A Little Laboring Help From Your Friends

Continuous support during labor leads to more satisfied moms with fewer interventions

(RxWiki News) Giving birth can be a beautiful thing for women, but it's rarely easy. Fortunately, there are ways to support women during their pregnancies, labors and deliveries. And that support makes a difference.

A recent review of the research found that pregnant women who received continuous support during labor were happier with their experience than those who did not have someone there supporting them.

In addition, women with continuous support were slightly less likely to have medical interventions or to use pain medication.

The researchers also found that continuous support during labor did not harm the women or their babies in any way.

"Plan for someone to support you during labor."

This study, led by Ellen D. Hodnett of the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto in Canada, looked at the outcomes of pregnancies where women received continuous support through their labor.

Continuous support refers to an individual who remains with a woman throughout her labor, providing emotional support, comfort measures and information.

The authors of this study noted that this kind of support "...may enhance physiologic labor processes as well as women’s feelings of control and competence, and thus reduce the need for obstetric intervention."

Obstetric interventions may include induction of labor, use of forceps, cesarean section (C-section) or other possible medical interventions.

The authors sought all the studies that compared women's experiences when they did and did not have continuous support during labor.

They identified 22 trials that had data that could be analyzed. The trials involved 15,288 women.

The individuals providing support included a broad range of people: "...hospital staff (such as nurses or midwives), women who were not hospital employees and had no personal relationship to the laboring woman (such as doulas) or by companions of the woman's choice from her social network (such as her husband, partner, mother or friend)."

When the researchers analyzed all the data from all the studies together, they found that women who had continuous support during labor were more likely to be satisfied with their birth experience than those without continuous support.

Women with continuous support were slightly more likely (8 percent more likely) to have a "spontaneous vaginal birth," which means a birth that did not involve a C-section and did not require forceps or a vacuum to help deliver the baby.

More specifically, these women were 22 percent less likely to have a C-section and 10 percent less likely to need forceps in their baby's delivery.

Women with continuous support were also a little less likely (10 percent less likely) to use a pain medication during their labor.

These women were 31 percent less likely to report being dissatisfied with the experience of giving birth.

Women with continuous support during labor also had shorter labors, by an average of 35 minutes, compared to women without continuous support.

When their babies were born, women with continuous support were 31 percent less likely to have a baby whose Apgar score was low at birth.

The Apgar score is an assessment given at birth, on a scale of 1 to 10, that is used to identify how healthy the baby is.

"There was no apparent impact on other interventions [during delivery], maternal or neonatal complications or breastfeeding," the authors wrote.

"Continuous support during labour has clinically meaningful benefits for women and infants and no known harm," they wrote. "All women should have support throughout labour and birth."

These findings match up with the experience of Andre Hall, MD, a dailyRx Contributing Expert and an OB/GYN at Birth and Women's Care, PA in Fayetteville, NC.

"There has been a trend as of late to move toward continuous support during labor," Dr. Hall said. "This support is often provided by family members as restrictions have relaxed as to whom is allowed in the room during the labor and delivery process."

"In addition, midwifery care and doulas add additional services to women as they are laboring," he said. Doulas are "childbirth coaches" who are not medically trained to deliver a baby but who support a woman during labor and delivery.

"This study reflects what I have seen in practice," Dr. Hall said. "Women who have continuous support during labor and delivery report a more positive experience with the birth of their child when compared to women where support is lacking."

This study was published July 15 in The Cochrane Library. The research was funded partly by the National Institute for Health Research in the United Kingdom.

It also received internal funding through the University of Toronto, University of Witwatersrand in South Africa, Fort Hare University in South Africa, East London Hospital in South Africa, National Perinatal Epidemiology Unit in the UK, Childbirth Connection in the US and the University of Warwick in the UK.

Two authors have conducted previous study trials related to labor support. No other possible conflicts of interest were reported.

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Review Date: 
July 26, 2013