Constant birth support tied to better outcomes for mothers and babies

(Reuters Health) - Mothers who receive continuous support during labor from a partner, friend or hospital worker may be less likely to need pain medications or have a surgical delivery than women who don’t get constant help, a research review suggests.

As a growing number of women in many countries are giving birth in hospitals, having continuous support during labor has become the exception rather than the norm in maternity care, researchers note in the review published by the Cochrane Library.

This type of support can include things like talking to women in labor to provide praise and reassurance, offering massage or warm baths or assistance walking to help them stay comfortable, or advocating for them.

“Supportive care during labor may enhance physiological labor processes, as well as women’s feelings of control and confidence in their own strength and ability to give birth,” said lead study author Meghan Bohren, a researcher with the World Health Organization in Geneva, Switzerland.

“This may reduce the need for obstetric intervention and also improve women’s experiences,” Bohren said by email.

For the review of existing evidence, Bohren and colleagues examined data from 26 previously published studies with data on more than 15,000 women who labored in a variety of circumstances in 17 countries.

Some women in the studies received continuous labor support from partners, mothers, friends or other family members, while others got this support from nurses, midwives, doulas or other women who weren’t hospital employees.

With continuous support, women were more likely to have vaginal deliveries than when they didn’t have this constant help, the review found.

In addition, women with continuous support were less likely to use pain medications and appeared more likely to have shorter labors and be satisfied with the delivery experience.

Babies born to mothers with continuous support were less likely to have low Apgar scores, an assessment of wellbeing that examines things like breathing and pulse shortly after birth.

Researchers did not, however, find a difference in the odds of babies being admitted to intensive care or being breastfed after two months based on whether or not mothers received continuous birth support.

Benefits of constant support appeared more pronounced in high-income countries than in less affluent nations, and there wasn’t enough evidence to determine how much this helped mothers and babies in low-income countries.

The main limitation of the review was the quality of evidence in the smaller studies was generally low, making it hard to draw broad conclusions from an analysis of multiple research efforts, the authors note.

Even so, the results underscore the potential for mothers and babies alike to benefit from continuous labor support, said Erin M Wright, a researcher at Johns Hopkins University School of Nursing in Baltimore, Maryland, and a practicing midwife at Johns Hopkins Bayview Medical Center.

“This kind of support can help reduce interventions in labor such as medication use for pain relief, which can have a variety of side effects resulting in the need for further interventions,” Wright, who wasn’t involved in the study, said by email.

“These can end up resulting in the need for a cesarean delivery or use of forceps or vacuum,” Wright added. “Continuous labor support, however, is the only intervention repeatedly demonstrated to have no adverse effects.”

SOURCE: Cochrane Library, online July 6, 2017.