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.
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 Cochrane 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 Randomization is the process of randomly dividing into groups the people taking part in a trial. One group (the intervention group) will be given the intervention being tested (for example a drug, surgery, or exercise) and compared with a group which does not receive the intervention (the control group). More A trial in which a group (the ‘intervention group’) is given a intervention being tested (for example a drug, surgery, or exercise) is compared with a group which does not receive the intervention (the ‘control group’). More 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 The certainty (or quality) of evidence is the extent to which we can be confident that what the research tells us about a particular treatment effect is likely to be accurate. Concerns about factors such as bias can reduce the certainty of the evidence. Evidence may be of high certainty; moderate certainty; low certainty or very-low certainty. Cochrane has adopted the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) for assessing certainty (or quality) of evidence. Find out more here: https://training.cochrane.org/grade-approach More was judged to be good to excellent and the A way of expressing the chance of an event taking place, expressed as the number of events divided by the total number of observations or people. It can be stated as ‘the chance of falling were one in four’ (1/4 = 25%). This measure is good no matter the incidence of events i.e. common or infrequent. More of Any factor, recognised or not, that distorts the findings of a study. For example, reporting bias is a type of bias that occurs when researchers, or others (e.g. drug companies) choose not report or publish the results of a study, or do not provide full information about a study. More low.
What does this mean in practice?
One of the good things about Cochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. More 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!
*Four new studies were added when the review was updated in 2016 but the conclusions are unchanged.
Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database of In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. More 2017, Issue 7. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub6.
Page last updated 06 March 2019.