The Mother-Friendly Childbirth Initiative
References for Mother-Friendly Childbirth Initiative Step 1:
Provide Birthing Mothers Access to Support Personnel
(Links are to abstracts of the papers below)
- Langer, A., Camero, L. Garcia, C., & Keynoso, S. (1988). Effects of psychosocial support during labor and childbirth on breastfeeding, medical interventions and mother's wellbeing in a Mexican public hospital: a randomized clinical trial . British Journal of Obstetrics and Gynecology, 105, 1056-1063.
- Waldenstrom, U., & Turnbull, D. (1998). A systematic review comparing continuity of midwifery care with standard maternity services. British Journal of Obstetrics and Gynecology, 105, 1160-1170.
- Berkowitz, G., Scott, K., & Klaus, M., (1999). A comparison of intermittent and continuous support during labor: A meta-analysis. American Journal of Obstetrics and Gynecology, 180 (5), 1054-1059.
- Madi, B.C., Sandall, J., Bennett, R., & MacLeod, C. (1999). Effects of female relative support in labor: A randomized controlled trial. Birth, 26 (1), 4.8.
Summary/Commentary
The research cited shows that continuous support makes a significant difference in the outcome of the mother's delivery. The available research to investigate that mothers should be allowed to have support from female relatives, doulas, and/or midwives is abundant and supports that their care is important. Research on the support from family and friends was scarce. Only one article was found that focused on the father's support. This missing research is important since many deliveries involve the father as a support person for the mother.
Abstracts:
- Langer, A., Camero, L. Garcia, C., & Keynoso, S. (1988). Effects of psychosocial support during labor and childbirth on breastfeeding, medical interventions and mother's wellbeing in a Mexican public hospital: a randomized clinical trial. British Journal of Obstetrics and Gynecology, 105, 1056-1063.
Premise: Doula support during labor results in shorter labors and more mother control over her birthing experience. At one month these mothers were more likely to exclusively breastfeed and to engage in behaviors that support breastfeeding.
Research: Question: Does psychosocial support during labor by a female companion (doula) help the mother both mentally and physically?
Background: It is hypothesized that psychosocial support during labor, birth, and the beginning of the postpartum period by a doula would help increase breastfeeding by supporting the mother's emotional status, shortening the length of labor and decreasing medical interventions.
Subjects: Seven hundred and twenty-four women with a single fetus, no previous vaginal deliveries, less that 6 cm dilated and no references for an elective cesarean section were randomly assigned to be assisted by a doula, or to receive routine care.
Study Design: Data was collected from a large social security hospital based in Mexico City. Blinded interviewers were able to obtain data from clinical records, asking questions to the women in the immediate postpartum period and at their homes forty days following giving birth.
Variables: The mother's age, the mother's plan of breastfeeding before giving birth, the labor process (difficult or easy, short or long), mother's education, doula's attitude, cultural beliefs.
Findings: The findings were as follows: the frequency of exclusive breastfeeding one month after birth was higher in the intervention group (odds ratio 1.64; confidence interval: 1.01-2.64), the behaviors that promote breastfeeding were also higher. The study also showed that more women in the intervention group perceived a high degree of control over their birthing experience, and the labor was shorter than in the control group (4.56 hours vs 5.58 hours; odds ratio 1.07 confidence ratio (95%)=1.52 to -0.51). There were no differences shown in the newborns condition, mother's self-esteem, anxiety, perception of pain and satisfaction.
Research reviewed by Rochelle Gower, RN, while a student at Virginia Commonwealth University, School of Nursing, Richmond, VA.
- Waldenstrom, U., & Turnbull, D. (1998). A systematic review comparing continuity of midwifery care with standard maternity services. British Journal of Obstetrics and Gynecology, 105, 1160-1170.
Premise: Midwifery care is associated with lower intervention rates than standard hospital care.
Research Question: Does midwifery care compared with standard maternity services have any significance on outcomes such as interventions during labor, maternal and infant outcomes?
Variables: Rates of cesarean sections, instrumental vaginal deliveries on the total number of deliveries, augmentation of labor, electronic fetal monitoring, and use of analgesia on all deliveries except cesarean, the number of episiotomies on vaginal deliveries and infant outcomes on the total number of babies including twins.
Subjects: The seven trials investigated included 9148 women.
Findings: In a meta analysis, midwives used fewer obstetric interventions during labor such as forceps, augmentation analgesia, and electronic monitoring. The cesarean section rate however, did not significantly differ (odds ratio 0.91; 95% confidence interval 0.78 to 1.05). Decrease in episiotomy rate in midwife care (odds ratio .069; 95% confidence interval 0.61 to 0.77) was also associated with an increase in perineal tears in the pooled alternative groups (odds ratio 1.11; 95% confidence interval 1.00 to 1.24). There was no significant change in the amount of maternal complications. No maternal deaths occurred. Apgar scores were also statistically similar. Thus fewer interventions used by midwives did not compromise the health of mothers or infants.
Research reviewed by Rochelle Gower, RN, while a student at Virginia Commonwealth University, School of Nursing, Richmond, VA.
- Berkowitz, G., Scott, K., & Klaus, M., (1999). A comparison of intermittent and continuous support during labor: A meta-analysis. American Journal of Obstetrics and Gynecology, 180 (5), 1054-1059.
Premise: Doula support in labor is shown to be effective only when it is continuous.
Research Question: Does continuous support by doulas during labor compared to intermittent support improve the outcome of delivery?
Variables: Continuos or intermittent support by the doulas, the age, race, culture, education, finances, parity for the patient, any obstetrical complications that arose during labor (need for pitocin for augmentation, forceps, analgesia, length of labor, need for c-section).
Subjects: 11 clinical trials by meta-analytic techniques of full-term pregnant women with no complications.
Data Collection: Laboring women in the hospital were assigned to an experimental and control group. Subjects in some investigations were randomly assigned.
Analysis: Continuous support, when compared to no doula support, was significantly associated with shorter labors (weighted mean difference &endash;1.64 hours, 95% confidence interval &endash;2.3 to -.96) and decreased need for analgesia (odds ratio .64, 95%, confidence interval .49 to .85), oxytocin use (odds ratio .29, 95% confidence interval .20 to .40), forceps (odds ratio .43, 95% confidence interval .28 to .65) and cesarean sections (odds ratio .49, 95% confidence interval .37 to .65). Intermittent doula support was not significantly associated with any of the positive outcomes.
Research reviewed by Rochelle Gower, RN, while a student at Virginia Commonwealth University, School of Nursing, Richmond, VA.
- Madi, B.C., Sandall, J., Bennett, R., & MacLeod, C. (1999). Effects of female relative support in labor: A randomized controlled trial. Birth, 26 (1), 4.8.
Premise: Women in labor benefit from support in labor from a female relative.
Research Question: Does support from a female relative provide any benefits to a laboring woman?
Variables: Maternal age, weight, height, gestation, prenatal visits, fundal height, cervical dilation; spontaneous delivery, analgesia, normal vaginal birth, fetal heart rate per min.
Subjects: 109 black primagravida Botswana women with uncomplicated pregnancies and with spontaneous labors who presented at a major referral center in 1994. Each woman was pregnant with one fetus, between 38-42 weeks gestation with cephalic presentation, cervix dilated between 1 and 6, and was accompanied by a female relative.
Study Design: The experiment group received standard hospital care with the female relative present for support during the entire labor. The control group received only standard hospital care. No exclusions occurred after the selection was done.
Findings: The mothers in the experimental group had significantly higher spontaneous vaginal deliveries (91% to 71%), less analgesia use during labor (53% to 73%), less oxytocin (13% to 30%), less amniotomies to augment labor (30% to 54%), fewer vacuum extractions (4% to 16%) and less cesarean sections (6% to 13%) compared to the control group. The support of a female relative while in labor is shown to have fewer interventions and increased frequency of normal vaginal deliveries.
Research reviewed by Rochelle Gower, RN, while a student at Virginia Commonwealth University, School of Nursing, Richmond, VA.