Enema Prior to Labor: A Controversial Routine in Taiwan

分娩前的灌腸：一個在台灣具爭議性的常規

曾雅玲(Ya-Ling Tzeng) ； 施怡如(Yi-Ju Shih) ； 鄧玉貴(Yu-Kuei Teng) ； 邱靜瑜(Ching-Yu Chiu) ； 黃美瑤(Mei-Yao Huang)

《The Journal of Nursing Research》 13卷4期 (2005/12) Pp. 263-270

摘要

縱使爭議性不斷，灌腸卻仍為台灣許多醫療院所分娩準備的常規項目。由於普遍施行會陰切開術，預防糞便污染造成會陰傷口感染即成為贊成維持此項常規的主要理由。因此本研究旨在比較有無常規灌腸對產婦與新生兒產後住院期間的感染率、胎頭下降時間、產程時間、產後開始排便時間及會陰傷口裂開的差異，以作為是否繼續執行此項常規之參考。研究對象為534位至台灣中部某醫學中心生產之低危險姙娠婦女。其中前6個月264位產婦依原有常規執行灌腸，後6個月270位產婦則未施予灌腸。記錄並比較二組產婦及新生兒於生產及產後住院期間感染、產程進展及產後排便等變項之差異。結果發現無論有無灌腸，產婦與新生兒在產後住院期間皆未出現感染徵象、胎頭下降所需的時間亦無顯著差異。雖然灌腸組在第二產程的時間較非灌腸組短，且有統計上的差異，但二組在第一、三產程及總產程的時間長度方面則無顯著差異。此外，在產後排便的時間方面，未灌腸的產婦並未延遲其產後排便時間，或增加會陰傷口裂開的機率。依據本研究之結果生產過程並無常規執行灌腸的必要；但由於受到研究設計之限制，建議未來的研究可採隨機臨床試驗，以提昇結果的推論性。

關鍵字

常規灌腸 ； 分娩 ； 人性化生產

並列摘要

While taking an enema to induce labor is a controversial issue worldwide, in Taiwan it remains a routine procedure in many hospitals in preparation for birth. Episiotomy is also a prevalent procedure performed during the birthing process. Some physicians believe that enemas help reduce the risk of feces contamination of the episiotomy incision and, therefore, are justified as a routine procedure. This study compared the neonatal infection rates, times to appearance of fetal head, times to first post-labor bowel movement, and rates of episiotomy dehiscence of women receiving a pre-labor enema against those who did not. A total of 534 women classified with low-risk pregnancies were recruited from a medical center in central Taiwan and assigned randomly into one of two groups for a six-month period. The first group (264 subjects) received routine enema procedures prior to delivery in the first 6 months. The second group (270 subjects) did not receive enemas. Study results revealed no significant difference between enema and non-enema groups in terms of infection rates in mothers or infants or in terms of average time to fetal head appearance. While labor duration was the same for the two groups in the first and third stages of labor, the enema group experienced a relatively shorter second stage. No significant difference was observed in times to first post-labor bowel movement or episiotomy dehiscence rates. The results of this study indicate that the administration of enemas as a routine practice prior to labor is not substantiated by medical necessity. However, limitations of the research design suggest that a randomized clinical trial be adopted in the future to explore further the scientific validity of study results.

並列關鍵字

routine enema ； labor ； humanized birth

參考文獻

Cuervo, L. G.,Rodriguez, M. N.,Delgado, M. B.(2004).Enemas during labour.(The Cochrane Database of Systematic Reviews).

Dickason, E. J.,Silverman, B. L.,Kaplan, J. A.(2001).Maternal & Infant Nursing Care.St. Louis, MO:

Drayton, S.,Rees, C.(1984).They know what they're doing.Nursing Mirror.159(5),IV-VIII.

Enkin, M.,Keirse, M. J. N. C.,Neilson, J.,Crowther, C.,Duley, L.,Hodnett, E.(2000).A guide to effective care in pregnancy and childbirth.New York:

Goer, H.(2004).Humanizing birth: A global grassroots movement.Birth.31(4),308-314.