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 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.

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What does research say about labor support?

The largest systematic review of continuous labor support is available here. It summarizes the experiences of more than 15,000 women who participated in 22 randomized controlled trials.

The authors conclude:

  • Continuous support during labor has clinically meaningful benefits for women and infants and no known harm. All women should have support throughout labor and birth.Hodnett, E.D., Gates, S., Hofmeyr, G.J., Sakala, C., & Weston, J. (2013). Continuous support for women during childbirth.Cochrane Database of Systematic Reviews, 2.
  • 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). Women with continuous labor support were also 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 wellbeing five minutes after birth).
    • Be dissatisfied with or negatively rate their childbirth experience..Hodnett, E.D., Gates, S., Hofmeyr, G.J., Sakala, C., & Weston, J. (2013). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 2.

Does it really matter who provides labor support?

Recent research looked at how having different people provide labor support affected the birthing process.Hodnett, E.D., Gates, S., Hofmeyr, G.J., Sakala, C., & Weston, J. (2013). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 2.

The study found that, compared with women who had no continuous support, women with companions (such as doulas) who were not on the hospital staff and were notthe woman’s partner, friend or relative were:

  • 28 percent less likely to have a C-section
  • 31 percent less likely to use synthetic oxytocin to speed up labor
  • 9 percent less likely to use any pain medication
  • 34 percent less like to rate their childbirth experience negatively

In comparison with women who had no labor support, women who got support from a partner, spouse, other family member or friend experienced greater satisfaction and the likelihood of her experiencing interventions (C-section, etc.) was not affected.

Relative to no labor support, support provided by a member of the hospital staff (such as a nurse) did not seem to affect a woman's likelihood of having a C-section, using pain medications or her satisfaction. She was more likely to use synthetic oxytocin. 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?

Hodnett and colleagues (2013)Hodnett, E.D., Gates, S., Hofmeyr, G.J., Sakala, C., & Weston, J. (2013). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 2. 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)
  • That used periodic listening to the fetal heart rate (intermittent auscultation) or periodic electronic fetal monitoring (versus settings where continuous electronic fetal monitoring 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. finds 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)

Choosing a maternity care provider and a birth setting with care providers who can offer this type of care can make a big difference in your satisfaction!