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Continuous support for women during childbirth
Abstract
Background:
Historically, women have generally been attended and supported by other women during labour. However, in hospitals worldwide, continuous support during labour has often become the exception rather than the routine.
Objectives:
The primary objective was to assess the effects, on women and their babies, of continuous, one-to-one intrapartum support compared with usual care, in any setting. Secondary objectives were to determine whether the effects of continuous support are influenced by:1. Routine practices and policies in the birth environment that may affect a woman's autonomy, freedom of movement and ability to cope with labour, including: policies about the presence of support people of the woman's own choosing; epidural analgesia; and continuous electronic fetal monitoring.2. The provider's relationship to the woman and to the facility: staff member of the facility (and thus has additional loyalties or responsibilities); not a staff member and not part of the woman's social network (present solely for the purpose of providing continuous support, e.g. a doula); or a person chosen by the woman from family members and friends;3. Timing of onset (early or later in labour);4. Model of support (support provided only around the time of childbirth or extended to include support during the antenatal and postpartum periods);5. Country income level (high-income compared to low- and middle-income).
Search methods:
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2016), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (1 June 2017) and reference lists of retrieved studies.
Selection criteria:
All published and unpublished randomised controlled trials, cluster-randomised trials comparing continuous support during labour with usual care. Quasi-randomised and cross-over designs were not eligible for inclusion.
Data collection and analysis:
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We sought additional information from the trial authors. The quality of the evidence was assessed using the GRADE approach.
Main results:
We included a total of 27 trials, and 26 trials involving 15,858 women provided usable outcome data for analysis. These trials were conducted in 17 different countries: 13 trials were conducted in high-income settings; 13 trials in middle-income settings; and no studies in low-income settings. Women allocated to continuous support were more likely to have a spontaneous vaginal birth (average RR 1.08, 95% confidence interval (CI) 1.04 to 1.12; 21 trials, 14,369 women; low-quality evidence) and less likely to report negative ratings of or feelings about their childbirth experience (average RR 0.69, 95% CI 0.59 to 0.79; 11 trials, 11,133 women; low-quality evidence) and to use any intrapartum analgesia (average RR 0.90, 95% CI 0.84 to 0.96; 15 trials, 12,433 women). In addition, their labours were shorter (MD -0.69 hours, 95% CI -1.04 to -0.34; 13 trials, 5429 women; low-quality evidence), they were less likely to have a caesarean birth (average RR 0.75, 95% CI 0.64 to 0.88; 24 trials, 15,347 women; low-quality evidence) or instrumental vaginal birth (RR 0.90, 95% CI 0.85 to 0.96; 19 trials, 14,118 women), regional analgesia (average RR 0.93, 95% CI 0.88 to 0.99; 9 trials, 11,444 women), or a baby with a low five-minute Apgar score (RR 0.62, 95% CI 0.46 to 0.85; 14 trials, 12,615 women). Data from two trials for postpartum depression were not combined due to differences in women, hospitals and care providers included; both trials found fewer women developed depressive symptomatology if they had been supported in birth, although this may have been a chance result in one of the studies (low-quality evidence). There was no apparent impact on other intrapartum interventions, maternal or neonatal complications, such as admission to special care nursery (average RR 0.97, 95% CI 0.76 to 1.25; 7 trials, 8897 women; low-quality evidence), and exclusive or any breastfeeding at any time point (average RR 1.05, 95% CI 0.96 to 1.16; 4 trials, 5584 women; low-quality evidence).Subgroup analyses suggested that continuous support was most effective at reducing caesarean birth, when the provider was present in a doula role, and in settings in which epidural analgesia was not routinely available. Continuous labour support in settings where women were not permitted to have companions of their choosing with them in labour, was associated with greater likelihood of spontaneous vaginal birth and lower likelihood of a caesarean birth. Subgroup analysis of trials conducted in high-income compared with trials in middle-income countries suggests that continuous labour support offers similar benefits to women and babies for most outcomes, with the exception of caesarean birth, where studies from middle-income countries showed a larger reduction in caesarean birth. No conclusions could be drawn about low-income settings, electronic fetal monitoring, the timing of onset of continuous support or model of support.Risk of bias varied in included studies: no study clearly blinded women and personnel; only one study sufficiently blinded outcome assessors. All other domains were of varying degrees of risk of bias. The quality of evidence was downgraded for lack of blinding in studies and other limitations in study designs, inconsistency, or imprecision of effect estimates.
Authors' conclusions:
Continuous support during labour may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter duration of labour, and decreased caesarean birth, instrumental vaginal birth, use of any analgesia, use of regional analgesia, low five-minute Apgar score and negative feelings about childbirth experiences. We found no evidence of harms of continuous labour support. Subgroup analyses should be interpreted with caution, and considered as exploratory and hypothesis-generating, but evidence suggests continuous support with certain provider characteristics, in settings where epidural analgesia was not routinely available, in settings where women were not permitted to have companions of their choosing in labour, and in middle-income country settings, may have a favourable impact on outcomes such as caesarean birth. Future research on continuous support during labour could focus on longer-term outcomes (breastfeeding, mother-infant interactions, postpartum depression, self-esteem, difficulty mothering) and include more woman-centred outcomes in low-income settings.
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This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2017, Issue 7. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review."
... The benefits of the presence of a birth companion also include the increasing number of spontaneous vaginal births, reduction of intrapartum analgesia, as well as the reduction of labor duration, c-sections and instrumental vaginal birth 2 . Besides, it has been associated with a more satisfying birth experience for the woman 5 and better 5-minute Apgar score after normal delivery 6 . ...
... The implementation of birth companions in health institutions, besides being a right guaranteed for women, helps to meet the good practices indicated by the WHO 4 . Besides, it collaborates with the increase of spontaneous vaginal deliveries, reduction of intrapartum analgesia, duration of labor, c-sections, instrumental vaginal births, and brings more satisfaction to women regarding the birth experience 6 . To guarantee the presence of a companion chosen freely by the Woman, it is essential that, since prenatal care, there are actions of education and promotion of health so that pregnant women be informed about such a right. ...
Objective
To verify the prevalence and identify the factors associated with the absence of birth companions among women in Southern Brazil.
Methods
This is a cross-sectional study carried out with 466 parturient women in a cohort of women from the urban area of the city of Pelotas, RS. At 18 months postpartum, a structured questionnaire was applied with sociodemographic, gestational data and questions related to childbirth. Logistic regression was performed to adjust for possible confounding factors.
Results
The prevalence of the absence of a birth companion among women was 22.3%. Parturient women with up to 8 schooling years (PR=2.0 [95%CI 1.1–3.8]), who did not live with a partner (PR=2.3 [95%CI 1.2–4.3]), who performed their prenatal care in the public sector (PR=1.9 [95%CI 1.0–3.7]) and who had a cesarean delivery (PR=6.0 [95%CI 2.9–12.4]) were more likely to not have had a birth companion.
Conclusion
The results shows relevant evidence for the verification of the presence of a companion in Southern Brazil, indicating the need for better use and adherence to this practice. In addition, the law that approves the presence of the birth companion in Brazil does not seem to be being fully implemented, disrespecting a right of parturient women and impacting the benefits for for maternal and child health.
Keywords:
Medical chaperones; Humanized delivery; Obstetric delivery; Birth
... Os benefícios da presença do acompanhante de parto também abrangem o aumento de partos vaginais espontâneos, redução da analgesia intraparto, bem como redução da duração do trabalho de parto, da cesariana e do parto vaginal instrumental 2 . Além disso, tem sido associada a uma maior satisfação da mulher com a experiência do nascimento 5 e melhores pontuações no Apgar de 5 minutos do bebê após o parto via baixa 6 . ...
... A implementação do acompanhante de parto nas instituições de saúde, além de ser um direito garantido para as mulheres, auxilia o cumprimento das boas práticas indicadas pela OMS 4 . Além disso, auxilia no aumento de partos vaginais espontâneos, redução da analgesia intraparto, da duração do trabalho de parto, da cesariana, do parto vaginal instrumental e traz maior satisfação para a mulher com a experiência do nascimento 6 . Para assegurar a presença do acompanhante de livre escolha da mulher, é imprescindível que desde o pré-natal haja ações de educação e pro-moção em saúde, para que as gestantes sejam informadas sobre esse direito. ...
Objective
To verify the prevalence and identify the factors associated with the absence of birth companions among women in Southern Brazil.
Methods
This is a cross-sectional study carried out with 466 parturient women in a cohort of women from the urban area of the city of Pelotas, RS. At 18 months postpartum, a structured questionnaire was applied with sociodemographic, gestational data and questions related to childbirth. Logistic regression was performed to adjust for possible confounding factors.
Results
The prevalence of the absence of a birth companion among women was 22.3%. Parturient women with up to 8 schooling years (PR=2.0 [95%CI 1.1–3.8]), who did not live with a partner (PR=2.3 [95%CI 1.2–4.3]), who performed their prenatal care in the public sector (PR=1.9 [95%CI 1.0–3.7]) and who had a cesarean delivery (PR=6.0 [95%CI 2.9–12.4]) were more likely to not have had a birth companion.
Conclusion
The results shows relevant evidence for the verification of the presence of a companion in Southern Brazil, indicating the need for better use and adherence to this practice. In addition, the law that approves the presence of the birth companion in Brazil does not seem to be being fully implemented, disrespecting a right of parturient women and impacting the benefits for for maternal and child health.
Keywords:
Medical chaperones; Humanized delivery; Obstetric delivery; Birth
... Whilst trauma responses are individual, a substantial body of research highlights the fact that negative interactions with caregivers during birth are associated with suboptimal outcomes. [27,28] Women with CB-PTSD report that poor support during birth contributed significantly to their CB-PTSD, with negative encounters with staff contributing to negative birth experiences, increasing risk of CB-PTSD. [29,30] Whilst every negative interaction in maternity care does not constitute mistreatment, various types of mistreatment have been identified by the WHO, [16] the International Federation of Gynecology and Obstetrics, [31] and research. ...
... 81 In fact, any kind of one-on-one continuous support, even from a stranger, predicts fewer interventions and greater birth satisfaction than being without such support. 82 Mothers' relatedness with their own infants is also disrupted by many common birth practices. Relatedness between the mother and infant, embodied in bonding and breastfeeding, is a typical outcome of a healthy birth. ...
Women often report being dissatisfied with their childbirth experience, which in turn predicts negative outcomes for themselves and their children. Currently, there is no consensus as to what constitutes a satisfying or positive birth experience. We posit that a useful framework for addressing this question already exists in the form of Basic Psychological Needs Theory, a subtheory of Self‐Determination Theory (Deci & Ryan, Can. Psychol., 49, 2008, 182). Specifically, we argue that the degree to which maternity care practitioners support or frustrate women's needs for relatedness, competence, and autonomy predicts their childbirth satisfaction. Using this framework provides a potentially powerful lens to better understand and improve the well‐being of new mothers and their infants.
... 5 Notably, the recommendations emphasise respectful maternity care practices to improve experiences of care that are often overlooked or de-prioritised in maternity care settings, including labour companionship, effective communication, pain relief and encouraging women to mobilise and adopt a birth position of choice during labour. [5][6][7][8][9][10][11][12] Monitoring and evaluation include collecting and regularly assessing data on predefined indicators that can reliably measure the use of selected clinical practices as well as important health, experience and satisfaction outcomes. 13 14 Standardised monitoring of the implementation of clinical guideline recommendations is essential to the delivery of evidence-based care, as monitoring can help to identify areas of strength and areas for improvement. ...
Objective
We aimed to identify all available studies describing measures or indicators used to monitor 41 intrapartum care practices described in the 2018 WHO intrapartum care recommendations, with a view to informing development of standardised measurement of implementing these recommendations.
Design
Systematic scoping review.
Methods
We conducted a scoping review to identify studies reporting measures of intrapartum care published between 1 January 2000 and 28 June 2021. Primary and secondary outcome measures included study characteristics (publication year, journal, country and World Bank classification) and intrapartum care measure characteristics (definition, numerator, denominator, measurement level and measurement approach). We searched MEDLINE, EMBASE, CINAHL, Cochrane Library, the Maternity and Infant Care Database, Global Index Medicus and grey literature using structured search terms related to included recommendations, focusing on respectful and supportive care, and clinical practices performed throughout labour and birth. The measures identified were classified by the WHO recommendation and their characteristics reported.
Results
We identified 150 studies which described 1331 intrapartum care measures. These measures corresponded to 35 of the 41 included WHO recommendations, and represented all domains of the WHO recommendations (care throughout labour and birth, first stage of labour, second stage of labour, third stage of labour). A total of 40.1% (534 of 1331 measures) of measures were related to respectful maternity care. Most studies used a questionnaire or survey measurement approach (522 of 1331 measures, 39.2%).
Conclusion
This scoping review presents a database of existing intrapartum care measures used to monitor the quality of intrapartum care globally. There is no clear consensus on a core set of measures for evaluating the practice of the WHO’s intrapartum care recommendations. This review provides a foundation to support the development of a core set of internationally standardised intrapartum care measures for the WHO intrapartum care recommendations, highlighting key areas requiring consensus and validation, and measure development.
Childbirth is a remarkable, life-changing process and is frequently regarded as an excruciating,
physically and emotionally demanding experience that women endure. Labor pain management
poses a significant challenge for obstetricians and expectant mothers. Although pharmacological
pain management is the gold standard, it still imposes risks on the mother and baby. Recently, nonpharmacological
pain management (NPPM) has emerged as a safe, effective option. Six databases
were searched for articles published up to 2023 using specific related keywords and defined inclusion
and exclusion criteria. The extraction and gathering of data was made so as to be categorized into
physical, psychological, and complementary NPPM techniques. In light of the enormous development
and diversity of NPPM techniques, the present review aims to examine contemporary NPPM
knowledge and application, discussing efficacy, advantages, limitations, and potential adverse effects,
with a specific focus on women’s individual requirements, to strengthen obstetricians’ knowledge in
guiding decision-making for women in childbirth.
This is a protocol for a Cochrane Review (Qualitative). The objectives are as follows:
The overall objective of the review is to describe and explore the perceptions and experiences of women, partners, community members, healthcare providers and administrators, and other key stakeholders who have experience with a labour companion. The review has the following objectives.
To identify, appraise and synthesise qualitative research evidence on women’s, partners’, community members’, healthcare providers’ and administrators’, and other key stakeholders’ perceptions and experiences regarding labour companionship in health facilities.
To identify barriers and facilitators to successful implementation and sustainability of labour companionship.
To explore how the findings of this review can enhance our understanding of the related intervention review (Hodnett 2013).
This report synthesizes evidence about innate hormonally-mediated physiologic processes in women
and fetuses/newborns during childbearing, and possible impacts of common maternity care practices
and interventions on these processes, focusing on four hormone systems that are consequential for
childbearing. Core hormonal physiology principles reveal profound interconnections between mothers
and babies, among hormone systems, and from pregnancy through to the postpartum and newborn periods.
Overall, consistent and coherent evidence from physiologic understandings and human and animal
studies finds that the innate hormonal physiology of childbearing has significant benefits for mothers
and babies. Such hormonally-mediated benefits may extend into the future through optimization of
breastfeeding and maternal-infant attachment. A growing body of research finds that common maternity
care interventions may disturb hormonal processes, reduce their benefits, and create new challenges.
Developmental and epigenetic effects are biologically plausible but poorly studied. The perspective of
hormonal physiology adds new considerations for benefit-harm assessments in maternity care, and suggests
new research priorities, including consistently measuring crucial hormonally-mediated outcomes
that are frequently overlooked. Current understanding suggests that safely avoiding unneeded maternity
care interventions would be wise, as supported by the Precautionary Principle. Promoting, supporting,
and protecting physiologic childbearing, as far as safely possible in each situation, is a low-technology
health and wellness approach to the care of childbearing women and their fetuses/newborns that is
applicable in almost all maternity care settings.
Background:
Supportive care during labor, the primary role of intrapartum nurses and midwives, provides comfort to prepartum women and helps facilitate a positive labor experience. It has been argued that supportive care during labor reduces fear and anxiety as well as the resultant side effects. However, evidence supporting this argument is insufficient.
Purpose:
The aim of this study was to assess the effects of intrapartum supportive care on fear of delivery and on the key parameters of the labor process.
Methods:
This study used a single-blind randomized controlled trial approach. Randomized block assignment was used to assign 72 participants to either the intervention group (n = 36) or the control group (n = 36). Three women in the intervention group and six in the control group were later excluded from the study because they received emergency cesarean delivery. The intervention group received continuous supportive care, and the control group received routine hospital care.
Results:
No significant differences were identified between the two groups at baseline. The intervention group reported less fear of delivery during the active and transient phases of labor, higher perceived support and control during delivery, lower pain scores during the transient phase of labor, and a shorter delivery period than the control group (p < .05). However, no significant difference in the use of oxytocin during delivery between the two groups was reported.
Conclusions/implications for practice:
The results of this evidence-based study suggest that continuous support during labor has clinically meaningful benefits for women and that all women should receive this support throughout their labor and delivery process.
Objective:
The purpose of this guideline is to provide guidance for the intrapartum management of spontaneous labour, whether normal or abnormal, in term, healthy women, and to provide guidance in the management of first and second stage dystocia to increase the likelihood of a vaginal birth and optimize birth outcomes.
Evidence:
Published literature was retrieved through searches of PubMed and the Cochrane Library in October 2011 using appropriate, controlled vocabulary (e.g., labour pain; labour, obstetric; dystocia) and key words (e.g., obstetric labor, perineal care, dysfunctional labor). When appropriate, results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Results were limited to the last 10 years. Searches were updated on a regular basis and incorporated in the guideline up to June 15, 2015.
Values:
The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1).
Summary statements:
RECOMMENDATIONS.
Background: Historically, women have been attended and supported by other women during labour. However, in hospitals worldwide, continuous support during labour has become the exception rather than the routine. Objectives: Primary: to assess the effects of continuous, one-to-one intrapartum support compared with usual care. Secondary: to determine whether the effects of continuous support are influenced by: (1) routine practices and policies; (2) the provider's relationship to the hospital and to the woman; and (3) timing of onset. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2013). Selection criteria: All published and unpublished randomised controlled trials comparing continuous support during labour with usual care. Data collection and analysis: We used standard methods of The Cochrane Collaboration Pregnancy and Childbirth Group. Two review authors independently evaluated methodological quality and extracted the data. We sought additional information from the trial authors. We used random-effects analyses for comparisons in which high heterogeneity was present, and we reported results using the average risk ratio (RR) for categorical data and mean difference (MD) for continuous data. Main results: Twenty-two trials involving 15,288 women met inclusion criteria and provided usable outcome data. Results are of random-effects analyses, unless otherwise noted. Women allocated to continuous support were more likely to have a spontaneous vaginal birth (RR 1.08, 95% confidence interval (CI) 1.04 to 1.12) and less likely to have intrapartum analgesia (RR 0.90, 95% CI 0.84 to 0.96) or to report dissatisfaction (RR 0.69, 95% CI 0.59 to 0.79). In addition, their labours were shorter (MD -0.58 hours, 95% CI -0.85 to -0.31), they were less likely to have a caesarean (RR 0.78, 95% CI 0.67 to 0.91) or instrumental vaginal birth (fixed-effect, RR 0.90, 95% CI 0.85 to 0.96), regional analgesia (RR 0.93, 95% CI 0.88 to 0.99), or a baby with a low five-minute Apgar score (fixed-effect, RR 0.69, 95% CI 0.50 to 0.95). There was no apparent impact on other intrapartum interventions, maternal or neonatal complications, or breastfeeding. Subgroup analyses suggested that continuous support was most effective when the provider was neither part of the hospital staff nor the woman's social network, and in settings in which epidural analgesia was not routinely available. No conclusions could be drawn about the timing of onset of continuous support. Authors' conclusions: 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.
Aim: To determine of continuous, effective and comfortable nursing care can lower the occurrence of negative psychology and reduce complications during the parturient period. Methods: 240 parturient women hospitalized at Department of Obstetrics and Gynecology, Affiliated Hospital, Zunyi Medical College from July 2004 to February 2005 were divided into two groups at random: 120 patients treated with comfortable nursing as observation group, providing comfortable environment, psychological communication for parturient with accompanying of family members. 120 patients in the control group received routine care to dispose the whole birth process. The numbers of the people who had the manifestation of anxiety, fear, adamancy, rivalry, depression and common etc. were compared between the two groups. The condition of active time in the first birth process was compared between the two groups. The effects of the two kinds of nursing cares on the birth process and parturition manner in the process of birth were compared. The quantity of bleeding was compared between the time of birth and the time after birth of the two groups. The incidence was compared between the anoxia of newborn in the two groups. Results: Totally 240 gravidas were involved in the result analysis without drop. 1 Comparison of the mental state in the parturient of the two groups: Common people were 87 cases and 21 cases, respectively. The number of anxiety, fear, adamancy, rivalry, depressive positive people, and there was significant difference of the general positive rate (21, 42; 2, 13; 7, 21; 0, 9; 3, 14; 27.50%,82.50%; χ2=73.3, P < 0.001). 2 Comparison of the birth process between the parturient in the two groups: The average value in active phase of the first stage of birth and the general process of birth in the observation group was lower than that in the control group [(145.6±34.9), (275.3±74.6) minutes; (436.6±128.7), (648.3±134.6) minutes; t=17.25, 12.45, P < 0.001]. 3 Comparison of the parturition manners, natural parturition and condition of birth difficulty of the parturient in the two groups: 109 cases were natural parturient by vagina, 8 cases were dissected the womb to birth and 3 cases were aided to birth by cephalotracter and suck the placenta in the observation group. Sixty-nine cases were natural parturient by vagina, 42 cases were dissected the womb to birth and 9 cases were aided to birth by cephalotracter and suck the placenta in the control group, and there were significant differences between the two groups (χ2=34.8, P < 0.001). 4 Comparison of the quantity of bleeding between the time of birth and the time after birth of the two groups: The average value in the observation group was significantly lower than that in the control group [(169±43.5), (192±31.6) mL;t=4.68, P < 0.001]. 5 Comparison of the Apgar score in the neonates of the two groups: The Apgar score was ≥ 8 points of the neonates in the observation group, which was higher than that in the control group (115, 97 cases, χ2=13.1, P < 0.001). Conclusion: Continuous, effective and comfortable nursing can keep parturients in a relaxing, pleasant, comfortable and confident state-of-mind, thus, it is beneficial to reduce the parturition complication.