Continuous Support for Women During Childbirth

Background to this systematic review

Questions and outcomes examined in the continuous support review

• policies about companions of the women's own choice: continuous support appeared to have a stronger impact on spontaneous birth and cesarean birth in settings in which other support was not permitted; the subgroups were not significantly different with respect to use of analgesia/anesthesia, instrumental birth, and dissatisfaction
• policies about epidural analgesia: whether epidural was or was not routinely available policies about continuous electronic fetal monitoring (EFM): whether continuous EFM was or was not routine
• types of caregiver: whether the caregiver was a member of the hospital staff (e.g., nurse, midwife or student midwife) or someone from outside
• timing in the onset of continuous support: whether the support did or did not begin before active labor.
  

• labor events: e.g., synthetic oxytocin, epidural analgesia
• birth events: e.g., cesarean birth, episiotomy
• newborn events: e.g., ow 5-minute Apgar score, admission to special care nursery
• immediate maternal psychological outcomes: e.g., anxiety during labor, negative rating of experience
• longer-term maternal outcomes: e.g., postpartum depression, difficulty mothering.
  

Review results

• have regional analgesia
• have any analgesia/anesthesia 
• give birth with vacuum extraction or forceps 
• give birth by cesarean 
• report dissatisfaction or a negative rating of their experience.
  

• synthetic oxytocin during labor
• newborn admission to special care nursery
• postpartum reports of severe labor pain.
  

• policies about companions of the women's own choice: continuous support appeared to have a stronger impact on analgesia/anesthesia use, spontaneous birth, and cesarean birth in settings in which other support was not permitted; the subgroups were not significantly different with respect to instrumental birth, and dissatisfaction
• policies about epidural analgesia: continuous support appeared to have a stronger impact on use of analgesia/anesthesia, spontaneous birth, and cesarean birth when epidural analgesia was not routinely available; the subgroups were not significantly different with respect to instrumental birth, and dissatisfaction
• policies about continuous EFM: continuous support appeared to have a stronger impact on spontaneous birth when EFM was not routine; the subgroups were not significantly different with respect to analgesia/anesthesia, instrumental birth, cesarean birth, and dissatisfaction
• type of caregiver: continuous support appeared to have a stronger impact on anesthesia/analgesia, spontaneous birth, and instrumental birth when the caregiver was not a hospital employee; it only had an impact on cesarean birth when the caregiver was not a hospital employee; the subgroups were not significantly different with respect to dissatisfaction
• timing in the onset of continuous support: continuous support appeared to have a stronger impact on analgesia/anesthesia, spontaneous birth, and cesarean birth when it began before active labor; the subgroups were not significantly different with respect to instrumental birth and dissatisfaction.
  

• settings: resource-constrained countries
• outcomes: effects on mothers' and babies' health and well-being in the postpartum period, economic analysis of relative costs and benefits
• models: comparison of effects of different models of providing continuous support.
  

Ongoing work to use review results to educate professionals, women and the media and to improve practice