Continuous emotional support during labor in a US hospital. A randomized controlled trial. A randomized trial of one-to-one nurse support of women in labor. Effects of social support during parturition on maternal and infant morbidity. Effect of continuous support during labor on duration of labor and rate of cesarean delivery. Effects of labor support from close female relative on labor and maternal satisfaction in a Thai setting. Effects of continuous intrapartum professional support on childbirth outcomes. Effectiveness of nurses as providers of birth labor support in North American hospitals: a randomized controlled trial. Evaluation of different policies for the management of labour. Assessment of the effect of psychosocial support during childbirth in Ibadan, south-west Nigeria: a randomised controlled trial.
The continuous presence of a supportive companion (doula) during labor and delivery in two studies in Guatemala shortened labor and reduced the need for cesarean section and other interventions. In a US hospital with modern obstetric practices, 412 healthy nulliparous women in labor were randomly assigned to a supported group (n = 212) that received the continuous support of a doula or an observed group (n = 200) that was monitored by an inconspicuous observer. Two hundred four women were assigned to a control group after delivery. Continuous labor support significantly reduced the rate of cesarean section deliveries (supported group, 8%; observed group, 13%; and control group, 18%) and forceps deliveries. Epidural anesthesia for spontaneous vaginal deliveries varied across the three groups (supported group, 7.8%; observed group, 22.6%; and control group, 55.3%). Oxytocin use, duration of labor, prolonged infant hospitalization, and maternal fever followed a similar pattern. The beneficial effects of labor support underscore the need for a review of current obstetric practices. Health researchers and provider groups have recommended that women in labor should receive continuous professional support. The objective of our study was to compare the risks and benefits of one-to-one nurse labor support with usual intrapartum nursing care.
                A randomized, controlled trial was conducted in a 637-bed university hospital in Montreal, Quebec, with 413 nulliparous women who were at more than 37 weeks' gestation, carrying singletons, and in labor. Women with scheduled cesarean section, scheduled induction, breech presentation, presence of paid labor support, or cervical dilatation over 4 cm were excluded. One-to-one care consisted of the presence of a nurse during labor and birth who provided emotional support, physical comfort, and instruction for relaxation and coping techniques. Usual care consisted of care for two or three laboring women with various types of supportive activities.
                A beneficial trend due to one-to-one nurse support was found with a 17 percent reduction in risk of oxytocin stimulation (relative risk of experimental vs control = 0.83; 95% confidence interval = 0.67, 1.04). No significant differences were found in overall labor durations and overall rates of total cesarean section, cesarean section for cephalopelvic disproportion, epidural analgesia, admission to the neonatal intensive care unit, instrumental vaginal delivery, and perineal trauma.
                The beneficial trend attributed to one-to-one nursing in reduction of oxytocin stimulation suggests that implementation of recommendations for continuous professional support by intrapartum nursing staff may be appropriate in North America. Because continuous social support during labour is a component of care in many societies but inconsistent in our own, the clinical effect of support during labour on maternal and neonatal morbidity were studied. Social support was provided by female companions. Four hundred and sixty five healthy primigravidous women were enrolled using a randomised design. Compared with 249 women undergoing labour alone 168 women who had supportive female companions throughout labour had significantly fewer perinatal complications (p less than 0.001), including caesarean sections (7% v 17%, p less than 0.01) and oxytocin augmentation (2% v 13%, p less than 0.001), and fewer infants admitted to neonatal intensive care (p less than 0.10). Of the women who had an uncomplicated labour and delivery requiring no interventions, those with a companion had a significantly shorter duration of labour (7.7 hours v 15.5 hours, p less than 0.001). This study suggests that constant human support may be of great benefit to women during labour. To evaluate the effect of continuous support provided by midwives during labor on the duration of the different stages of labor and the rate of cesarean delivery.
                A randomized trial of 100 eligible nulliparous women who had not received education classes on childbirth. In the intervention group (n=50), continuous support during labor was provided; the control group (n=50) did not receive continuous support.
                The two groups did not differ by age, employment, educational level, gestational age, economic status, and neonatal weight. Mean duration of the active phase of labor (167.9+/-76.3 vs 247.7+/-101 min, P<0.001), second stage of labor (34.9+/-25.4 vs 55.3+/-33.7 min, P=0.003), and the number of cesarean deliveries (4 vs 12, P=0.026) were significantly lower in the intervention group compared with the control group. The rates of oxytocin use and Apgar scores of less than 7 at 5 minutes were similar between the two groups.
                Continuous support provided by midwives during labor may reduce the duration of labor and the number of cesarean deliveries; this model of support should be available to all women.
                Copyright 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. To evaluate the efficacy of a close female relative providing emotional and physical support during active labor and birth.
                Randomized, two-group controlled clinical trial.
                Regional teaching hospital in the eastern part of Thailand with 782 beds.
                Primiparous women (N = 120) whose gestational ages were ≥ 36 weeks and who had uncomplicated pregnancies.
                Participants were randomly assigned to receive usual care and support from a chosen close female relative from admission until 2 hours after birth or usual care only. Within 24 hours of birth, labor outcomes (length of labor & type of birth) and levels of maternal satisfaction were assessed.
                Those in the experimental group had a significantly shorter duration of active labor and were more satisfied with their childbirth experiences than those in the control group. Differences between groups with respect to incidence of spontaneous delivery were not found.
                A close female relative was effective in providing supportive care during labor and delivery. The integration of this nursing intervention for women and their families at public hospitals in Thailand is supported.
                © 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. The purpose of this stratified randomized trial was to determine the physical and psychological effects of continuous, one-to-one professional support on childbirth outcomes. Data were gathered during prenatal and postpartum interviews with, and from the medical records of, 103 low-risk women. All subjects had attended one of two types of prenatal education programs, were accompanied by husbands or partners during labor, and had vaginal deliveries. Subjects in the experimental group were less likely to have medication for pain relief and less likely to have episiotomies. Three variables were found to predict perceived control during childbirth--expectations of control, the presence of a continuous professional caregiver, and pain medication usage. The results demonstrate the importance of the traditional nursing support role during childbirth. North American cesarean delivery rates have risen dramatically since the 1960s, without concomitant improvements in perinatal or maternal health. A Cochrane Review concluded that continuous caregiver support during labor has many benefits, including reduced likelihood of cesarean delivery.
                To evaluate the effectiveness of nurses as providers of labor support in North American hospitals.
                Randomized controlled trial with prognostic stratification by center and parity. Women were enrolled during a 2-year period (May 1999 to May 2001) and followed up until 6 to 8 postpartum weeks.
                Thirteen US and Canadian hospitals with annual cesarean delivery rates of at least 15%.
                A total of 6915 women who had a live singleton fetus or twins, were 34 weeks' gestation or more, and were in established labor at randomization.
                Patients were randomly assigned to receive usual care (n = 3461) or continuous labor support by a specially trained nurse (n = 3454) during labor.
                The primary outcome measure was cesarean delivery rate. Other outcomes included intrapartum events and indicators of maternal and neonatal morbidity, both immediately after birth and in the first 6 to 8 postpartum weeks.
                Data were received for all 6915 women and their infants (n = 6949). The rates of cesarean delivery were almost identical in the 2 groups (12.5% in the continuous labor support group and 12.6% in the usual care group; P =.44). There were no significant differences in other maternal or neonatal events during labor, delivery, or the hospital stay. There were no significant differences in women's perceived control during childbirth or in depression, measured at 6 to 8 postpartum weeks. All comparisons of women's likes and dislikes, and their future preference for amount of nursing support, favored the continuous labor support group.
                In hospitals characterized by high rates of routine intrapartum interventions, continuous labor support by nurses does not affect the likelihood of cesarean delivery or other medical or psychosocial outcomes of labor and birth. Various policies of management of prolonged labour have been proposed to prevent its two main consequences--caesarean section and fetal distress. Two randomised controlled trials were organised; the first to assess the value of amniotomy with oxytocin compared to a more conservative approach. The second trial compared the effect of continuous professional support during labour with the intermittent presence of a member of staff. These were multicentre studies in several countries of Europe. Preliminary results of early amniotomy suggested no difference in the rate of operative delivery. Continuous professional support was associated with a significant reduction in operative deliveries. To assess the effect of psychosocial support on labour outcomes.
                A randomised control trial conducted at the University College Hospital Ibadan, Nigeria, from November 2006 to 30 March 2007. Women with anticipated vaginal delivery were recruited and randomised at the antenatal clinic. The experimental group had companionship in addition to routine care throughout labour until two hours after delivery, while the controls had only routine care. The primary outcome measure was caesarean section rate. Others included duration of active phase, pain score, time of breast-feeding initiation and description of labour experience. Multivariable analyses were used to adjust for potential confounders. The level of statistical significance was set at 5%.
                Of the 632 recruited, 585 were eventually studied: 293 and 292 were in experimental and control groups, respectively. Husbands constituted about two-thirds of the companions. Women in the control group were about five times more likely to deliver by caesarean section (95% confidence interval (CI) 1.98-12.05), had significantly longer duration of active phase (P < 0.001), higher pain scores (P = 0.011) and longer interval between delivery and initiation of breast-feeding (P < 0.001). However, those in experimental group had a more satisfying labour experience (odds ratio 3.3 95% CI 2.15-5.04).
                Women with companionship had better labour outcomes compared to those without. It is desirable to adopt this practice in our health-care settings as an alternative strategy to provide comparable quality services to would-be mothers in labour.
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.