Continuous support for women during childbirth

Jul 18 2007

When it comes to giving birth, some traditional approaches could result in happier and healthier moms and newborns, according to two research reviews.

Women who have a midwife, doula or a supportive family member with them throughout labor are more likely to have a shorter labor, less likely to use painkillers during labor and more likely to be satisfied with their childbirth experience, compared to those who receive regular hospital care.

In addition, women who practice “kangaroo care” — skin-to-skin snuggling with their newborns — directly after birth are more successful early on at breastfeeding, compared to births where the newborns are taken away to be swaddled or washed.

The reviews appear in The Cochrane Library , a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Skin-to-skin contact and supportive labor care were the norm for centuries, before hospital births became the accepted practice in Western culture. However, “concerns about the consequent dehumanization of women's birth experiences have led to calls for a return” to some of these practices, said Ellen Hodnett of the University of Toronto.

Hodnett and colleagues reviewed 16 studies of 13,391 women that compared supportive one-on-one care with routine hospital care during labor. In the studies, supportive care included a variety of elements, from encouragement and massage to relaying a woman's wishes to the attending medical staff.

In general, the researchers found that supportive care worked best when it began in early labor and someone other than hospital staff provided it. The authors conclude, “Continuous support during labor should be the norm, rather than the exception.”

Early skin-to-skin contact between mother and newborn is another practice that has fallen by the wayside in hospital births. In skin-to-skin contact, the naked baby rests on the mother's bare chest immediately after birth, taking advantage of what Elizabeth Moore, Ph.D., calls “a sensitive period for programming future behavior.”

In 30 studies of 1,925 mother-infant pairs analyzed by Moore and colleagues, pairs who had early skin-to-skin contact were more likely to breastfeed and to breastfeed for longer than those who did not. The review also showed that babies who had kangaroo care immediately after birth “interacted more with their mothers, stayed warmer and cried less,” said Moore.

The University of Toronto, Canada; the University of the Witwatersrand, Fort Hare University, and East Long Hospital Complex, South Africa; National Perinatal Epidemiology Unit and Warwick Clinical Trials Unit, UK; and Childbirth Connection in the United States supported the Hodnett study.

Moore ER, Anderson GC, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. The Cochrane Database of Systematic Reviews 2007, Issue 3.

Hodnett ED, et al. Continuous support for women during childbirth. The Cochrane Database of Systematic Reviews 2007, Issue 3.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.