Continuous Support for Women During Childbirth
Background to this systematic review
Questions and outcomes examined in the continuous support review
Ongoing work to use review results to educate professionals, women and the media and to improve practice
This review is descended from the first systematic review of controlled trial research of effects of labor support, which appeared in Effective Care in Pregnancy and Childbirth (1989). It has contributed to the development of policy statements and guidelines, legislation, and programs promoting continuous labor support in many countries throughout the world.
The most recent update incorporates six new randomized controlled trials, expands outcomes included in subgroup analyses, discriminates among three types of labor support companions in a subgroup analysis, and has been updated to reflect current methodologic guidelines.
Supportive care during labor does not include clinical care, and may involve helping women with physical comfort, providing emotional support, offering information, helping women communicate their wishes to caregivers, and engaging their spouses or partners, as desired by the couple.
The new review adhered to established Cochrane Collaboration procedures for limiting bias, including a thorough strategy for identifying relevant studies, eliminating relevant studies that are not methodologically adequate, and summarizing remaining "included studies" with meta-analysis when appropriate.
Subgroup analyses were planned to compare effects of continuous labor support in different birth environments, with different caregivers, and beginning at different times:
The review identified 17 outcomes of interest for the main comparison. Primary outcomes were as follows:
Pre-determined outcomes for subgroup analyses were: any analgesia/anesthesia, synthetic oxytocin during labor, spontaneous vaginal birth, cesarean birth, admission to special care nursery, and negative rating of the childbirth experience.
Continuous Support For Women During Childbirth review (PDF) compare all data that were available from all included studies for the specified outcomes of interest. Overall, women who received continuous support were less likely than women who did not to:
Women receiving continuous support were more likely than those who did not to:
Overall, continuous support did not seem to impact:
Data were not available to compare subgroups with onset of continuous support before and after active labor. Here are other subgroup analysis results:
Continuous support during labour should be the norm, rather than the exception. Hospitals should permit and encourage women to have a companion of their choice during labour and birth, and hospitals should implement programs to offer continuous support during labour… In present maternity care environments, benefits of continuous support are likely to be greater with companions who are not hospital staff members than with members of the hospital staff … Given the clear benefits and absence of adverse effects of continuous labour support, policymakers should consider including it as a covered service for all women.
The reviewers drew the following conclusions about areas warranting further research:
Ongoing work to use review results to educate professionals, women and the media and to improve practiceChildbirth connection carried out media outreach to publicize results of this review and regularly collaborates with DONA International, a major organization for doulas, caregivers who provide support to women during labor and in the early postpartum period. We collect and publicize data about women's knowledge of and experience with continuous support in our Listening to Mothers surveys. This website includes an in-depth Pregnancy Topic for childbearing women about the established benefits of continuous labor support, options for labor support companions, and strategies for arranging for labor support.
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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 of maternity care through research, education, advocacy and policy. Childbirth Connection promotes safe, effective and satisfying evidence-based maternity care and is a voice for the needs and interests of childbearing families.
Most recent page update: 3/12/2013