Continuous support for women during childbirth
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. ISSN 1469-493XFull text not available from this repository.
Official URL: http://dx.doi.org/10.1002/14651858.CD003766.pub3
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.
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.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2010).
All published and unpublished randomized controlled trials comparing continuous support during labour with usual care.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.
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.
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 Medicine > Warwick Medical School|
|Journal or Publication Title:||Cochrane Database of Systematic Reviews|
|Publisher:||John Wiley & Sons Ltd.|
|Book Title:||Cochrane Database of Systematic Reviews|
|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|
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