Continuous support for women during childbirth
Abstract
Background
Historically, women have been attended and supported by other women during labour. However, in recent decades in hospitals worldwide, continuous support during labour has become the exception rather than the routine. Concerns about the consequent dehumanization of women's birth experiences have led to calls for a return to continuous support by women for women during labour.
Objectives
Primary: to assess the effects, on mothers and their babies, of continuous, one‐to‐one intrapartum support compared with usual care. Secondary: to determine whether the effects of continuous support are influenced by: (1) routine practices and policies in the birth environment that may affect a woman's autonomy, freedom of movement and ability to cope with labour; (2) whether the caregiver is a member of the staff of the institution; and (3) whether the continuous support begins early or later in labour.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2007).
Selection criteria
All published and unpublished randomized controlled trials comparing continuous support during labour with usual care.
Data collection and analysis
We used standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group. All authors participated in evaluation of methodological quality. One author and a research assistant independently extracted the data. We sought additional information from the trial authors. We used relative risk for categorical data and weighted mean difference for continuous data to present the results.
Main results
Sixteen trials involving 13,391 women met inclusion criteria and provided usable outcome data. Primary comparison: women who had continuous intrapartum support were likely to have a slightly shorter labour, were more likely to have a spontaneous vaginal birth and less likely to have intrapartum analgesia or to report dissatisfaction with their childbirth experiences. Subgroup analyses: in general, continuous intrapartum support was associated with greater benefits when the provider was not a member of the hospital staff, when it began early in labour and in settings in which epidural analgesia was not routinely available.
Authors' conclusions
All women should have support throughout labour and birth.
PICOs
Plain language summary
Continuous support for women during childbirth
Continuous support in labour increased the chance of a spontaneous vaginal birth, had no identified adverse effects and women were more satisfied.
Historically women have been attended and supported by other women during labour and birth. However in many countries these days, as more women are giving birth in hospital rather than at home, continuous support during labour has become the exception rather than the norm. This has raised concerns about the consequent dehumanization of women's childbirth experiences. Modern obstetric care frequently subjects women to institutional routines, which may have adverse effects on the progress of labour. Supportive care during labour may involve emotional support, comfort measures, information and advocacy. These may enhance normal labour processes as well as women's feelings of control and competence, and thus reduce the need for obstetric intervention. The review of studies included 16 trials, from 11 countries, involving over 13,000 women in a wide range of settings and circumstances. Women who received continuous labour support were more likely to give birth 'spontaneously', i.e. give birth with neither caesarean nor vacuum nor forceps. In addition, women were less likely to use pain medications, were more likely to be satisfied, and had slightly shorter labours. In general, labour support appeared to be more effective when it was provided by women who were not part of the hospital staff. It also appeared to be more effective when commenced early in labour. No adverse effects were identified.
