Best Evidence: Labor Support



Best 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?

The most recent and largest systematic review (PDF) of continuous labor support is available in full right on this website, along with a brief overview of the review. It summarizes the experiences of over 15,000 women who participated in 21 randomized controlled trials. The authors conclude:
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:
  • have an epidural or other "regional" analgesia to manage pain
  • use any type of pain medication (including narcotics)
  • give birth by cesarean section
  • give birth with vacuum extraction or forceps
  • give birth to a baby with a low Apgar score rating of well being 5 minutes after birth
  • be dissatisfied with or negatively rate their childbirth experience (Hodnett and colleagues 2011).

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:
  • 28% less likely to have a cesarean section
  • 31% less likely to use synthetic oxytocin to speed up labor
  • 9% less likely to use any pain medication
  • 34% less like to rate their childbirth experience negatively.
Support provided by a person that the woman selected from her social network (for example, her partner, spouse, other family member, or friend) increased her satisfaction, but did not seem to impact her use of obstetric interventions.

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
  • that did not allow them to bring companions of choice (versus settings that do allow spouses, friends, etc.)
  • where epidural analgesia was not routine (versus settings where epidural is routine) 
  • that allowed intermittent auscultation (periodic listening to the fetal heart rate) or intermittent electronic fetal monitoring (versus settings where continuous electronic fetal monitoring is routine).

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:
  • having good support from caregivers
  • having a high-quality relationship with caregivers
  • being involved in decision-making about care
  • having better-than-expected experiences, or having high expectations.
Arranging for labor support may make a big difference in your childbirth experience!



References

Hodnett 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.

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Tips & Tools: Labor Support

Most recent page update: 3/12/2013


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