MATERNAL AND EARLY CHILD HEALTH

Health Evidence Bulletins - Wales

Date of Completion: 27.10.97

The contents of this bulletin are likely to be valid for approximately one year, by which time significantly new research evidence may become available


15. Maternal support in labour

(Users are advised to consult the supporting evidence for a consideration of all the implications of a recommendation)

This chapter should be read in conjunction with Chapter 10 "Where to be born"

The Statements The Evidence
15a. There is no doubt that continuity of care from pregnancy to labour should be provided whenever possible(i) and that all labouring women should receive emotional and psychological support from those close to them and from carefully trained caregivers(ii,iii).

Continuity of caregivers has been shown to result in less need for induction, pharmacologic pain relief, neonatal resuscitation and fewer episiotomies, with an increased risk of perineal tear. Women receiving continuity of care are more likely to be satisfied with that care. It is unclear whether these benefits are due to greater continuity or more midwifery involvement (iv,v,vi,vii).

(Cochrane health gain notation - 2 "likely to be beneficial")

i. see Statement 5c. in Chapter 5. ‘Support in Pregnancy
ii. Chalmers I, Enkin M, Keirse MJNC. Effective care in pregnancy and childbirth. Oxford: Oxford University Press, 1989 pp. 810-813
(Type I evidence - systematic review. Summary in Enkin M, Keirse MJNC, Renfrew M, Neilson J. A guide to effective care in pregnancy and childbirth. 2nd ed. Oxford: Oxford University Press. 1995. p. 196);
iii. MIDIRS and the NHS Centre for Reviews and Dissemination. Support in labour. Informed choice for professionals Leaflet No. 1. MIDIRS, January 1996
(Type I evidence - systematic review);
iv. Hodnett ED. Continuity of caregivers during pregnancy and childbirth. Cochrane database of systematic reviews. Cochrane Library 1997 Issue 4.
(Type I evidence - systematic review);
v. Hundley VA, Cruickshank FM, Lang GD, Glazener CMA, Milne JM et al. Midwife managed delivery unit: a randomised controlled comparison with consultant led care. British Medical Journal. 1994; 309:1400-1404
http://www.bmj.com/cgi/content/full/309/6966/1400
(Type II evidence - randomised controlled trial of 2844 women);
vi. Rowley MJ, Hensley MJ, Brinsmead MW, Wlodarczyk JH. Continuity of care by midwife team versus routine care during pregnancy and birth: a randomised trial. Medical Journal of Australia. 1995; 163: 289-293
(Type II evidence - randomised controlled trial of 405 women);
vii. McCourt C, Page L (eds.). Report on the evaluation of one-to-one midwifery. London: Centre for Midwifery Practice, 1996. pp.70-73
(Type IV evidence - prospective cohort study)

Top

15b. Women should be permitted free mobility and choice of position during the first stage of labour. There is no evidence from controlled studies to suggest that the supine position should be encouraged(i).
(Cochrane health gain notation - 1 "beneficial")
i. MIDIRS and the NHS Centre for Reviews and Dissemination. Positions in labour and delivery. Informed Choice for Professionals Leaflet No.5. MIDIRS, 2nd ed. July 1996
(Type I evidence - systematic review)
15c. There is a continued debate between the advantage of complete restriction of food and drink, with the aim of avoiding gastric aspiration at general anaesthetic, against the advantages of allowing a low-residue low-fat diet for women in normal early labour(i).
(Cochrane health gain notation - 4 "unknown")
i. Expert anaesthetic opinion to the Internal Review Group (see Contributors)
15d. Women in labour should be given as much information as they desire(i).

(Cochrane health gain notation - 2 "likely to be beneficial")

i. Chalmers I, Enkin M, Keirse MJNC. Effective care in pregnancy and childbirth. Oxford: Oxford University Press, 1989 p. 825
(Type V evidence - expert opinion. Summary in Enkin M, Keirse MJNC, Renfrew M, Neilson J. A guide to effective care in pregnancy and childbirth. 2nd ed. Oxford: Oxford University Press. 1995. p. 206)
15e. It is likely to be beneficial to allow the woman her own choice of position for the second stage of labour and for giving birth, whenever possible (i).

(Cochrane health gain notation - 2 "likely to be beneficial")

i. Chalmers I, Enkin M, Keirse MJNC. Effective care in pregnancy and childbirth. Oxford: Oxford University Press, 1989 pp. 1129-1144
(Type I evidence - systematic review. Summary in Enkin M, Keirse MJNC, Renfrew M, Neilson J. A guide to effective care in pregnancy and childbirth. 2nd ed. Oxford: Oxford University Press. 1995. pp. 228-229)
15f. Early mother-child contact should be encouraged. The inflexible use of central nurseries has jeopardized breastfeeding and may have increased the risk of infection (i).

(Cochrane health gain notation - 2 "likely to be beneficial")

i. Chalmers I, Enkin M, Keirse MJNC. Effective care in pregnancy and childbirth. Oxford: Oxford University Press, 1989 pp. 1323-1336, 1339-1340
(Type I evidence - systematic review. Summary in Enkin M, Keirse MJNC, Renfrew M, Neilson J. A guide to effective care in pregnancy and childbirth. 2nd ed. Oxford: Oxford University Press. 1995. pp. 340-343)
Top

Contents Home

Health Evidence Bulletins: Wales, Duthie Library, UWCM, Cardiff CF14 4XN. e-mail: weightmanal@cardiff.ac.uk