The Evidence on Continuous Support during Birth
“In the past, women have been cared for and supported by other women during labour and birth, and have had someone with them throughout, which we call ‘continuous support’. However, in many countries more women are giving birth in hospital rather than at home. This has meant continuous support during labour has become the exception rather than the norm.” (Cochrane)
Continuous Support for women during labour and birth is recommended by the World Health Organisation and research shows that is beneficial for the mum and the baby.
What is continuous support?
Evidentlycochrane defined continuous support as “support provided from at least early labour (or within one hour of hospital admission), through until at least the birth, and provided by a person whose sole responsibility is to provide support to the woman.”
This support may include:
Emotional support (continuous presence, building women’s confidence through reassurance and praise).
Information about labour progress.
Advice about coping techniques, comfort measures (comforting touch, massage, warm baths/showers, encouraging mobility, promoting adequate fluid intake and output).
Helping to bridge communication gaps between the woman and her health workers.
When some women learned about the type of tasks that companions could help with (holding her hand, rubbing her back, encouraging her), they believed that this was already the role of the clinical staff and that companions, therefore, could not provide any additional benefit. (2)
The unfortunate reality is that continuous support through the hospital staff, like the midwife, not possible in most situations as midwives have to take care of several women at the same time and have to make sure that the hospital procedure and protocols are followed.
What are the benefits?
Supportive care can enhance physiological labour processes, as well as mothers’ feelings of control and confidence in their own strength and ability to give birth which in return reduces the need for obstetric intervention and improves women’s experiences.
The Cochrane Review on 26 studies from 17 countries, involving more than 15,000 women in a wide range of settings and circumstances showed that women who received continuous support were more likely to
give birth 'spontaneously'
have shorter labour
be satisfied
and less likely to
use pain medications
have a csesarean birth
have a vaginal assisted birth such as forceps
have postpartum depression following birth.
The babies of women who received continuous support may be less likely to have low five-minute Apgar scores (the score used when babies’ health and well-being are assessed at birth and shortly afterwards).
Conclusion
Cochrane concludes that “continuous support in labour may improve a number of outcomes for both mother and baby, and no adverse outcomes have been identified. Continuous support from a person who is present solely to provide support, is not a member of the woman's own network, is experienced in providing labour support, and has at least a modest amount of training (such as a doula), appears 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 experience.”
Sources:
Cochrane: Continuous support for women during childbirth
Evidently Cochrane: Implementing continuous support for women during labour and childbirth
WHO: Continuous support during childbirth may improve health outcomes for women and infants
