Continuous Support Promotes Obstetric Labor Progress and Vaginal Delivery in Primiparous Women – A Randomized Controlled Study

Abstract

Background: Obstetric labor and childbirth are mostly regarded as a physiological process, whereas social, cultural, psychological and transcendental aspects have received less attention. Labor support has been suggested to promote labor progress. The aim of this study was to investigate whether continuous labor support by a midwife promotes labor progress and vaginal delivery.Material and Methods: A randomized controlled study at a university hospital in Sweden in 2015–17. Primiparous women with singleton pregnancy and spontaneous labor onset were randomized to continuous support (n = 30) or standard care (n = 29) during delivery. The primary outcome was the duration of active labor. Secondary outcomes were delivery mode, women's need of labor analgesia and satisfaction with delivery, maternal cortisol levels, and neonatal morbidity.Results: Continuous support was followed by shorter active labor 11.0 ± 5.7 h compared to 13.7 ± 3.9 h with standard care (p = 0.001). Women in the continuous support group tended to have lower cortisol levels and low cortisol during the first (p = 0.02) and second (p = 0.04) stages of labor were correlated with shorter active labor. Continuous support was followed by spontaneous delivery in 73%, instrumental delivery in 24% and emergency cesarean section in 3% in contrast to standard care which was followed by spontaneous delivery in 62%, instrumental delivery in 24% and cesarean in 14% (p = 0.19). The continuous support group received combined analgesic methods more often (p = 0.04). Women's satisfaction with delivery and neonatal morbidity were comparable.Conclusion: Continuous labor support was followed by shorter active labor compared to standard care. Women with continuous support had a high rate of vaginal delivery and tended to have lower cortisol levels during all stages of active labor reflecting a lower stress level. Low cortisol was correlated to shorter active labor. Based on these results, we recommend continuous labor support for all primiparous women during active labor.

The concept, importance and values of support during childbearing and breastfeeding – A discourse paper

“…However, in most western countries, more women give birth in hospitals than at home or via midwife‐led continuity of care models. This means that continuous support during labour is often the exception rather than the norm, despite its beneficial effects (Bohren et al., 2017), such as a shorter active phase of labour and accompanying lower levels of the stress hormone cortisol compared to standard care (Stjernholm et al., 2021).…”

Use and Effects of Augmentation of Labor with Oxytocin: A Single-Center, Retrospective, Case-Control Study of 4350 Women in Warsaw, Poland, 2015-2020

“…However, if these methods do not bring the expected effect, pharmacological methods are used to intensify the contractile activity of the uterus. Exogenous oxytocin infusion is used in standard clinical practice to aid delivery [ 6 , 7 ].…”

The Effect of Continuous Support Combined with Breathing Exercise on The Progress of Labor and Intrapartum Fatigue

“…Similarly, Bostanoglu and Demirgoz Bal (2021) found that the total childbirth duration in the intervention group was significantly shorter than the control group. According to Stjernholm et al (2021), continuous labour support resulted in shorter active phase of labour than routine care. Continuously supported women were more likely to deliver vaginally and tended to have lower cortisol levels during the whole of active phase of labour, which indicated less stress.…”