A trial on continuous human support during labor: feasibility, interventions and mothers' satisfaction

Abstract

This paper reports the results of two trials using midwifery students and a small pilot trial using laywomen as support persons during labor and the feasibility and experiences in organizing such support. In the trials with students, healthy mothers with single, full-term infants not expected to have immediate delivery were randomly allocated to support (12 = 122) and control ( n = I 18) groups; most mothers had the father of the baby with thcm. In the support group, a student stayed with the mother constantly. Many students and midwives did not consider constant support by professionals important or requiring special skills. Mothers were vcry satisfied with having a midwifery student stay with them. The length of hospital stay before birth W A S shorter and the number of women whose contractions stopped after randomization was smaller. Otherwise, the progress of labor, interventions and the mother's and infant's health were similar in the two groups. In the trial with laywomcn, nine out of the ten mothers Corrcspondmce to: Elina Hemminki, MI), 1)eyartnient of Public Health, University of Helsinki. Haartmaniiikatii 3. 00290 Hclsinki, Fiiiland. 239 Downloaded by [McMaster University] at 13:36 26 March 2016 240 Hcmminki et al.were very satisfied with their presence. Our study suggests that constant support may be important for successful birth.

Continuous support for women during childbirth

“…In nine trials (Breart -Belgium 1992;Breart -France 1992;Breart -Greece 1992;Dickinson 2002;Gagnon 1997;Hemminki 1990a;Hemminki 1990b;Hodnett 2002;Kashanian 2010), the support was provided by a member of the hospital staff, for example, a midwife, student midwife or nurse. In seven trials the providers were not members of the hospital staff and were not part of the woman's social network; they were women with or without special training, such as doulas or women who had given birth before (Hodnett 1989;Kennell 1991;Klaus 1986;McGrath 1999): a childbirth educator (Cogan 1988), or retired nurses (Langer 1998).…”

“…Excluded studies-Sixteen trials were excluded altogether (Bender 1968;Bochain 2000;Brown 2007;Dalal 2006;Gordon 1999;Hemminki 1990c;Lindow 1998;McGrath 1999;Orenstein 1998;Pinheiro 1996;Ran 2005;Scott 1999;Sosa 1980;Trueba 2000;Tryon 1966;Zhang 1996). Seven trials were excluded as they were not randomised trials (Bender 1968;Dalal 2006;Ran 2005;Scott 1999;Sosa 1980;Trueba 2000;Tryon 1966).…”

“…Other potential sources of bias-Three trials were assessed as being at high risk of other bias: in two trials the mothers had been told the purpose of the study differentially (Hemminki 1990a;Hemminki 1990b) and one trial was stopped early for 'a range of largely organizational issues' when only a quarter of the original sample size had been enrolled (Thomassen 2003). Risk of bias was unclear in one study (Campbell 2006) and no other sources of bias were apparent in the remaining trials.…”

Re-significando a dor e superando a solidão: experiências do parto entre adolescentes de classes populares atendidas em uma maternidade pública de Salvador, Bahia, Brasil

“…Ambas, além de Domingues et al 12 , discutem a importância da presença de um acompanhante durante a parturição, considerando-o de grande importância para o enfrentamento da dor 24 . Sabe-se que o suporte emocional e social a uma parturiente diminui o tempo do trabalho de parto e o uso de intervenções obstétricas, como cesá-rea, uso de fórceps, ocitocina e analgesia peridural, possibilitando, ainda, melhores condições de vitalidade ao recém-nascido 9,10,25,26 . Mas também isso é negado à parturiente do HMB.…”

De reclusiones maternas y habitantes de los «no lugares». La gestión del acompañamiento paterno en el marco de los partos hospitalarios públicos.

“…Se trata de una realidad que la evidencia científica ha cuantificado en términos de resultados obstétricos, abundando la literatura que apunta que el apoyo emocional continuo, dado preferentemente por un familiar significativo para la madre como el padre 2 , se traduce en una menor sensación dolorosa, en un menor uso de la analgesia epidural, en un mayor índice de partos vaginales normales y en un mayor grado de satisfacción general de la madre (Lally et al 2008;Hodnett et al 2012;2013). Además el acompañamiento en el parto hace el trabajo de parto más breve, disminuyendo las instrumentaciones y cesáreas y mejorando la adaptación neonatal al medio extrauterino (Klaus y Kennel 1993;Hofmeryr et al 1991;Hemminki, Virta y Koponen 1990;Enkin, Keirse y Renfrew 1989). Las hipótesis apuntan a que el apoyo mejora la sensación de control y de competencia de la madre, reduciendo la dependencia a las intervenciones médicas y el uso de la epidural, que puede enlentecer el expulsivo del bebé.…”