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Continuous support for women during childbirth.
Meghan A Bohren1, G Justus Hofmeyr, Carol Sakala
1Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, Geneva, Geneve, Switzerland, 1211.
The Cochrane Database of Systematic Reviews
|July 7, 2017
Summary
Continuous labor support for women during childbirth improves outcomes, leading to more spontaneous vaginal births and fewer cesarean births. This support also shortens labor duration and enhances the overall childbirth experience, with no observed harms.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Evidence-Based Midwifery
Background:
- Historically, women received continuous support during labor from other women.
- Continuous intrapartum support has become uncommon in hospital settings globally.
Purpose of the Study:
- To evaluate the effects of continuous, one-to-one intrapartum support versus usual care on mothers and newborns.
- To explore how factors like birth environment policies, provider relationship, timing, model of support, and country income level influence these effects.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) and cluster-RCTs.
- Searched multiple databases including Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, and ICTRP.
- Included 26 trials with 15,858 women; assessed risk of bias and used GRADE for evidence quality.
Main Results:
- Continuous support increased spontaneous vaginal birth rates (RR 1.08) and decreased cesarean births (RR 0.75) and instrumental births (RR 0.90).
- Labor duration was shorter (MD -0.69 hours), and women reported fewer negative childbirth experiences (RR 0.69) and less need for analgesia.
- Subgroup analyses indicated greater benefits in settings without routine epidural analgesia or with restrictions on chosen support persons; middle-income countries showed larger reductions in cesarean births.
Conclusions:
- Continuous labor support positively impacts maternal and infant outcomes, including higher spontaneous vaginal birth rates and reduced interventions.
- No evidence of harm associated with continuous support; potential benefits are influenced by provider type and setting characteristics.
- Further research should investigate long-term outcomes and include more woman-centered outcomes in low-income settings.
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