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Intervention Review

Continuous support for women during childbirth

  1. Ellen D Hodnett1,*,
  2. Simon Gates2,
  3. G Justus Hofmeyr3,
  4. Carol Sakala4

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 18 JUL 2007

Assessed as up-to-date: 17 APR 2007

DOI: 10.1002/14651858.CD003766.pub2


How to Cite

Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub2.

Author Information

  1. 1

    University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada

  2. 2

    Warwick Medical School, University of Warwick, Warwick Clinical Trials Unit, Coventry, UK

  3. 3

    University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Department of Obstetrics and Gynaecology, East London Hospital Complex, East London, Eastern Cape, South Africa

  4. 4

    Childbirth Connection, Natick, Massachusetts, USA

*Ellen D Hodnett, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario, M5T 1P8 , Canada. ellen.hodnett@utoronto.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 JUL 2007

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

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 strategy

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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. 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.