Hodnett, Ellen D., Gates, Simon, Hofmeyr, G. Justus, Sakala, Carol and Weston, Julie (2011) Continuous support for women during childbirth. Cochrane Database of Systematic Reviews (No.2). CD003766. doi:10.1002/14651858.CD003766.pub3

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Abstract

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 strategy

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2010).

Selection criteria

All published and unpublished randomized controlled trials comparing continuous support during labour with usual care.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 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 risk ratio for categorical data and mean difference for continuous data.

Main results

Twenty-one trials involving 15061 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% CI 1.04 to 1.12) and less likely to have intrapartum analgesia (RR 0.90, 95% CI 0.84 to 0.97) or to report dissatisfaction (RR 0.69, 95% CI 0.59 to 0.79). In addition their labours were shorter (mean difference -0.58 hours, 95% CI -0.86 to -0.30), they were less likely to have a caesarean (RR 0.79, 95% CI 0.67 to 0.92) or instrumental vaginal birth (fixed-effect, RR 0.90, 95% CI0.84 to 0.96), regional analgesia (RR 0.93, 95% CI 0.88 to 0.99), or a baby with a low 5-minute Apgar score (fixed-effect, RR 0.70, 95% CI 0.50 to 0.96). There was no apparent impact on other intrapartum interventions, maternal or neonatal complications, or on breastfeeding. Subgroup analyses suggested that continuous support was most effective when provided by a woman who 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.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General) R Medicine > RG Gynecology and obstetrics
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Journal or Publication Title:	Cochrane Database of Systematic Reviews
Publisher:	John Wiley & Sons Ltd.
ISSN:	1469-493X
Book Title:	Cochrane Database of Systematic Reviews
Official Date:	2011
Dates:	Date Event 2011 Published
Number:	No.2
Page Range:	CD003766
DOI:	10.1002/14651858.CD003766.pub3
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Funder:	University of Toronto, Canada , University of the Witwatersrand, South Africa , Fort Hare University, South Africa , East London Hospital Complex, South Africa , National Perinatal Epidemiology Unit, Oxford, UK , Childbirth Connection (formerly Maternity Center Association), USA , Warwick Clinical Trials Unit, University of Warwick, UK

Data sourced from Thomson Reuters' Web of Knowledge

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