OBJECTIVE: To evaluate the efficacy of a close female relative providing emotional and physical support during active labor and birth.
DESIGN: Randomized, two-group controlled clinical trial.
SETTING: Regional teaching hospital in the eastern part of Thailand with 782 beds.
PARTICIPANTS: Primiparous women (N = 120) whose gestational ages were ≥ 36 weeks and who had uncomplicated pregnancies.
METHODS: Participants were randomly assigned to receive usual care and support from a chosen close female relative from admission until 2 hours after birth or usual care only. Within 24 hours of birth, labor outcomes (length of labor & type of birth) and levels of maternal satisfaction were assessed.
RESULTS: Those in the experimental group had a significantly shorter duration of active labor and were more satisfied with their childbirth experiences than those in the control group. Differences between groups with respect to incidence of spontaneous delivery were not found.
CONCLUSIONS: A close female relative was effective in providing supportive care during labor and delivery. The integration of this nursing intervention for women and their families at public hospitals in Thailand is supported.
BACKGROUND: Initiation of breastfeeding can be difficult in a busy maternity centre with inadequate manpower and social support. This study aims to explore the role of psychosocial support offered by companions on breastfeeding initiation among first-time mothers.
METHODS: This is a secondary data analysis of a randomised controlled trial conducted among women attending the antenatal clinic of the University College Hospital, Ibadan, Nigeria in 2007. Those in the experimental group were asked to bring someone of their choice to the labour room to act as a companion; the comparison group received standard care. The results of 209 HIV negative women who had vaginal births were analysed. The main outcome measure was time to initiation of breastfeeding after childbirth.
RESULTS: Of the total, 94 had companions during labour while 115 did not have a companion. The median time to breastfeeding initiation was significantly shorter in those with companions compared to controls (16 vs. 54 minutes; p < 0.01). The cumulative survival analysis indicated that all in the treatment group had initiated breastfeeding by 26 minutes, while among the control group none had commenced at 30 minutes post-delivery with some as late as 12 hours. After Cox regression analysis was used to adjust for possible confounders, the outcome still showed a significant hazard ratio of 207.8 (95%CI 49.2, 878.0; p < 0.01) among women who were supported by a companion.
CONCLUSION: Use of companions during labour is associated with earlier time to breastfeeding initiation among first-time mothers in Nigeria.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12609000994280.
OBJECTIVE: To assess the effect of psychosocial support on labour outcomes. METHODOLOGY: A randomised control trial conducted at the University College Hospital Ibadan, Nigeria, from November 2006 to 30 March 2007. Women with anticipated vaginal delivery were recruited and randomised at the antenatal clinic. The experimental group had companionship in addition to routine care throughout labour until two hours after delivery, while the controls had only routine care. The primary outcome measure was caesarean section rate. Others included duration of active phase, pain score, time of breast-feeding initiation and description of labour experience. Multivariable analyses were used to adjust for potential confounders. The level of statistical significance was set at 5%. RESULTS: Of the 632 recruited, 585 were eventually studied: 293 and 292 were in experimental and control groups, respectively. Husbands constituted about two-thirds of the companions. Women in the control group were about five times more likely to deliver by caesarean section (95% confidence interval (CI) 1.98-12.05), had significantly longer duration of active phase (P < 0.001), higher pain scores (P = 0.011) and longer interval between delivery and initiation of breast-feeding (P < 0.001). However, those in experimental group had a more satisfying labour experience (odds ratio 3.3 95% CI 2.15-5.04). CONCLUSION: Women with companionship had better labour outcomes compared to those without. It is desirable to adopt this practice in our health-care settings as an alternative strategy to provide comparable quality services to would-be mothers in labour.
BACKGROUND: Previous randomized controlled studies in several different settings demonstrated the positive effects of continuous labor support by an experienced woman (doula) for low-income women laboring without the support of family members. The objective of this randomized controlled trial was to examine the perinatal effects of doula support for nulliparous middle-income women accompanied by a male partner during labor and delivery. METHODS: Nulliparous women in the third trimester of an uncomplicated pregnancy were enrolled at childbirth education classes in Cleveland, Ohio, from 1988 through 1992. Of the 686 prenatal women recruited, 420 met enrollment criteria and completed the intervention. For the 224 women randomly assigned to the experimental group, a doula arrived shortly after hospital admission and remained throughout labor and delivery. Doula support included close physical proximity, touch, and eye contact with the laboring woman, and teaching, reassurance, and encouragement of the woman and her male partner. RESULTS: The doula group had a significantly lower cesarean delivery rate than the control group (13.4% vs 25.0%, p = 0.002), and fewer women in the doula group received epidural analgesia (64.7% vs 76.0%, p = 0.008). Among women with induced labor, those supported by a doula had a lower rate of cesarean delivery than those in the control group (12.5% vs 58.8%, p = 0.007). On questionnaires the day after delivery, 100 percent of couples with doula support rated their experience with the doula positively. CONCLUSIONS: For middle-class women laboring with the support of their male partner, the continuous presence of a doula during labor significantly decreased the likelihood of cesarean delivery and reduced the need for epidural analgesia. Women and their male partners were unequivocal in their positive opinions about laboring with the support of a doula.
BACKGROUND: Data collected on more than 12,000 women in 15 randomized controlled trials provide robust evidence of the beneficial effects of doula support on medical outcomes to childbirth. The objective of this paper was to examine the association between doula support and maternal perceptions of the infant, self, and support from others at 6 to 8 weeks postpartum. The doula was a minimally trained close female relative or friend. METHODS: Six hundred low-risk, nulliparous women were enrolled in the original clinical trial and randomized to doula support (n = 300) or standard care (n = 300). The mother-to-be and her doula attended two 2-hour classes about providing nonmedical, continuous support to laboring women. For the secondary study, presented here, research participants (N = 494) were interviewed by telephone using a 42-item questionnaire. RESULTS: Overall, when doula-supported mothers (n = 229) were compared with mothers who received standard care (n = 265), they were more likely to report positive prenatal expectations about childbirth and positive perceptions of their infants, support from others, and self-worth. Doula-supported mothers were also most likely to have breastfed and to have been very satisfied with the care they received at the hospital. CONCLUSIONS: Labor support by a minimally trained female friend or relative, selected by the mother-to-be, enhances the postpartum well-being of nulliparous mothers and their infants, and is a low-cost alternative to professional doulas.
OBJECTIVE: To compare labor outcomes in women accompanied by an additional support person (doula group) with outcomes in women who did not have this additional support person (control group). DESIGN: Randomized controlled trial. SETTING: A women's ambulatory care center at a tertiary perinatal care hospital in New Jersey. PATIENTS/PARTICIPANTS: Six hundred nulliparous women carrying a singleton pregnancy who had a low-risk pregnancy at the time of enrollment and were able to identify a female friend or family member willing to act as their lay doula. INTERVENTIONS: The doula group was taught traditional doula supportive techniques in two 2-hour sessions. MAIN OUTCOME MEASURES: Length of labor, type of delivery, type and timing of analgesia/anesthesia, and Apgar scores. RESULTS: Significantly shorter length of labor in the doula group, greater cervical dilation at the time of epidural anesthesia, and higher Apgar scores at both 1 and 5 minutes. Differences did not reach statistical significance in type of analgesia/anesthesia or cesarean delivery despite a trend toward lower cesarean delivery rates in the doula group. CONCLUSION: Providing low-income pregnant women with the option to choose a female friend who has received lay doula training and will act as doula during labor, along with other family members, shortens the labor process.
We wanted to study the effect of extra emotional support in the form of a non-professional woman (doula) before and during delivery. About 200 primiparae were invited to participate in a prospective study which intended to assess differences in delivery outcome between women with and without a doula. Fifty-four declined to participate, 55 had a delivery with doula and 46 were controls. Lower rate of emergency caesarean sections in the doula-group was noted. The parents as well as the staff, became to regard the doula as a valuable support during delivery.
OBJECTIVE: To assess maternal satisfaction with childbirth and intrapartum pain relief in nulliparous women labouring at term. METHODS: Prospective randomised clinical trial comparing epidural and non-epidural analgesic techniques on term labour outcomes in nulliparous women. Within 24 h of delivery the women were surveyed regarding their opinions about the birthing experience and the allocated analgesic regimen. A postal survey was conducted 6 months postpartum to assess opinions about intrapartum analgesia in a subsequent pregnancy. RESULTS: A total of 992 women were randomised to receive continuous midwifery support (CMS) or epidural (EPI) analgesia on presentation for delivery. There was a high crossover rate from CMS to EPI (61.2%) and a lesser non-compliance rate in the EPI group (27.8%). The early post-partum recollections revealed a high satisfaction with epidural analgesia and lower satisfaction with alternative pain relief measures. Ten percent of women in the CMS group reported negative feelings about their allocated pain relief compared with 1% in the EPI group (P < 0.001), and 10% of all women reported negative feelings about their overall childbirth experience. At the 6-month postpartum survey factors associated with the planned use of epidural analgesia in a subsequent pregnancy were induction of labour (odds ratio (OR) 2.4, 95% confidence interval (CI) 1.2, 4.7) and prior utilisation of epidural analgesia (OR 28.1, 95% CI 14.5, 54.7). CONCLUSIONS: Maternal satisfaction with intrapartum analgesia was significantly higher with epidural analgesia than non-epidural analgesic techniques. Overall satisfaction scores for labour and delivery were high regardless of analgesic approach, reflecting the multiple issues other than pain relief that are involved in the childbirth experience.
To evaluate the efficacy of a close female relative providing emotional and physical support during active labor and birth.
DESIGN:
Randomized, two-group controlled clinical trial.
SETTING:
Regional teaching hospital in the eastern part of Thailand with 782 beds.
PARTICIPANTS:
Primiparous women (N = 120) whose gestational ages were ≥ 36 weeks and who had uncomplicated pregnancies.
METHODS:
Participants were randomly assigned to receive usual care and support from a chosen close female relative from admission until 2 hours after birth or usual care only. Within 24 hours of birth, labor outcomes (length of labor & type of birth) and levels of maternal satisfaction were assessed.
RESULTS:
Those in the experimental group had a significantly shorter duration of active labor and were more satisfied with their childbirth experiences than those in the control group. Differences between groups with respect to incidence of spontaneous delivery were not found.
CONCLUSIONS:
A close female relative was effective in providing supportive care during labor and delivery. The integration of this nursing intervention for women and their families at public hospitals in Thailand is supported.
