Excerpted from Birth as an American Rite of Passage

The Enema

Web Editor's Note: Although use of the enema is non-existant in my area, I have posted this section for two reasons.
1) Just because it isn't happening where I live doesn't mean that women in other parts of the country or world are not currently experiencing it.
2) The daughters of women who were given an enema are having babies. As mothers share their stories, they may find this information interesting or useful in understanding the differences between what they experienced and modern birth practices.

Description and Official Rationale

As part of the prep, an enema is usually administered by a nurse. Medical personnel maintain that enemas reduce the chance that fecal material will be pushed out during birth, thus decreasing the chance of infection. A few whom I interviewed also frankly admitted that they do not like to clean up feces and so give enemas to all their patients in the hopes of avoiding this unpleasantness. Other reasons include "preventing hard fecal matter in the rectum from compressing the birth canal, stimulating labor progress, and avoiding the embarrassment for the woman" that might result if she expels stool during labor-- especially likely during pushing (Mahan and McKay, 1983:244).

Physiological Effects

Williams recommends a simple Fleet enema. In a short diatribe against the all-too-common misuse of the enema, the 17th edition of Williams states that that the "infamous 3H enema (High, Hot and a Hell of a Lot) has no place in obstetrics!" (Pritchard and Macdonald 1985:333). (This felicitous statement has been removed from the 18th edition [Cunningham et al. 1989:309]). Unfortunately, this hot water and soapsuds enema is still most commonly used in many hospitals. Soap often causes rectal irritation and other complications, and its use in enemas is medically contraindicated (Barker 1945, Bendit 1945, Lewis 1965, Pike 1971, Smith 1964).

"A substantial portion of women in labor will have bowel movements, whether or not enemas are given," especially during both early labor and pushing (Mahan and McKay 1983:247). Available evidence indicates that enemas do not in fact decrease the chances of elimination during birth nor the incidence of fecal contamination during labor, whereas they do often cause considerable pain and distress to the laboring mother (Romney and Gordon 1981; Whitley and Mack 1980). Moreover, the explusion of feces during labor does not seem to increase infection rates: in a study of 274 birthing women randomly assigned to enema or no enema groups, no difference in infection rates was found (Romney 1981), and the risk of neonatal infection was very remote (seven babies from each group showed signs of infection which may or may not have had to do with bowel organisms). Another finding of this study was that the two groups had similar durations of labor, contradicting the notion that enemas shorten labor.

Women's Responses

"The enema was the single most painful part of Johnathan's birth."
Melinda Simpson

"I simply refused to have an enema. I wasn't going to let anybody humiliate me like that."
Jacqueline Barrett

"I asked for the enema; I felt it would be just too embarrassing to push without it. But when the time came, I pushed out some feces anyway."
Betsy Yellin

"I didn't want to...um... inconvenience the nurses like that."
-Toni Kyle

I did want an enema. I had talked with other people and I was convinced that it would help. In fact, I had to insist. [My obstetrician, who was very accomodating] said, "You can if you want to." But I had to insist on it during labor. I don't know why--I guess because I was in the alternative birth center--I had to ask for it three or four times, but it did help. It relieved a lot of the pressure and I felt better. But I didn't get the rest of the prep at all. It didn't seem to give anybody any problems.
-Patricia Hellman

The consensus on the enema among the women in my study seemed to be that it should be strictly a matter of personal choice. Some also felt that doctors should let women know that the self-administration of Fleet enemas at home is a viable option.

Ritual Purposes

The enema is readily recognizable as the obligatory ritual cleansing of the initiate traditional in many rites of passage. But because it is the lower region of the body that is cleansed, the enema also constitutes an intensification of the symbolic inversion accomplished by the shaving and the gown--from most private to institutional property. Accompanying this process (especially when the enema is high, hot, and soapy) is the clear message that the laboring woman's most private parts were internally dirty while they were private, and that it is the institution, as society's representative, which made them clean. Underlying this message is the deeper message that individuals are impure, whereas society (like Ivory soap) is pure. (As is indicated in Patricia's response above, when an individual herself requests or administers the enema, it loses many of its symbolic connotations in terms of the technocratic model.)

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