Enemas & Childbirth
Dr. Jerry Glenn Knox BA, DC
It is delivery time. You arrive at the hospital. A smiling nurse waits for you. You want to run away, but you don't even waddle well. Flop, into the wheel chair. She takes you to the labor room and preps you. A laxative would be nice. You prefer a laxative? Wouldn't a laxative work? She explains it might work the next morning or right at delivery. The doctor has in mind catching a baby not the results of a laxative. The nurse is adamant. A laxative is not a good plan. She tells you that you are going to have an enema. Why would you want to let her do that to you? She tells you that if you have anything in there that it may come out in front of the doctor when you are having the baby. Now that would be embarrassing wouldn't it? You have to admit it would. It violates the most basic rule of good manners. One never defecates on another person. You don't want to do that. Your doctor doesn't want you to do that. You agree to the enema even though you feel bad enough at the moment and go back and forth between wanting to be cared for and wanting to be left alone.
Now is that the real reason for the enema? It is true that having the enema does usually prevent this from happening. Well, the old fashion large enemas help. The current hospital enemas of small quantity and chemical action might not, and the little chemical enemas could cause you to dehydrate as well. With child birth enemas should be just plain water, or perhaps a little salt if your blood pressure is good, or baking soda. No soap or other chemicals should be used. Particularly the sort of enemas that work by absorbing water from the system to fill the bowel should not be used. The mother needs fluid, not dehydration, and the little sodium phosphate enemas have been known to cause a calcium deficiency problems. Plain water enemas don't.
The enema(s) should be as large as you can take and bearing down to release them is perfectly acceptable. In fact, that is the primary desired result of the enema. They can be warm to relax you if you are having difficulty relaxing into the process, or cool to stimulate you if you are not contracting enough. The bottom line is that the enemas are to help increase the strength and rhythm of your contractions.
Did your nurse tell you this? She may not even know that this is the primary reason for giving enemas early in the labor process. I do not know if this is taught in nursing schools. They used to teach the prevention of bowel movements at delivery. I do not know if they taught the increasing of contractions. Even some doctors did not know that the reasons for enemas were to hasten and ease labor. In fact the only research I have yet to find on whether enemas were useful in labor was not directed at the real reason they were done. In this article it was admitted that physicians used enemas to stimulate contractions. However, the research was directed at whether the phosphate enemas were as effective as soapy enemas at preventing soiling at birth. (1)
It does make sense though. If the nurse, doing the primary care was focusing on increasing your contractions and told you this as the reason for your enemas it might have been much more difficult to convince you to take them. The soiling routine is much easier to sell. Contractions are often interpreted as painful, you may know intellectually that you need to do them. Like most painful things, tomorrow would be a good time to start-- not now. Salesmen, nurses and those in direct contact with the customer are often taught the company line that sells best, not the truth. It was so with enemas. I am sure that sometime long ago in a cave far away some nurse came up with this line. Telling young mothers that, she had a much easier time getting her quarts in to avoid the embarrassment of losing control during the birth process. The explanation stuck. The real reasons were never discussed with patients after that in most cases. Rationality is not a constant characteristic of women in childbirth. Explanations are often geared to this.
A few minutes spread eagled for a shave and it is time for your enema. It's a good one, at least a quart more than the point you wanted to stop. Ten minutes squeezing it back and she tells you, you can go. You run, no waddle holding your bottom, toward the toilet sputtering out the enema on alternate steps. So much for dignity. The next time your nurse brings you a bed pan. A few tries to fill it to overflowing and they let your husband come in.
This time you bear down not to push out the enema, but with a real contraction. It hurts, gripping the bed rail with his fingers in between you beg, "Do something!" He mutters something about having done all he can do while trying to extricate his fingers. The bed pan, you want the bed pan again! It's not the enema this time. You want to see how he would look with a knot on top of his head. The bed pan will do that just perfectly.
You have been planning for months to wake him up at 2 A.M. and have him go bananas getting you to the hospital. First falling down the stairs on getting the news that the baby is coming, then the 90 miles per hour chase to the hospital. It was going to be so grand. It was 2 P.M. on his day off. You were playing hearts. He was winning. Your water broke. He scurried you into the bathroom to save the carpet. He called the doctor. He drove you the 30 miles to the hospital at 45 miles an hour so the car wouldn't over heat or hit any bumps too hard! While you were trying out for the enema Olympics, he had time to pop down to the hospital cafeteria for an early dinner! A knot, a knot from the bed pan, that is what is needed-- immediately if not sooner!
Another contraction over takes the thought and you hold his hand tight. He does love you after all! This just hurts. They ease up for a while. You talk. It is nice to just lay back and let it go. He smiles at you, brushing your hair back from your forehead and tells you he loves you. A gentle kiss, and you whisper you love him too. You are having his baby. About an hour passes without much pain. You don't want him to leave your bed even to go to the bathroom. Then she is back. Bag in hand, your nurse appears. "Another enema," you protest, roll over and slide your bare bottom to the edge of the bed. She gives you the enema. This time your husband stays. You want him too. He holds your hand as you take it. As you expel it, the contractions come back. You will get even with him later. You will see how he likes whisker rubs next month as your pubic hair starts growing back.
An initial part of the admission of a mother to be for the birth of her child has traditionally been a shave and an enema. In fact the enema has been a part of the delivery of a child for a very long time. You are not the first, nor will you be the last to receive enemas in the labor room.
The physiology of why enemas help with childbirth does not require formal education or knowledge of physiology. It is likely that the use of enemas in labor predates writing. The use of enemas has been suggested from archeological evidence into the stone age. Early written records go back to 1000 to 2000 BC in the early Vedas. Written records are also in the writings of the ancient Egyptians, Sumerians, Chinese, Hindus, Greeks and Romans. (2) The movement of the bowels is essential to life. Any disease or process that stops the movement of feces from the body does result in death if allowed to continue without remission. Early healers would have been expected to master the art of flushing the bowels with water to attempt to correct this long before the more abstract ideas of recording thoughts in symbols would have developed.
Once the correction of constipation was discovered via an enema, it is certain that enemas would have been applied to other illnesses and processes in which patients seek the care of others. Childbirth was probably one of the first conditions that brought about the development of professional healers. The enema is very useful in natural childbirth and would have been one of the basic tools of any good healer called on for the care of mothers to be as well as many other conditions. In fact the enema remained one of the mainstays of almost all obstetrics practices until the last quarter of this century.
There are many good books on midwifery, childbirth etc. I am not going to address anything except the use of the enema in this process, except to ad that while some new procedures have proven useful and true miracles, the changing of care too unnatural does have occasional consequences. "It isn't nice to fool with mother nature." Certainly no one wants mothers to bear children in pain. I profoundly appreciate the labors of my wives in giving the children they gave. It is a hard, difficult experience for most women. Some of this I am sure is the result of the social consciousness that it is a painful, difficult process. Other cultures are much more accepting of the normal process of having a baby. The level of pain and discomfort suffered by the women of these cultures is much less than those of our society in which it is expected to be a horrendous process.
There was and is a real reason to often institute serious intervention and observation of the birth process to protect women and children. Four of my great great grand father's wives died in childbirth, and he had difficulty finding a fifth. The reasons for concern are very real. In reality the risk of child birth has been greatly reduced by modern medicine. That being said, women have been having babies since long before medical care was even imagined. It is now rare for ladies to die in childbirth. As war, violence and disease always cut a wider swath through the male population, it has been child birth that historically kept the numbers of men and women relatively equal. As childbirth and better care of mothers has become common place the relative number of women to men has increased. Some of our current social disruption has a small element of cause in this changing ratio of women to men. There are much more serious causes, such as lifestyle, diet and the break down of the environment and increasing complexity of living. However, the alteration of natural childbirth is in many ways a microcosm of the problems inherent in society.
We care about the death and pain of our ladies, so we changed the birth process to make it less painful and safer, a good thing. This has been an important factor in the increasing number of people. The reduction in pain via anesthetics while on the surface being a good thing is not without difficulty. The physical pain and birth process of a conscious woman certainly is to be respected, and to seek to relieve that pain is a natural thing to want to do. However, a woman as part of that natural process becomes a mother. Being a mother is much more than just a physical act. The bonding with a baby is a fundamental part of living. All of us need loving, caring mothers that put the love of their babies before all other values. This is as it should be. During the birth process a woman forms much more than an intellectual link with her baby. We did not know how important that linking was until anesthetized birth was developed by modern medicine.
Large increases in child abuse and social decay of the family etc., has paralleled the growth of the treatment of child birth as a disease. Women anesthetized, and whose babies are taken away from them at birth do not develop the same attachment as those who bear them in pain and care from them unceasingly at birth. If a woman suckles her baby at birth, this helps her with breast feeding later and helps increase the contractions to deliver the after birth. All this bonding to a living infant is important.
Unfortunately some babies die at birth, and there are miscarriages and spontaneous abortions. A woman should never develop an attachment to a non living product of her uterus. This is unhealthful. The pain and the process of having a baby set the stage for normal maternal feelings. The cry and suckling of the child at birth lock love for the infant in her soul. If the mother is not conscious or aware of the live baby at birth, she may not develop these normal maternal feelings. If she is separated from the experience by well-intentioned care it can make it as though the baby has died or not been born in her physiological frame of reference. It is now well accepted that a mother separated physically, or even by medication from her infant at birth has more difficulty with forming normal attachments to that child.
This is a very good reason to consider natural childbirth. Certainly, I nor any loving husband wants to see his wife in pain. Neither do we want to destroy an important part of their being a woman nor being a mother. The pain of childbirth and the process can be an important part of being a woman. It is the ladies' lot to bear, love and remember throughout life. I must note that four of my children were caesarian births. My ex-wife and these babies would not be here if it were not for this unnatural process. Nor would I be. My mother and I almost died at my birth. Good maternity care is important, and I feel that all pregnant ladies should get good prenatal and birth care. If intervention is necessary to protect the mother or the baby this should be done. If it is not necessary, the process should be allowed to occur as naturally as possible. This is a choice. Pain killers and removal of the lady from the trauma of the process is always an option.
One of the natural things to do, and a key part of having a baby naturally is the use of the enema. This tool has been used by mankind as I noted for up to ten thousand years. To my knowledge other animals do not use enemas for childbirth. This is likely because they do not have the physical or mental ability to apply it and because we are different. Other mammals do not have the large heads we do in relation to our body size, and if they do, they have larger pelvises. The delivery of a human baby is more difficult than other animals primarily due to this. There is every reason to believe that as we developed tools to deal with life we changed as well. Our ancestors were physically smaller than we are. Their heads were much smaller than ours. As we developed tools, we became larger. Our head size increased much faster than our body sizes have. Big heads and small pelvises do not go together well. This is a major reason for the high incidence of infant mortality, maternal death and birth damages in humans. Still, nature rarely creates a problem without offering a solution. As we develop problems, we develop tools to deal with these problems.
It is likely that the enema was one of the first of those tools. If you ask any woman, who has vaginally delivered a baby, the process of bearing down and having a bowel movement is the same. When a lady bears down to push, it is with the same abdominal muscles and way that she would bear down to push out either constipated feces or a baby. This is the primary reason enemas are given to women in the early stages of labor. The act of defecating helps get her in the rhythm of bearing down to have the baby. Enemas provide extra water to help keep her blood volume up and prevent thirst. Enemas also help to clear the feces from the colon so that these are not pushed out with the baby, soiling the birth canal and increasing the risk of infection. Enemas also help to keep her mind off the process during the early stages as she makes frequent runs to the toilet to release the enemas.
Foremost in the reasons for the enema is to increase the contractions and to help the mother get into contracting and bearing down. This is, and rightly so, the reason that enemas are counter indicated in pregnancy. The uncontrolled bearing down during pregnancy in a case where a miscarriage is a possibility may result in a spontaneous abortion. I believe that if constipation is present or enemas are indicated otherwise during pregnancy they could be used, but with unskilled care and/ or a mother that does not release properly there could be problems. As well it is known that constipation can cause miscarriage, spontaneous abortion, and contribute to urinary tract problems and toxemia, so that functioning of the bowels should not be ignored. In pregnancy, if enemas are used at all, the water temperature is very important. It should be exactly body temperature, and probably normal saline. Baking soda may be ok, but certainly no other chemical or soap, including chlorinated water should be used. Once she has her enema she must release it, not push it out. The act of vigorously pushing out her enema may initiate delivery, and the baby should come when it is ready, not sooner, or later.
This all worked well for thousands of years,---. then, along comes corporate medicine. Sometime during the 1940's someone down at the local drug company figures out that enemas are not good for business. They stop headaches, constipation, relieve the symptoms of colds and allergies, etc., without any real complications, side effects--- or profits! All sorts of problems that can more profitably be treated with prescriptions or over the counter medications are disappearing down the toilet, a condition that must be remedied.
In my research the very first condition that appears in a home medical book advising against enemas was in an American Medical Association home health reference book during the 1940's. It opposed the use of enemas in pregnancy. As I stated earlier I agree with this, when the enemas are improperly given, or the patient strains at the stool and abortion or miscarriage is a possibility. So, it was good advice, but curiously given during the same time that corporations bent on making profit were making health care more of a business.
It did take some years of drug company financing of all medical education in the western world to reach the point that most doctors who knew the value of good enemas were in a minority. By the 1960s most of these doctors were approaching retirement. By the 1970s almost all doctors were primarily educated by drug company funds. It had to wait until these old obstetricians were out of the way before enemas could be seriously attacked in the labor rooms. Their uses in other arenas were under simultaneous attack as well. For infections, scientific and teaching references started disappearing in the 50s. By the 70s enemas were on their way out in hospitals except for phosphate enemas, and the necessary use of real quantity enemas for barium studies. The new form of barium enemas was greatly increased in the level of discomfort by the addition of air. This made sure it was a procedure viewed negatively by almost all patients.
Quantities were reduced. The average adult patient can hold from two to four quarts, without pain or difficulty. It has been my experience that ladies tend to the higher side of this. So that without adequate filling of the colon, or repetition of the procedure as was historically used and-- surprise, surprise, they were less effective in preventing soiling at delivery.
The study referenced earlier was done to show this. (3)In this study the enemas were a singe injection of 1200 to 1500 cc with 2/3 ounce of soap. No controls as to temperature were noted. As could be predicted these very soapy enemas with no control of temperature produced cramps and discomfort for the mothers. A good enema which would produce good clearing and not produce painful cramps for most moms would require closer to 4000 cc's of warm water and possible multiple injections. These smaller than necessary enemas were not effective in preventing soiling at birth.
The use of the enema to provide water to the mother and increase contractions were replaced by the IV drips in which hormones can be introduced at will to increase contractions and fluids can be maintained. By the 90s almost all the old doctors that knew the real reasons for the enemas are dead, and current literature sites that improperly given enemas are ineffective in preventing soiling at birth, so they should no longer be given and are not recommended, even though much more dangerous and less proven treatments are now routinely done.
Enemas are not effective in preventing ingrown toe nails either! It is important now that the real reasons for enemas and natural therapies be stated rather than the sales pitch. So often in society we are the victims of a good pitch designed by medical entrepreneurs bent on making a profit, with helping people as a secondary goal. Nothing is wrong with profits, but they must be based on sound principles of service, and honest facts, with the benefit of the consumer in mind. The elimination of good warm water enemas from American health care to promote the sale of laxatives and unnecessary medical procedures for profit is a major problem we must deal with. The fact is that enemas help do the same things naturally as do pitocin and IV drips. Are the drips and hormones wrong? No, they are not, and they are useful tools. However, there are problems with their use. Increased pain in childbirth and much more serious ones--- such as rupture of the uterus, oxygen starvation of the fetus, etc. (4) There are other natural alternatives that have been used for many thousands of years with good results and where there is no problem requiring artificial intervention, it is best to do things naturally.
It is a complicated issue in some ways. Fifty years ago when all doctors had knowledge of the use and benefits of enemas it was worth asking their opinion, in fact most would insist on your having enemas as part of childbirth. Now it is still worth asking, but unless they understand the physiology of the treatment their knowledge is incomplete. Their advice is not as well founded as the older generation of doctors in this area. Most doctors are still open to the mother electing to have enemas at childbirth even if they have not been trained in the effects and procedures. However, this may get progressively more difficult as the knowledge of the science behind these procedures becomes less common.
Additionally there is another incentive to the health care industry to eliminate enemas from both child care and maternity. It is during childhood that we become familiar with this form of care and develop acceptance and knowledge that last a lifetime with strong positive memories. Children that have had enemas and known the good feeling and relief of symptoms that they usually bring will not be as easy to con into more expensive, less effective pharmaceutical cures. Our attachments to our mothers are also very strong, and her experiences as a part of childbirth can have a strong emotional bond with her as well. If she had enemas as part of childbirth, and almost everyone over 20's mother did, she may also be quite accepting and supportive of the treatment. This is particularly true if she was treated in a kind and respectful manner. Unfortunately many mothers were not. Childbirth was and still often is treated in a very brutal inhuman way in Western medicine. There was little to endear the procedure to most women. One of the good things to come in the 70s was a kinder, gentler form of childbirth. Natural birth has again become more popular, even if enemas have declined. Many otherwise caring midwives, relating to the hospital cruelty have not continued the use of enemas as before. Not understanding the gentleness and support that good enemas can achieve or the way to properly give them, many have elected not to do enemas.