Influence of Support During Labour on Maternal and Neonatal Outcome

Aleks Finderle

Croatia

Support in labour

• In human tradition women have been attended and supported by other women during labour and childbirth

Support in labour

• In the second part of 20th century, as more women where giving birth in hospital rather than at home

• Continuous support during labour has become the exception rather than the norm

Support in labour

• The family member wasn’t able to contact the newborn, and often the mother, before they left the hospital

Support in labour

• Childbirth become a highly medicalized event in the hospital

• Pregnancy outcomes for mother and baby have improved but rates of medical intervention and operative delivery have increased and is still increasing

Support in labour

• Today routine procedures in modern maternity hospitals, especially the one with a large number of patients, sometimes may have adverse effects on the progress of labour

• In the prospective of many civil rights and women organizations, this may contribute to the dehumanization of women's childbirth experience

Childbirth as a highly medicalized event

• Failure to breastfeed

• Difficulties coping as a mother

• High rates of postpartum depression

Childbirth as a highly medicalized event

• Concerns about dehumanization of women's birth experiences have led to calls for a return to continuous, one-to-one support during labour in many countries

• In the recent years, a continuous support in labour has become widely accepted as a response to dehumanization in maternity wards

Continuous labour support

• Include emotional support (continuous presence, reassurance and praise), information about labour progress and advice regarding coping techniques, comfort measures (comforting touch, massage, warm baths/showers, promoting adequate fluid intake and output) and advocacy (helping the woman articulate her wishes to others)

Continuous labour support

• The continuous support in labour can be provided by hospital staff, companions of the woman's choice or a person who is neither a hospital employee nor has a personal relationship to the laboring woman but has experience in providing labour support.

Continuous labour support

– Hospital staff can include midwifes, student midwifes and nurses

– Companions of the woman's choice can be her partner or other, usually female, family members and friends

– Third possibility are trained nonmedical persons who assists a woman before, during, and/or after childbirth, in some countries known as doulas

Doula

• Term "doula" is derived from ancient Greek word δούλη meaning "female slave", but it was first used in modern language in 1969 in one antropological study

Support in labour• First studies that analyzed

influence of untrained female volunteer who supported women in labour was from Central America

• At that time most of public hospital was crowded and with unfamiliar environment

• Hospital policy prohibited family members, friends or continuous nurse caretakers

Support in labour

• The authors concluded that this type of labour support might be useful for low-income, single, young mothers who lack support from family and may have no formal or strong cultural preparation for childbirth

Sosa R, Kennell JH, Klaus M, Robertson S, Urrutia J. The effect of a supportive companion on perinatal problems, lenght of labour and mother-infant interaction. N Engl J Med 1980;303:597-600.

Support in labour

• Soon after many papers pointed up different advantages of labour support

• Despite first results, high developed countries was first who predominantly accepted new initiative

Influence of Support During Labour - explanations

• One possible mechanism when companionship is used in stressful, threatening and disempowering clinical birth environments

• Modern obstetric care frequently subjects women to institutional routines, high rate interventions, unfamiliar personnel, lack of privacy…

• Continuous support in labour may stop the influence of these stressors

Influence of Support During Labour - explanations

• Reduction of anxiety and fear

• Lower level of stress hormone – epinephrine

• High level of epinephrine conected to abnormal FHR patterns, decreased uterine contracitility, longer active labour phase and lower Apgar score

Influence of Support During Labour - explanations

• Pain relief effect• Reduced use of epidural analgesia• Less use of electronic fetal monitoring• Less use of intravenous drips, antihypertensive

drugs, bladder catheterisation, vacuum extraction or forceps, episiotomy …

• Increase mobility during labour

Continuous support for women during childbirth

• Published in 2013• 16 countries• 23 trials• More than 15000 women

Continuous support for women during childbirth

• More likely to have spontaneous vaginal birth• Less likely to have intrapartum analgesia or to

report dissatisfaction• Labours were shorter• Decreased oxytocin augmentation, increased

sense of personal control, lower rates of postpartum depression, failed breastfeeding

Support in labourguidlines

• National Institute for Health and Care Excellence (NICE) – confirm importance of continuous support in labour

• According to NICE, the evidence now shows midwife-led units to be safer than hospital for women having a straightforward (low risk) pregnancy

Continuous labour support

• When support in labour was intermittent the influence was much less important

• Among different persons who support the women in labour one review point up that untrained women starting in early labour and continuing into the postpartum period demonstrates the most consistent beneficial effect on childbirth outcomes

Continuous labour support

• Women’s partner, as a continuous labour support person, can provoke more spasmoanalgetics and epidural analgesia in labour and even more oxytocine end episiotomies

Continuous labour support

• Beside different persons engaged in a labour support, for the influence on perinatal outcome very important are socioeconomic background and type of maternity ward

Continuous labour support

Continuous support for women during childbirth

AUTHOR’S CONCLUSIONS:All women should have support throughout

labour and birth

Thank You