Continuous support during labour beneficial

Clinical question: 
How effective is continuous, one-to-one intrapartum support when compared with usual care?
Bottom line: 
Continuous support in labour increased the chance of a spontaneous vaginal birth, reduced intrapartum analgesia, caused no known harm, and women were more satisfied. In addition, labours were shorter, and women were less likely to have a caesarean section or instrumental vaginal birth, regional analgesia, or a baby with a low 5-minute Apgar score. There was no apparent impact on other intrapartum interventions, maternal or neonatal complications, or on breastfeeding. Subgroup analyses suggested continuous support was most effective when provided by a woman who was neither part of the hospital staff nor the woman’s social network, and in settings in which epidural analgesia was not routinely available.
Caveat: 
No conclusions could be drawn about the timing of onset of continuous support. The subgroup analyses should be interpreted with caution. Individually, each should be considered exploratory and hypothesis-generating, particularly as the sample size in one subgroup was much smaller than in the other. There remains relatively little information about the effects of continuous intrapartum support on mothers’ and babies’ health, and wellbeing in the postpartum period.
Context: 
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. 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.
Review CD#: 
CD003766
PEARLS No: 
318
Date: 
July, 2011
Authored by: 
Brian R McAvoy