Strategies for reducing maternal mortality: getting on with what works

Historically women have been attended and supported by other women during labour and birth However in many countries, as more women are giving birth in hospital rather than at home, continuous support during labour has become the exception rather than the norm This may contribute to the dehumanisation of women's childbirth experiences Modern obstetric care frequently subjects women to institutional routines, which may have adverse effects on the progress of labour Supportive care during labour may involve emotional support, comfort measures, information and advocacy These may enhance physiologic labour processes as well as women's feelings of control and competence, and thus reduce the need for obstetric intervention The review of studies included 23 trials (22 providing data), from 16 countries, involving more than 15,000 women in a wide range of settings and circumstances The continuous support was provided either by hospital staff (such as nurses or midwives), women who were not hospital employees and had no personal relationship to the labouring woman (such as doulas or women who were provided with a modest amount of guidance), or by companions of the woman's choice from her social network (such as her husband, partner, mother, or friend) Women who received continuous labour support were more likely to give birth 'spontaneously', ie give birth with neither caesarean nor vacuum nor forceps In addition, women were less likely to use pain medications, were more likely to be satisfied, and had slightly shorter labours Their babies were less likely to have low five-minute Apgar scores No adverse effects were identified We conclude that all women should have continuous support during labour Continuous support from a person who is present solely to provide support, is not a member of the woman's social network, is experienced in providing labour support, and has at least a modest amount of training, appears to be most beneficial In comparison with having no companion during labour, support from a chosen family member or friend appears to increase women's satisfaction with their childbearing experience

Continuous support for women during childbirth.

Safe prevention of the primary cesarean delivery

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(14)60792-3.pdf

Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(14)60789-3.pdf

Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care

Background: Historically, women have been attended and supported by other women during labour. However, in recent decades in hospitals worldwide, continuous support during labour has become the exception rather than the routine. Concerns about the consequent dehumanization of women's birth experiences have led to calls for a return to continuous support by women for women during labour.



Objectives:  Primary: to assess the effects, on mothers and their babies, 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 in the birth environment that may affect a woman's autonomy, freedom of movement, and ability to cope with labour; (2) whether the caregiver is a member of the staff of the institution; and (3) whether the continuous support begins early or later in labour.



Search strategy:  We searched the Cochrane Pregnancy and Childbirth Group trials register (30 January 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003).



Selection criteria:  All published and unpublished randomized controlled trials comparing continuous support during labour with usual care.



Data collection and analysis:  Standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group were used. All authors participated in evaluation of methodological quality. Data extraction was undertaken independently by one author and a research assistant. Additional information was sought from the trial authors. Results are presented using relative risk for categorical data and weighted mean difference for continuous data.



Main results:  Fifteen trials involving 12,791 women are included. Primary comparison: Women who had continuous intrapartum support were less likely to have intrapartum analgesia, operative birth, or to report dissatisfaction with their childbirth experiences. Subgroup analyses: In general, continuous intrapartum support was associated with greater benefits when the provider was not a member of the hospital staff, when it began early in labour, and in settings in which epidural analgesia was not routinely available.



Reviewers’ conclusions:  All women should have support throughout labour and birth.



Citation:  Hodnett ED, Gates S, Hofmeyr G J, Sakala C. Continuous support for women during childbirth (Cochrane Review). In: The Cochrane Library, Issue 3, 2004. Chichester, UK: John Wiley & Sons, Ltd. •••The preceding report is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X). The Cochrane Library is designed and produced by Update Software Ltd, and published by John Wiley & Sons, Ltd.

G.J. Hofmeyr

Papers

Continuous Support for Women During Childbirth

Continuous support for women during childbirth (Review)