for it to stretch in labour? This was certainly recommended by the National Childbirth Trust classes when I had ds1 in the mid '90s.

Regarding the enema - when you get to the hospital, could you tell the staff that you gave yourself one at home because you 'misunderstood' what the midwives told you, and thought that's what you had to do? Then they hopefully would see no need to give you another, and if you were to poo during labour (which isn't a given - I didn't poo when delivering any of my three dses), you could apologise and say you must not have done it right.

You could also make sure you've been having plenty of fibre in your diet in the last weeks of your pregnancy, and drink plenty of fluids to make sure that you are 'going' regularly, which should decrease the chance of your pooing at the point of delivery.

Regarding the episiotomy - I had one with ds1 - I had been in labour for nearly 38 hours, and pushing for nearly 1.5, and was very tired, so the midwife told me if I had an episiotomy, the head would be delivered on the next contraction, and the rest of the baby on the one after, and I agreed with alacrity. I had previously been very anti the idea of an episiotomy, but by that stage, was more than happy to have one, and finally deliver the baby.

My episiotomy was nicely stitched up by the midwife, and I had no problems with healing or infections, though I have to admit it was pretty sore down there for a few days. Once that was past, it was fine and there was no more discomfort. When I had ds2 and ds3 I did worry that the scar tissue from the episiotomy might cause problems, but it was fine, and I had a tiny tear with each of them, and didn't require stitching either time.

I have the crappest pelvic floor imaginable & delivered a big headed ten pounder without tearing or an episiotomy so no, definitely no correlation.
Don't make me laugh or sneeze mind you

Sorry i haven't read it all properly, but another thing to consider is birthing position. Whether they will let you move around or have you lying down, as this will affect episiotomies etc. (Also if they can't see it, i.e. kneeling, etc then they can't do nothing )

Gherkins I just wanted to let you know that I´m in spain and was also really worried about the birth as it is so different to everything you hear about on here re. the UK. Not enemas and shaving but not doulas and birth balls either. Birth plans are almost totally unheard of and i can´t imagine they´d make much of it if you presented them with one either.

But it was fine, it really was. The standard of care was excellent and my baby was delivered safe and sound. If you would feel more comfortable in the UK that is one thing but i just wanted to let you know that ime I would choose being where i live, and having dh on hand, than going to the UK just so I may or may not avoid an episiotomy (something i was terrified about but which in the end was really not a big deal - it is so true that by the time you get that far you would let them do just about ANYTHING as long as they get the baby out! haha)

I would look into the enema, I am sure they can´t force you... also just make sure your dh is really up on what you need/want and feels strong enough to stand up for you and you will be fine.

Is a home birth totally out of the question? Sorry if you have mentioned this. Here is it a bit of a grey area, kind of not legal/not illegal from what I gather, but you can still contract a private midwife to assist you to labour at home for as long as possible and minimise hospital time/potential intervention. would this be a possibility?