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Best Evidence: Labor SupportBest evidence: When making important maternity decisions, women should have information from the best available research about the safety and effectiveness of different choices. In general, we can be most confident about results of systematic reviews that summarize randomized controlled trials (or RCTs, a type of study). What is the bottom line about labor support? What is the best evidence about the benefits of continuous support during labor? Does it matter who provides continuous support in labor? Does labor support have the same impact in all types of birth settings? What factors most contribute to women's satisfaction in childbirth? What is the bottom line about labor support?Continuous support during labour has clinically meaningful benefits for women and infants and no known harm. All women should have support throughout labour and birth (Hodnett and colleagues 2011). What is the best evidence about the benefits of continuous support during labor?The review found that, in comparison with women who had continuous support, women who labored without continuous support had longer labors and were less likely to have a "spontaneous" birth (with neither cesarean section nor vacuum extraction, nor forceps). Women without support were more likely to:
Does it matter who provides continuous support in labor?The most recent systematic review looked closely at how effects of labor support varied by type of person providing labor support, and offers new knowledge (Hodnett and colleagues 2011).Effects were strongest when the person was neither a member of the hospital staff nor a person in the woman's social network, and was present solely to provide one-to-one supportive care. Compared with women who had no continuous support, women with companions (such as a doula) who were neither on the hospital staff nor in the woman's social network were:
Support provided by a member of the hospital staff (such as a nurse) did not seem to impact a woman's likelihood of having a cesarean or her satisfaction. The authors note that hospital employees may have divided loyalties and other duties, and may be influenced by hospital policies, which could limit the impact of their supportive care. Does labor support have the same impact in all types of birth settings?Hodnett and colleagues (2011) found that benefits of continuous labor support appeared to be greater when women received it in settings
What factors most contribute to women's satisfaction in childbirth?In considering whether to make arrangements for labor support, it may be helpful to consider results of research about satisfaction in childbirth. A systematic review of the best available research (Hodnett 2002) found that the following four factors made the greatest contribution to women's satisfaction in childbirth:
ReferencesHodnett ED. Pain and women's satisfaction with the experience of childbirth: a systematic review. Am J Obstet Gynecol 2002; 186(5) S160-72.Hodnett ED, Gates S, Hofmeyr G J, Sakala C, Weston J. Continuous support for women during childbirth [PDF]. Cochrane Database Syst Rev 2011, Issue 2. Most recent page update: 3/12/2013
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Childbirth Connection is a national not-for-profit organization founded in 1918 as Maternity Center Association. Our mission is to improve the quality and value of maternity care through consumer engagement and health system transformation. Childbirth Connection promotes safe, effective and satisfying evidence-based maternity care and is a voice for the needs and interests of childbearing families. |
News and Features
Listening to MothersSM III is the third national
survey exploring women’s experiences in pregnancy and childbirth.
Commissioned by Childbirth Connection, conducted by Harris Interactive, and
funded by the W.K. Kellogg Foundation, the survey polled 2,400 women who gave
birth in U.S. hospitals from 2011 to 2012. Results show that medically
intensive experiences are typical, and evidence-based practices are
underutilized. Childbearing women need better support and knowledge to
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