Where there’s a Will. Why women should have support through labour

Key message: All women should have continuous support throughout labour. It has benefits for both mums and babies and no known harms.

First there was the disastrous choice of meal, eaten as I started to go into labour, of ‘chicken with 40 cloves of garlic’ (just my Other Half and me; we hadn’t done the maths…). We just knew we wouldn’t be able to say ‘hospital’ or ‘hello’, without knocking out those greeting us. Then there was the curry which OH dashed out for at some point during the long hours of the next day but which he then dropped down his front. I can’t see the Duke of Cambridge having to rough it in a shirt covered in lashings of tikka masala but let’s hope he’s there to support Kate all through labour. Unless he and his Gran want to take turns of course.

Aristocratic fathers were more likely to be present at the arrival of their heir

Traditionally, women have been supported by other women during childbirth. Until the 1970s, in Britain at least, it was not the norm for men to be present at the birth of their children, although aristocratic and royal fathers were more likely to be present to see their heirs arrive. According to Dr Laura King, who recently ran a public engagement project exploring people’s experiences of fatherhood and childbirth in Britain, from the 1950s to the present, the 1970s saw a change from a minority of dads being present at the birth of their child to around 70-80%. Today, it’s seen as the norm, with over 90% in attendance.

Despite this change, in hospitals worldwide, having one-to-one support for the whole labour may not be the norm. A review from a team at the Cochrane Pregnancy and Childbirth Group looked at what difference this support makes to women and their new babies. They were able to include 22 randomized controlled trials from 16 countries, involving more than 15,000 women in a variety of settings. Continuous support, given by a midwife, nurse, childbirth educator or doula, or by the woman’s partner, relative or friend, was compared with ‘usual care’, which did not involve continuous support through labour.

What did they find?

Compared to those without constant support through labour, women who were continuously supported:

• were more likely to give birth ‘spontanously’ (without the need for instruments such as forceps, or caesarian section)
• were less likely to need pain-relieving medicines
• were more satisfied
• had slightly shorter labours
• were less likely to have babies with a low 5 minute Apgar score

No adverse (bad) effects were reported.

How good was the evidence?

The quality of the evidence was judged to be good to excellent and the risk of bias low.

What does this mean in practice?

One of the good things about Cochrane reviews is that they are updated at intervals, to take account of new, relevant evidence; this one’s latest version was published today. An earlier version of this review prompted organizations in the UK, Canada and the USA to issue practice guidelines advocating continuous support for women in labour and the evidence in the current version of the review offers continued justification for this recommendation. The reviewers conclude that this practice should be the norm, rather than the exception. They note that we still don’t know much about the effects of such support on mums and babies health later on and that there is relatively little evidence from countries with poorer resources.

As for Kate, there’ll be no shortage of paparazzi and well-wishers camped out on the pavement, and flowers, flags and fluffy toys, when she emerges from the hospital proudly displaying little HRH, but let’s hope she’ll have someone with her all through her labour, whether that’s Will or not!

Links:

Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub5.

Cochrane summary http://summaries.cochrane.org/CD003766/continuous-support-for-women-during-childbirth