Research and Evidence
"Evidence-based maternity care" means using results of the best research about the safety and effectiveness of specific tests, treatments and other interventions to help guide maternity care decisions. In this section, we review the best research available about labor support to help you understand the risks (none are known!) and benefits and make your own informed decision. We strongly encourage you to read the Maternity Care section for more information about maternity care decision-making and the role evidence plays.
What does research say about labor support?
The largest systematic review of continuous labor support was updated in 2017. The full review and an overview are available here. The review summarizes the experiences of 15,858 women who participated in 26 randomized controlled trials (a rigorous type of study).
The studies found that:
- Continuous support during labor has clinically meaningful benefits for women and infants and no known harms.Bohren, M.A., Hofmeyr, G.J., Sakala, C., Fukuzawa, R.K., & Cuthbert, A. (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 2017(7), 1-162.
- Compared with women who had usual care (no labor support), women who labored with continuous support had shorter labors and were more likely to have a "spontaneous" birth (with neither cesarean section nor vacuum extraction, nor forceps). And women with continuous labor support were less likely to:
- Have an epidural or other "regional" analgesia to manage pain.
- Use any type of pain medication (including narcotics).
- Give birth by C-section.
- Give birth with vacuum extraction or forceps.
- Give birth to a baby with a low Apgar score (a rating of the baby’s well-being five minutes after birth).
- Be dissatisfied with or negatively rate their childbirth experience.Bohren, M.A., Hofmeyr, G.J., Sakala, C., Fukuzawa, R.K., & Cuthbert, A. (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 2017(7), 1-162.
This is a very impressive set of benefits for laboring women and their newborns! Further, unusual among health care interventions, continuous labor support has no known harms.
Other benefits that were found in fewer studies with fewer women. More studies and women are needed to help clarify whether they are true effects of continuous support.
Does it really matter who provides labor support?
The review looked at how having different types of people provide continuous labor support affected the birthing experience.Bohren, M.A., Hofmeyr, G.J., Sakala, C., Fukuzawa, R.K., & Cuthbert, A. (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 2017(7), 1-162.
In looking at six selected outcomes, it found that women with companions (such as doulas) who were not on the hospital staff and were not the woman’s partner, friend or relative experienced the greatest - and quite impressive - benefits. Compared with women with no labor support, those with a labor companion such as a doula were:
- 39 percent less likely to have a C-section
- 35 percent less likely to rate their childbirth experience negatively
- 15 percent more likely to have a "spontaneous" vaginal birth (no forceps or vacuum extraction)
The review also found that women with labor support from someone in doula role were notably less likely than women with no labor support to use synthetic oxytocin (pitocin or "pit") to speed up labor, to use any pain medication while giving birth and to have their babies admitted to a special care nursery. However, these results were based on fewer studies and women, and the groups were not significantly different in statistical tests. More studies are needed to help understand whether these are true effects.
In comparison with women who had no labor support, women who got support from a partner, spouse, other family member or friend also were less likely to rate their birth experience poorly. However, their likelihood of experiencing interventions (C-section, etc.) was not different from women with usual care.
Relative to no labor support, support provided by a member of the hospital staff (such as a nurse) did not seem to affect women's likelihood of having a C-section, their use of synthetic oxytocin or their ratings of their birth experience. Women with "staff" support were slightly more likely to have a spontaneous vaginal birth, and slightly less likely to use pain medications. The study authors note that hospital employees may have other duties and/or be limited in their ability to offer labor support by hospital policies.
Does labor support have the same impact in all types of birth settings?
Bohren and colleagues (2017)Bohren, M.A., Hofmeyr, G.J., Sakala, C., Fukuzawa, R.K., & Cuthbert, A. (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 2017(7), 1-162. found that benefits of continuous labor support appeared to be greater when women gave birth in places:
- 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)
What is most important to making sure I have a satisfying childbirth experience?
A systematic review of the best available researchHodnett, E.D. (2002). Pain and women's satisfaction with the experience of childbirth: a systematic review. American Journal of Obstetrics and Gynecology, 186(5), S160-72. found that the following four factors make the greatest contribution to women's satisfaction in childbirth:
- Having good support from care providers
- Having a high-quality relationship with care providers
- Being involved in decision-making about care
- Having better-than-expected experiences (or having high expectations)