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Continuous support for women during childbirth (Review)

Copyright 2012 The Cochrane Collaboration !ublished by "ohn

Continuous support for women duringchildbirth (Review)

Hodnett ED, Gates S, Hofmeyr GJ, Sakala C

This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration andpublished in TheCochraneLibrary

2012, Issue 10

http://ww w.thec oc hranelibrary.c om
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T ' * + , C + - T * - T%

!"#!$ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

"%&T$"CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

'("I) (")*+"*! &+"$- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

%"C*$+)# . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

%!CTI!& . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

!T#& . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$!&+(T& . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4i5ure 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

4i5ure 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

#I&C+&&I) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

"+T/$&7C/)C(+&I/)& . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

"C)9(!#*!!)T& . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

$!4!$!)C!& . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

C"$"CT!$I&TIC& 4 &T+#I!& . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

#"T" ")# ")"(-&!& . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6;

"nalysis 1.1. Comparison 1 Continuoussupport versus usual care < all trials, utcome 1 "ny anal5esia/anaesthesia. . 63

"nalysis 1.2. Comparison 1 Continuoussupport versus usual care < all trials, utcome 2 $e5ional anal5esia/anaesthesia. 6=

"nalysis 1.;. Comparison 1 Continuoussupport versus usual care < all trials, utcome ; &ynthetic o>ytocin durin5

labour. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

"nalysis 1.. Comparison 1 Continuoussupport versus usual care < all trials, utcome (abour len5th. . . . . . 81

"nalysis 1.6. Comparison 1 Continuoussupport versus usual care < all trials, utcome 6 &pontaneous va5inal birth. 82

"nalysis 1.8. Comparison 1 Continuoussupport versus usual care < all trials, utcome 8 Instrumental va5inal birth. 8;

"nalysis 1.. Comparison 1 Continuoussupport versus usual care < all trials, utcome Caesarean birth. . . . . 8

"nalysis 1.3. Comparison 1 Continuoussupport versus usual care < all trials, utcome 3 'erineal trauma. . . . . 86

"nalysis 1.=. Comparison 1 Continuoussupport versus usual care < all trials, utcome = (ow 6


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ii

"nalysis 2.. Comparison 2 Continuoussupport versus usual care perience. . . . . . . . . . . . . . . . . . . 31

"nalysis 2.3. Comparison 2 Continuoussupport versus usual care


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iii

I&T/$- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

C)T$I%+TI)& 4 "+T/$& . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

#!C("$"TI)& 4 I)T!$!&T . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11;

&+$C!& 4 &+''$T . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11;

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1

[Intervention Review]

Continuous support for women duringchildbirth

!llen # odnett1 , &imon *ates2 , * ustus ofmeyr; , Carol

&a@ala

1 (awrence &. %loomber5 4aculty of )ursin5, +niversity of Toronto, Toronto, Canada. 2 9arwic@ Clinical Trials +nit, #ivision

of ealth &ciences, 9arwic@ edical &chool, The +niversity of 9arwic@, Coventry, +. ; #epartment of bstetrics and

*ynaecolo5y, !ast (ondon ospital Comple>, +niversity of the 9itwatersrand, +niversity of 4ort are, !astern Cape #epartment

of ealth, !ast (ondon, &outh "frica. Childbirth Connection, )ew -or@, +&"

Contact address: !llen # odnett, (awrence &. %loomber5 4aculty of)ursin5, +niversity of Toronto, 166 Colle5e &treet, &uite

1;0, Toronto, ntario, 6T 1'3, Canada.elle n.hodnettAutoronto.c a.

Editorial grou! Cochrane 're5nancy and Childbirth *roup.

"u#li$ation status and date! )ew search for studies and content updated Bno chan5e to conclusions, published in Issue 10,

2012.Review $ontent assessed as u%to%date! 1 "u5ust 2012.

Citation! odnett !#, *ates &, ofmeyr *, &a@ala C. Continuous support for women durin5 childbirth. Cochrane Databaseof

Systematic Reviews 2012, Issue 10. "rt. )o.: C#00;88. #I:10.1002/1861363.C#00;88.pub.

Copyri5ht D 2012 The Cochrane Collaboration. 'ublished by ohn 9iley E &ons,(td.

&a$kground

% T R C T

istorically, women have been attended and supported by other women durin5 labour. owever, in hospitals worldwide,

continuous support durin5 labour has become the e>ception rather than the routine.

'#(e$tives

'rimary: to assess the effects of continuous, onetracted the data. 9e sou5ht additional information from the trial authors.

9e used random< effects analyses for comparisons in which hi5h hetero5eneity was present, and we reported results usin5 the

avera5e ris@ ratio B$$ for cate5orical data and mean difference B# for continuous data.
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


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2

*ain results

Twenty


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CI 0.36 to 0.=8, re5ional anal5esia B$$ 0.=;, =6H CI 0.33 to 0.==, or a baby with a low fiveception rather than

the norm. This may contribute to the dehumanisation of women7s childbirth e>periences. odern obstetric care freGuently

subects women to institutional routines, which may have adverse effects on the pro5ress of labour. &upportive care durin5 labour

may involve emotional support, comfort measures, information and advocacy. These may enhance physiolo5ic labour processes as

well as women7s feelin5s of control and competence, and thus reduce the need for obstetric intervention. The review of studies

included 2; trials B22providin5 data, from 18 countries, involvin5 more than 16,000 women in a wide ran5e of settin5s and

circumstances. The continuous support was provided either by hospital staff Bsuch as nurses or midwives, women who were not

hospital employees and had nopersonal relationship to the labourin5 woman Bsuch as doulas or women who were provided with a

modest amount of 5uidance, or by companions of the woman7s choice from her social networ@ Bsuch as her husband, partner,

mother, or friend. 9omen who received continuous labour support were more li@ely to 5ivebirth 7spontaneously7, i.e. 5ivebirth

with neither caesarean nor vacuum nor forceps. In addition, women were less li@ely to usepain medications, were more li@ely to be

satisfied, and had sli5htly shorter labours. Theirbabies were less li@ely to have low five


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cisions to modify the bac@5round and methods. The authors

de< cided that the best approach would be to write a new

protocol for the review. The new protocol was submitted

throu5h the peer review process of the Cochrane 're5nancy and

Childbirth *roup and has subseGuently evolved into a review

that has been updated.

istorically and cross


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periences Bin hi5htentbuffer such stressors.

The second theoretical e>planation does not focus on a

particular type of birth environment. $ather, it describes two

pathways < enhancedpassa5e of the fetus throu5h thepelvis and

soft tissues, as well as decreased stress response < by which labour

support may reduce the li@elihood of operative birth and

subseGuent compli< cations, and enhance women7s feelin5s of

control and satisfaction with their childbirth e>periences

Bodnett 2002a. !nhanced fe< topelvic relationships may be

accomplished by encoura5in5 mo< bility and effective use of

5ravity, supportin5 women to assume their preferred positions

and recommendin5 specific positions for specific situations.

&tudies of the relationships amon5 fear and an>< iety, the stress

response and pre5nancy complications have shown that an>iety

durin5 labour is associated with hi5h levels of the stress hormone

epinephrine in the blood, which may in turn lead to ab< normal

fetal heart rate patterns in labour, decreased uterine contraction or forceps, episiotomy and

less morbidity associated with these, and may increase mobility

durin5 labour and spontaneous birth BCaton 2002.

" systematic review e>aminin5 factors associated with women7s

sat< isfaction with the childbirth e>perience su55ests that

continuous support can ma@e a substantial contribution to this

satisfaction. 9hen women evaluate their e>perience, four factors

predominate: the amount of support from care5ivers, the Guality

of relationships with care5ivers, bein5 involved with decisionpectations or havin5 e>periences thate>ceed e>pectations Bodnett 2002a.

Clarification of the effects of continuous support durin5

labour, overall and within specific circumstances, is important in

li5ht ofpublic and social policies and pro5rams that encoura5e

this type of care. 4or e>ample, the Con5ress in +ru5uay passed a

law in 2001 decreein5 that all women have the ri5ht to

companionship durin5 labour. In several low< and middletra cost

to families or health systems, it is important to understand their

effectiveness as providers of continuous labour support.

In addition to Guestions about the impact of the type of

provider of labour support, there are other Guestions about the

effectiveness of support, includin5 its impact under a variety of

environmental conditions, and whether its effects are mediated

by when contin< uous support be5ins Bearly versus active

labour.

Childbearin5 women,policy


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ii not a staff member but not part of the woman7s

social networ@ andpresent solely for thepurpose of providin5

continuous supportF or

iii aperson chosenby the woman from family

members and friends.

;. 9hether the continuous support be5ins early or later

in labour.

* T 6 + 4%

Criteria for considering studies forthis review

Types of studies

"ll controlled trials comparin5 continuous labour support by

ei< ther a familiar or unfamiliar person Bwith or without

healthcare professional Gualifications with usual care, in

which there was random allocation to treatment and control

5roups, were consid< ered for inclusion in the review.

Types of participants

're5nant women, in

labour.

Types of interventions

The form of care that was evaluated was continuous presence

and support durin5 labour and birth. The person providin5 the

sup< port could have Gualifications as a healthcare professional

Bnurse, midwife or trainin5 as a doula or childbirth educator,

or be a family member, spouse/partner, friend or stran5erwith little or no special trainin5 in labour support. The control

5roup received usual care, as defined by the trialists. In all cases,

7usualcare7did not involve continuous intrapartum support,but

it could involve other measures, such as routine epidural

anal5esia, to help women to cope with labour.

Types of outcome

measures

Theoretically, continuous support can have many diversephysiotract data. 4or eli5ible studies, data

were independently e>tractedby twopeople Beither two review

authors or an author and an assistant, usin5 the a5reed form.9e resolved discrepancies throu5h discussion. 9e entered data

into $eview ana5er software B$evan 2011 and chec@ed for

accuracy. 9hen information re5ardin5 any of the above was

unclear, we attempted to contact authors of the ori5inal

reports to provide further details.

ssessment of ris8 of bias inincluded studies

4or each study, at least two review authors independently

assessed ris@ of bias, usin5 the criteria outlined in the Cochrane

Handbook for SystematicReviewsofInterventionsBi55ins 2011.

9e would have resolved any disa5reement by discussion or by

involvin5 a third assessor.
http://www.mrw.interscience.wiley.com/cochrane/clabout/articles/PREG/frame.htmlhttp://www.mrw.interscience.wiley.com/cochrane/clabout/articles/PREG/frame.htmlhttp://www.mrw.interscience.wiley.com/cochrane/clabout/articles/PREG/frame.htmlhttp://www.mrw.interscience.wiley.com/cochrane/clabout/articles/PREG/frame.htmlhttp://www.mrw.interscience.wiley.com/cochrane/clabout/articles/PREG/frame.htmlhttp://www.mrw.interscience.wiley.com/cochrane/clabout/articles/PREG/frame.htmlhttp://www.mrw.interscience.wiley.com/cochrane/clabout/articles/PREG/frame.htmlhttp://www.mrw.interscience.wiley.com/cochrane/clabout/articles/PREG/frame.htmlhttp://www.mrw.interscience.wiley.com/cochrane/clabout/articles/PREG/frame.htmlhttp://www.mrw.interscience.wiley.com/cochrane/clabout/articles/PREG/frame.htmlhttp://www.mrw.interscience.wiley.com/cochrane/clabout/articles/PREG/frame.html


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(1) %e9uence generation (chec8ing for

possible selection bias)

9e described for each included study the method used to

5enerate the allocation seGuence in sufficient detail to allow an

assessment of whether it shouldproduce comparable 5roups.

9e assessed the method as: low ris@ ofbias Bany truly randomprocess, e.5. random

number tableF computer random number5eneratorF

hi5h ris@ ofbias Bany nonclusions from the analysis. 9e stated whether

attrition and e>clusions were reported, the numbers included in

the analysis at each sta5e Bcompared with the total randomised

participants, rea< sons for attrition or e>clusion where reported,

and whether miss< in5 data were balanced across 5roups or were

related to outcomes. To be included in the review, data on a

5iven outcome had to be available for at least 30H of those who

were ori5inally randomised.


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4or outcomes collected postplicit ud5ements about whether studies are at hi5h

ris@ of bias, accordin5 to the criteria 5iven in the Handbook

Bi55ins

2011. 9ith reference to B1 to B8 above, we assessed the

li@ely ma5nitude and direction of the bias and whether we

considered it is li@ely to impact on the findin5s. 9e e>plored

the impact of the level of bias throu5h underta@in5 sensitivity

analyses < see &ensitivity analysis.


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easures of treatmenteffect

4ichotomous

data

4or dichotomous data, we presented results as summary ris@

ratio with =6H confidence intervals.

Continuousdata

"ll but one pre


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ssessment ofheterogeneity

9e assessed statistical hetero5eneity in each meta


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() +ne subgroup analysis that concerns

characteristics of the providers of labour

support

Trials in which the care5ivers were employees of the

institution, compared with trials in which the care5ivers were not

employees and were not members of the woman7ssocialnetwor@, compared with trials in which theproviders were not

employees and were lay people chosen by theparticipants Be.5.

husband/partner, friend, close relative.

(C) +ne subgroup analysis that concerns

differences in the timing of onset of continuous

support

Trials in which continuous labour support be5anprior to or

durin5 early labour Bas defined by trial authors, comparedwith

trials in which continuous support be5an in activelabour.

%ecause few of the trial reports contained all of the information

needed for the above sub5roup analyses, we contacted the trial

au< thors in an attempt to verify thepresence/absenceof routine

elec< tronic fetal monitorin5 B!4, the presence/absence of

epidural anal5esia and timin5 of onset of continuous support.

9e e>cluded some studies included in the primary comparisons

from the sub< 5roup analyses concernin5 the use of !4

because their status re5ardin5 !4 use was un@nown. 4or tests

of differences between these sub5roups, we recalculated the

overall analysisby includin5 only the studies in which !4 use

was @nown.The seven primary outcomes and one secondary outcomewere

used in the sub5roup analyses. 9hile normally, sub5roup analyses

are restricted to primary outcomes, we also included the

outcome of caesarean delivery, because there is widespread

concern about escalatin5 caesarean rates worldwide, and sub5roup

analyses could be helpful to policy ma@ers in decisions about

the provision of continuous labour support. Thusthe outcomes

in the sub5roup analyses were: any anal5esia/anaesthesia,

synthetic o>ytocin dur< in5 labour, spontaneous va5inal birth,

caesareanbirth, postpartum depression, ne5ative ratin5s of the

birth e>perience, admission to special care nursery, and

breastfeedin5 at one to two monthsposttremely low, we compared the results of randomeded


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%ensitivityanalysis

9eperformed sensitivity analyses, for the primary outcomes, in

instances in which there was a hi5h ris@ of bias associated with

the Guality of included trials.

R * % ' T %

4escription of

studies

&ee: Characteristics of included studiesF Characteristics of

e>cluded studiesF Characteristics of studies awaitin5 classificationF

Characteristics of on5oin5 studies.

.ncludedstudies

'lease see Characteristics of included studies table. 9hile 2;

trials met the inclusion criteria, one trial BThomassen 200;

provided no usable outcome data. 9e do not describe it here,

but provide details in the Characteristics of included studies

table.

"ll 22 trials Bn Q 16,233 that provided usable outcome data

were conducted in hospitals. The trials were conducted in

"ustralia, %el< 5ium, %otswana, %raJil, Canada, Chile, 4inland,

4rance, *reece, *uatemala, e>ico, )i5eria, &outh "frica,

&weden, Thailand, and the +nited &tates, under widely disparate

hospital conditions, re5< ulations and routines. There was

remar@able consistency in the descriptions of continuous support

across all trials. In all instances the intervention included

continuous or nearly continuous pres< ence, at least durin5 activelabour. Twenty of the 22 trials that pro< vided usable outcome

data Ball e>cept Co5an 1=33 and #ic@inson

2002 also included specific mention of comfortin5 touch and

words ofpraise and encoura5ement.

In 11 trials B%reart < %el5ium 1==2F %reart < 4rance 1==2F

Campbell 2008F Co5an 1=33F #ic@inson 2002F *a5non 1==F

emmin@i 1==0aF emmin@i 1==0bF odnett 1=3=F odnett

2002F c*rath 2003, hospital policy permitted women to be

accompanied by their husbands/partners or other family memcluded because they

did not provide any us< able data B*ordon 1===F emmin@i

1==0c. 'lease refer to table Characteristics of e>cluded studies

for details.

Ris8 of bias in includedstudies

The trials were of 5enerally 5ood Guality B4i5ure 1F 4i5ure

2.


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1

,igure 1 ethodological 9uality summary@ review authorsA Budgements about each

methodological 9uality item for each included study


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1

,igure 2 ethodological 9uality graph@ review authorsA Budgements about each

methodological 9uality item presented as percentages across all

included studies

llocation

$andom seGuence 5eneration: Twelve trials were at unclear

ris@ of bias B%reart < %el5ium 1==2F %reart < 4rance 1==2F

%reart < *reece 1==2F Co5an 1=33F #ic@inson 2002F

emmin@i 1==0aF emmin@i 1==0bF ennell 1==1F laus

1=38F adi 1===F c*rath 2003F Thomassen 200; because

they did not describe the method of random assi5nment. !leven

trials described usin5 a computer random number 5enerator or

referred to a random number table B%ru55emann 200F

Campbell 2008F *a5non 1==F odnett 1=3=F odnett 2002F

ofmeyr 1==1F ashanian 2010F (an5er 1==3F orhason trials Bn Q =681, the support

was provided by a member of the hospital staffF $$ 1.08, =6H

CI 1.01 to 1.11. In three trials Bn Q 1013, the support was

providedby a woman who was not a member of the staff and

was not part of the woman7ssocial networ@F $$ 0.8=, =6H CI

0.60 to 0.=. In si> trials Bn Q 201, the support was

provided by a member of the woman7ssocial networ@F $$

0.==, =6H CI

0.=8 to 1.01. ChiP for the sub5roup comparison Q 11.8, ' Q

0.00;, "nalysis 6.2.

Thus the effects of continuous support on use of synthetic

o>ytocin durin5 labour did not appear to be influenced by

policies about thepresence of companions, use of routine !4,

or availability of epidural anal5esia. The effectiveness of

continuous support in reducin5 the li@elihood of intrapartum

o>ytocin seemed to be stron5est when theprovider was neither

a staff member nor part of the woman7ssocial networ@.

'ut$ome!sontaneous vaginal #irt)

1. 'olicies about companions: In nine trials Bn Q 10,33=companions werepermittedF $$ 1.0;, =6H CI 1.00 to 1.06.

In ten trials Bn Q ;;2= companions were not permittedF

$$1.11,

=6H CI 1.0 to 1.18. ChiP for the sub5roup comparison Q

11.32, ' R 0.001, "nalysis 2.;.

2. "vailability of epidural anal5esia: In 1; trials Bn Q 12,82,

epidural anal5esia was routinely availableF $$ 1.0, =6H CI 1.01

to 1.08. In si> trials Bn Q 168 epidural anal5esia was not

routinely availableF $$ 1.11, =6H CI 1.08 to 1.1. ChiP for the

sub5roup comparison Q 8.6=, ' Q 0.01, "nalysis ;.;.


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;. $outine use of !4: In ei5ht trials Bn Q =1 !4

was routineF $$ 1.0;, =6H CI 1.01 to 1.08. In seven trials Bn

Q

1=1; !4 was not routineF $$ 1.11, =6H CI 1.08 to 1.1.

In four trials Bn Q 2681, thepolicy about routine !4 is not

@nownF $$ 1.0, =6H CI 1.01 to 1.1;. ChiP for the sub5roup

comparison Q 3.68, ' Q 0.01, "nalysis .;.

. 'rovider characteristics: in nine trials Bn Q 10,31; the

support was provided by a member of the hospital staffF $$

1.0;, =6H CI 1.01 to 1.08. In five trials Bn Q 1=;6 the

support was provided by a woman who was not part of the

hospital staff nor part of the woman7ssocial networ@F $$ 1.12,

=6H CI 1.0 to 1.1. In five trials Bn Q 10, the support was

provided by a member of the woman7ssocial networ@F $$

1.0, =6H CI 0.== to 1.16. ChiP for the sub5roup comparison

Q =.=, ' Q 0.00, "nalysis 6.;.

Thus the effectiveness of continuous support in increasin5 the

li@elihood of spontaneous va5inal birth appeared to be

stron5er when hospital policies did not permit companions,

when epidural anal5esia was not available, when !4 was not

routine, and when the support provider was neither a staff

member nor part of the woman7ssocial networ@.

'ut$ome!$aesarean #irt)

1. 'olicies about companions: in 11 trials Bn Q 11,;28

companions werepermittedF $$ 0.=, =6H CI 0.36 to 1.0;. In

11 trials Bn Q ;3= companions were not permittedF $$ 0.6,

=6H CI 0.86 to 0.38. ChiP for the sub5roup comparison Q

8.8, ' Q 0.01, "nalysis 2..

2. "vailability of epidural anal5esia: in 1 trials Bn Q 1;,08,

epidural anal5esia was routinely availableF $$ 0.=;, =6H CI0.38 to 1.02. In seven trials Bn Q 20, epidural anal5esia was

not routinely availableF $$ 0.6, =6H CI 0.; to 0.83. In one

very small trial Bn Q ;, we were unable to determine if

epidural anal5esia was routinely availableF $$ 1.0, =6H CI

0.1 to

1;.=3. ChiP for the sub5roup comparison Q 1=.;0, ' R

0.0001, "nalysis ;..

;. $outine use of !4: in nine trials Bn Q 10,12;, !4

was routineF $$ 0.=2, =6H CI 0.3; to 1.01. In ei5ht trials Bn Q

26 !4 was not routineF $$ 0.88, =6H CI 0.66 to 0.=. In

five trials Bn Q 26=6, it is not @nown whether !4 was

routineF $$ 1.08, =6H CI 0.3 to 1.;;. ChiP for the sub5roup

comparison Q 12.3, ' Q 0.002, "nalysis ... 'rovider characteristics: in nine trials Bn Q 10,38,

the support was provided by a member of the hospital

staffF $$

0.=6, =6H CI 0.36 to1.06. In seven trials Bn Q 2;;0, the

support was provided by a woman who was not a member of

the hospital staff and not part of the woman7ssocial networ@F

$$

0.2, =6H CI 0.80 to 0.38. In si> trials Bn Q 206=, the

support was provided by a member of the woman7ssocial

networ@F $$

0.3;, =6H CI 0.8= to 1.01. ChiP for the sub5roup comparison Q

8.33, ' Q 0.0;, "nalysis 6..


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Thus the effectiveness of continuous support in reducin5 the

li@e< lihood of caesareanbirth appeared to be stron5er in settin5s

where companions were not permitted, epidural anal5esia was

not rou< tinely available and !4 was not routine, and when

the provider was neither a staff member nor part of the woman7s

social networ@.

'ut$ome!admission to se$ial $are nursery

1. 'olicies about companions: in two trials Bn Q ;23,

companions werepermittedF $$ 0.==, =6H CI 0.3 to 1.1. In

five trials Bn Q 168=, companions were not permittedF $$

0.=1,

=6H CI 0.1 to 1.1. ChiP for the sub5roup comparison Q 0.23,

' Q 0.80, "nalysis 2.6.

2. "vailability of epidural anal5esia: in five trials Bn Q 3;30

epidural anal5esia was routinely availableF $$ 0.=3, =6H CI 0.36

to 1.1;. In two trials Bn Q 61 epidural anal5esia was not

routinely availableF $$ 0.28, =6H CI 0.03 to 0.33. ChiP for the

sub5roup comparison Q .61, ' Q 0.0;, "nalysis ;.6.

;. $outine use of !4: in three trials Bn Q 0 !4 was

routineF $$ 0.=, =6H CI 0.3 to 1.11. In three trials Bn Q

2= !4 was not routineF $$ 0.3, =6H CI 0.21 to 1.12. In

one trial Bn Q 23, it is not @nown whether !4 was routineF

$$

1.=3, =6H CI 0.8 to 6.13. ChiP for the sub5roup comparison Q

.8, ' Q 0.0=, "nalysis .6.

. 'rovider characteristics: in three trials Bn Q 23, the

support was provided by a member of the hospital staffF

$$

0.==, =6H CI 0.3, 1.1. In two trials Bn Q 32=, the support

was provided by a woman who was not a member of the

hospital staff and not part of the woman7ssocial networ@F $$

0.38, =6H CI 0.88 to 1.12. In two trials Bn Q 80 the support

wasprovided by a member of the woman7ssocial networ@F $$

1.0, =6H CI

0.8 to 2.=;. ChiP for the sub5roup comparison Q 1., ' Q

0.2, "nalysis 6.6.


li@e< lihood of admission of the newborn to a special care

nursery ap< peared to be stron5er in settin5s in which epidural

anal5esia was not routinely available, but effectiveness did not

appear to be in< fluenced by policies about companions or

routine !4, or byprovider characteristics.

'ut$ome!negatives ratings of0negativeviews a#out t)e #irt)

e1erien$e

1. 'olicies about companions: in five trials Bn Q 38;=

companions werepermittedF $$ 0.0, =6H CI 0.82 to 0.3.

In si> trials Bn Q 26;= companions were not permittedF $$

0.82,

=6HCI 0.68 to 0.8=. ChiP for the sub5roup comparison Q 2.0;,

' Q 0.16, "nalysis 2..

2. "vailability of epidural anal5esia: in nine trials Bn Q 10,0

epidural anal5esia was routinely availableF $$ 0.0, =6H CI 0.8

to 0.. In two trials Bn Q epidural anal5esia was not

routinely availableF $$ 0.66, =6H CI 0.3 to 0.8;. ChiP for the

sub5roup comparison Q .=2, ' 0.0006, "nalysis ;..


34/170

;. $outine use of !4: four trials Bn Q 8 were

conducted in settin5s with routine !4F $$ 0.8, =6H CI

0.80 to 0.8. 4our trials Bn Q 110 were conducted in settin5s

in which !4 was not routineF $$ 0.80, =6H CI 0.6; to 0.83.

Three trials Bn Q

1= were in settin5s in which the use of routine !4 is not

@nownF $$ 0.3, =6H CI 0.86 to 1.03. ChiP for the

sub5roup comparison Q 6.66, ' Q 0.08, "nalysis ..

. 'rovider characteristics: in four trials Bn Q 316 support

providers were hospital staffF $$ 0.3, =6H CI 0.; to 1.0;. In

three trials Bn Q 1;26 theproviders were not hospital staff and

not part of the woman7ssocial networ@F $$ 0.88, =6H CI 0.6

to 0.. In four trials Bn Q 103,providers werepart of the

woman7ssocial networ@F $$ 0.6, =6H CI 0.61 to 0.8. ChiP

for the sub5roup comparison Q 18., ' Q 0.000;, "nalysis

6..


li@e< lihood of dissatisfaction with or ne5ative views of the

childbirth e>perience appeared to be stron5er in settin5s in

which epidural anal5esia was not routinely available, and when

the provider was neither a staff member nor part of the

woman7ssocial networ@.

4 . % C % % . +-

This review summarises results of 22 trials involvin5 16,233

women, conducted in 18 countries under a wide variety of

circum< stances. Continuousonecellent. 4or all outcomes in which summary statistics were

computed, comparisons of fi>ed< effect and random


35/170

)IC! Intrapartum Care 200F &*C 1==6. The results of the

primary comparison in the current review offer continuedustifiperiences.

There remains relatively little information about the effects of

continuous intrapartum support on mothers7 and babies7 health

and well


37/170

ucational materials for the %etter %irths Initiative include a

videopresentation on childbirth companions which is available

in the 9orld ealth r5aniJation $eproductive ealth (ibrary

B9/

2010. It can be accessed free of char5e on the Internet in

"rabic, Chinese, 4rench, !n5lish, &panish, $ussian and

ietnamese and is distributed on C# to health wor@ers in

resource


38/170

#ec 1;


39/170

differentpolicies for the mana5ement of labour. arly

H!manDevelo#ment 1==2F43:;0=S12.

%reart *, li@a


40/170

$o!rnal o fPsychosomatic'bstetricsand (ynaecolo)y 1==0F22:

2;=S60.

Hodnett 23


41/170

effect on stress hormone levels. $o!rnal of 'bstetricsand

(ynaecolo)y 1==6F2;:13S31. ofmeyr *, )i@odem C, 9olman 9(, Chalmers

%!, ramer T. Companionship to modify the clinical

birth environment: effects onpro5ress andperceptions of

labour, andbreastfeedin5. &ritish$o!rnal of 'bstetrics

and (ynaecolo)y 1==1F3


42/170

*adi 2333 {published and unpublished data}

adi %C, &andall , %ennett $, ac(eod C.

!ffects of female relative support in labor: a

randomiJed controlled trial.&irth 1===F49:S3.

*$Grat) 455< {published data only}

c*rath &, ennell . " randomiJed controlled

trial of continuous labor support for middle


43/170



2

labor #attern 4thesis5. $hode Island: +niversity of $hode

Island, 2000.

&rown 4557 {published data only}

%rown , ofmeyr *, )i@odem C, &mith ,

*arner '. 'romotin5 childbirth companions in &outh

"frica: a randomised pilot study. &%C%edicine200F;:.

Dalal 4559 {published data only}

#alal $, $athna@umar, &antamani. %irth companion

and mother < apreliminary report abstractU. =th "ll

India Con5ress of bstetrics and *ynaecolo5yF 2008 an

8


44/170



2

Sosa 23ryon 2399 {published data only}

Tryon '". +se of comfort measures as support durin5 labor.

"!rsin)Research1=88F2;B2:10=S13.

@)ang 2339 {published data only}

Mhan5 C(, -u M, 4en5 ". &tudy of

psycholo5ical nursin5 to easepain durin5 labour.

Chinese$o!rnal of"!rsin)1==8F

:2B8:;11S;.

Referen$es to studies awaiting assessment

Dong 4553 {published data only}

#on5 ?, Ni , u (, (uo ?, Mhu -, Cai . The

effects of air sac combined with nitrous o>ide and

#oula companyin5 delivery in va5inal delivery.

International $o!rnal of (ynecolo)y and 'bstetrics

200=F257:&163S&16=.

Huang 455: {published data only}

uan5 ?, ?ian5 ?-, &hen $*, &han5 N, Mhu (', Nian

?, et al.&tudy on intrapartum service model durin5 normal

labor. Ch!n)-H!a8! Chan 2o TsaChih 4Chinese$o!rnal

of 'bstetrics (ynecolo)y5 200;F:


45/170

and reduces postpartum problems for hospitaliJed pre5nant

women. Contem#orary"!rse2011F:7B2:1=S6=.

Referen$es to ongoing studies

Janssen {published data only}

anssen '. Impact of doula support on intrapartumoutcomes for women under5oin5 a va5inalbirth after

cesarean Bvbac.

http://c linic a ltria ls.5ov/ct2/sho w/re cord/)C T 012180= 3

Baccessed 16 4ebruary 2012.

+dditional referen$es

+nim%Somua) 4522

"nim


46/170

=laus 4554

laus , ennell , laus '. Thedo!la

book3 how a trained labor com#anion can hel# yo!

have a shorter, easier and healthier birth. 2nd

!dition. Cambrid5e, ": 'erseus %oo@s, 2002.

-ederman 237presentations.

Trial in %el5ium: n Q 28 B1;; permanent supportF 1;1 control

Interventions 'ermanentpresence of a midwife compared to varyin5 de5rees ofpresence. 4athers

were allowed to bepresent

utcomes >ytocin, epidural anal5esia, labour len5th, mode ofbirth, "p5ar scores, mothers7

views of their e>periences

)otes !pidural anal5esia was available and it is not @nown whether !4 was used routinely

Risk of bias

&ias +ut)ors,(udgement Suort for(udgement

$andom seGuence 5eneration Bselection

bias+nclear ris@ 9omen were 7randomly assi5ned7. The envelopes were

prepared by the co


49/170

&reart % 6ran$e 2334

ethods &ee %reart cept that mothers7views were not reported

)otes !pidural anal5esia was not available.)ot stated if !4 was used routinely

Risk of bias

&ias


+ut)ors,(udgement

+nclear ris@

Suort for(udgement

9omen were 7randomlyassi5ned7. The envelopes were

bias by the copected behaviour when confronted with si5ns of tiredness, an>iety,

concern, cryin5, screamin5 and/or the woman7s feelin5s of inability to cope,

compliance with re5ulations and the possibility of reGuestin5 information from staff

7. in .8H of the


51/170

&ruggemann 4557 BContin!ed=

sample the woman7s companion was her partner, for 2=.6H it was hermother

The control 5roup received usual care where a companion durin5 labour and

delivery was not permitted

4or both 5roups labour and delivery care was provided 7accordin5 to the routine

protocol includin5 active mana5ement of labour Bearly amniotomy, use of o>ytocin,

intermittent !4 and systematic anal5esiaC7

utcomes &atisfaction with labour and delivery, perinatal and breastfeedin5 outcome in the 12

hours post delivery

)otes "ll women in labour at this hospital received epidural anal5esia as a routine practice.

Therefore, we did not include epidural anal5esia data in the

review

!4 was not used routinely.

Risk of bias



bias(ow ris@ 7Computer5enerated seGuence of random numbers.7

"llocation concealment Bselection bias i5h ris@ 7Individual assi5nment numbers were all placed in an

opaGue container to assure the concealment. The eli5ible

women who had a5reed to participate selected one of the

numbers once, and were therefore allocated to either

intervention 5roup or control accordin5 to the list.7

This process was open to selection bias as women could havere< pic@ed another number from the container. )o audit

process ispossible with this system of randomisation

%lindin5 Bperformance bias and detection

bias

"ll outcomes

i5h ris@ #ata collectionby author, who @new 5roup allocation.

Incomplete outcome data Battrition bias

"ll outcomes

(ow ris@ edical record data were collected and in


52/170

12 and ;3 wee@s75estation. They were considered low ris@, with no contraindications


53/170

Cam#ell 4559 BContin!ed=

to labour and had a female friend or relative willin5 to act as their lay doula. The

doula was in addition to support people of their own choosin5

Interventions Intervention: continuous supportby a female friend or relative who had had 2, 2t envelope. It was unclear whether the

research assistant enrollin5 the woman was the same one that

opened the envelope


bias"ll outcomes

i5h ris@ edical record abstraction was done by the author who was

not blinded. The 8


54/170

%lindin5 Bperformance bias and detection (ow ris@

had fore@nowled5e of the treatment allocation scheme

edical record information collected by 7researchassistants

bias"ll outcomes

did not @now the 5roup membership of the women7

Incomplete outcome data Battrition bias

"ll outcomes

i5h ris@ 9ithdrawals occurred before analysis B8 B;0H in support

5roup and ; B21H in control. This resulted in a follow


55/170

Di$kinson 4554

ethods $CT, stratifiedby induced or spontaneous labour at trial entry

'articipants ==2 nulliparous women at term B== to continuous support and =; to control,

cephalic fetal presentation, cervical dilatation R 6 cm, in a hospital in 'erth, 9estern"ustralia

Interventions *roup 1: continuous physical and emotional support by midwifery staff, and women

were encoura5ed to use pharmacolo5ic and nonpharmacolo5ic alternatives to epidural

anal5esia.

*roup 2: continuous midwifery support was notprovided and women were

encoura5ed to have epidural anal5esia as theirprimary method of pain relief in labour

utcomes (abour len5th Be>pressed as median and interGuartile ran5e, epidural anal5esia,

mode of delivery, 6 min "p5ar score R , arterial cordp

)otes The stated purpose was to compare the effects of intrapartum anal5esic techniGues on

labour outcomes. Continuous midwifery support was conceptualised as an anal5esic

techniGue. %oth 5roups had access to opioids and nitrous o>ide. )o data were

presented about the number of women who used nopharmacolo5ic anal5esia. %ecause

the type of anal5esia used was a measure of compliance rather than an outcome, no data

on anal5esic outcomes are included in this review

It was not stated if other support person was allowed. epidural anal5esia was available

and !4 was used routinely

Risk of bias


$andom seGuence 5eneration Bselectionbias

+nclear ris@ )o details about how the bloc@s of treatcluded women were

provided by the author

(abour len5th data were only available

for

3.H of the sam le 226 of 86 and

&elective reportin5 Breportin5 bias (ow ris@ "ll outcomes were reported on.

ther bias (ow ris@ )o other sources ofbias noted.

=laus 23


69/170



;

-anger 233< BContin!ed=

)otes 'artners and family members were not permitted. !pidural anal5esia was available but

it was not stated if !4 was used routinely

Risk of bias

&ias


+ut)ors,(udgement

(ow ris@

Suort for(udgement

7Computer5enerated random number list7. 7Thetreatment se of envelopes that were shuffled in the woman7spresence.

9hen opened the envelope revealed a code indicatin5 her

5roup.7 "n assistant that was not involved in the recruitment

process shuf< fled the envelopes


bias

"ll outcomes

i5h ris@ The researcher, who was involved in the recruitment of

partici


71/170

*$Grat) 455< BContin!ed=

utcomes Caesarean delivery, epidural anaesthesia, o>ytocin use, labour len5th, mode of

delivery, fever durin5 labour, satisfaction at 8 wee@spostpartum

)otes !pidural anal5esia was available and !4 was used routinely.

The author hasbeen contacted for data splitby study 5roup and Guestionnaire data

for the control 5roup

Risk of bias



bias

+nclear ris@ )o details stated.

"llocation concealment Bselection bias (ow ris@ 79hen the research cot seGuentially

numbered opaGue envelope to determine

random as< si5nment to the doula or

control 5roup7. The research co


72/170

*or)ason%&ello 4553

ethods $CT.

'articipants 80; women fromIbadan, )i5eria with anticipated va5inal delivery were enrolledbetween

;0 and ;2 wee@s7 5estation at an antenatal clinic B;06 to intervention and 2=3 tocontrol

from)ovember 2008 to arch 200

Interventions Those in the e>perimental 5roup were informed to brin5 someone of their choice to

act as a companion durin5 labour. n arrival in labour the accompanyin5 companions

were provided with an information leaflet that e>plained their responsibilities. These

included: 5entle massa5e of the woman7s bac@ durin5 contraction, reassurin5

words, spiritual support inform ofprayers and also actin5 as intermediary between the

woman and healthcare team. "fter studyin5 the leaflets, they were allowed to see@

clarifications. The information leaflet was also interpreted for those that are not literate.

The attendin5 midwife allowed and ensured companions performed their e>pected

duties throu5hout. The companions were told to offer continuous support < they were

to be by the patient7s side e>cept for feedin5 and use of toilet until two hours afterchildbirth. usbands were the most common support person B86.H

The women in the control 5roup had only routine care where relatives of patients

are usuallybarred from the labour ward

utcomes Caesarean section rate, active phase of labour duration, pain score, need for anal5esia,

need for o>ytocin au5mentation, time from delivery to initiation ofbreastfeedin5 and

the emotional e>perience durin5 labour

)otes !pidural anal5esia was not available and it was not stated whether !4 was used rouperimental 5roup tended to

be more educated B32H vs 3H with tertiary level and s@illed wor@ers B3H vs ;=H.This imbalance was noted and discussedby the authors

Risk of bias

&ias


+ut)ors,(udgement

(ow ris@

Suort for(udgement

7The randomisation seGuence was 5enerated usin5 a table of

bias random numbers7

"llocation concealment Bselection bias (ow ris@ 7$andompermuted bloc@s of siJe four were used to ensure a

bal< anced desi5n.7 7%ased on the seGuence of treatments

5enerated usin5 this method, treatment 5roups B" and % were

written on pieces of cardboard paper and put into sealed

opaGue envelopes. !ach of the opaGue envelopes had a serial

number on it.7 7Two trained research assistants B$"s non)omassen 455: BContin!ed=

reported for 66/2 B8H of the

interven< tion 5roup and 8/2 B8H of

the control 5roup. $eason for the 1

KdropoutsL were preterm birth, induction,

or caesarean sec< tion Kfor medical

reasonsL, and participant withdrawal. )o

numbers are 5iven for in< dividual reasons,

or by 5roup, but it is clear that some

KdropoutsL were prior to labour and

others were durin5 labour. )umbers in

the report show the number of dropouts

was actually ;

&elective reportin5 Breportin5bias +nclear ris@ &ample siJe was based on caesarean section

rate. The only outcome reported was emerorres 2333

ethods $CT.

'articipants ;6 women B21 in companion 5roup, 213 in control 5roup with a sin5leton

pre5nancy and considered to be lowperienced a va5inal birth

Control 5roup did not have companion.

%oth 5roups laboured in a room with other women where curtains were pulled forprivacy

utcomes Caesarean section, e>clusive breastfeedin5, duration of labour, mode of delivery, use

of o>ytocics, presence of meconium, re5ional anaesthesia,birth asphy>ia, "p5ar scores,

level of neonatal care, maternal satisfaction

)otes !pidural anal5esia was available. It was not stated if !4 was used routinely.

"uthors havebeen contacted for further details

Risk of bias



75/170

>orres 2333 BContin!ed=


bias

(ow ris@ Computer


76/170

?uenyong 4524 BContin!ed=

"llocation concealment Bselection bias (ow ris@ &ealed opaGue envelopes were used. !nvelopes were consecuytocin

level for 18 minutes postytocin, caesarean delivery, or forcepsLF or if the infant

was asphy>iated or ill at birth, etc. KIf a woman was removed, her 5roup assi5nment was inserted at random

into the pool of unused assi5nments. 9omen were enrolled in the study until there were 20 in the control

5roup and 20 in the e>perimental 5roup.L The total study sample of 12 mothers includes =6 in the control

5roup and ;2 in the e>perimental 5roup. Thusassi5nment was not random

Trueba 2000 #irect contact with investi5ator revealed that randomisation was not used. n arrival at the hospital,

women were as@ed if they wanted to have a doula. If they accepted, a doula was assi5ned to them. "lso

support was not continuous throu5hout active labour for most women, since admission to the labour ward

Band assi5nment of a doula did not usually occur until 3 cm

Tryon 1=88 )ot an $CT. K"fter a random start, the matched 5roups were alternately assi5ned to e>perimental and

control 5roups.L 9omen who developed severe complications in labour Bnumber not specified, such as fetal

distress, were dropped from the study

Mhan5 1==8 )ot a trial of continuous 1


78/170



ed, =6H CI

$is@ $atio BI, 4i>ed, =6H CI

0.6 0.86, 0.38U

&ubtotals only

6.1 ther support permitted 2 ;23 $is@ $atio BI, 4i>ed, =6H CI 0.== 0.3, 1.1U

6.2 ther support not

permitted

8 'ostpartum depression

6

2

168= $is@ $atio BI, 4i>ed, =6H CI


0.=1 0.1, 1.1U

&ubtotals only

8.1 ther support permitted 1 668 $is@ $atio BI, 4i>ed, =6H CI 0.38 0.;, 1.02U


permitted

1 1= $is@ $atio BI, 4i>ed, =6H CI 0.13 0.0=, 0.;8U

)e5ative ratin5 of/ne5ative

feelin5s about birth e>perience

.1 ther support permitted

11

6 38;=



&ubtotals only

0.0 0.82, 0.3U

.2 ther support not

permitted

8 26;= $is@ $atio BI, 4i>ed, =6H CI 0.82 0.68, 0.8=U

3 %reastfeedin5 at 1ed, =6H CI


&ubtotals only

0.= 0.=2, 1.02U


permitted

2 30 $is@ $atio BI, 4i>ed, =6H CI 1.06 0.=3, 1.1;U

Comarison :/ Continuous suort versus usual $are % availa#ility of eidural analgesia

'ut$ome or su#grou title

.o/ of

studies

.o/ of

arti$iants Statisti$al met)od Effe$t sie

1 "ny anal5esia/anaesthesia 1 $is@ $atio BI, 4i>ed, =6H CI &ubtotals only

1.1 !pidural anal5esia

routinely available

= 10333 $is@ $atio BI, 4i>ed, =6H CI 0.= 0.=8, 0.=3U

1.2 !pidural anal5esia not

routinely available

2 &ynthetic o>ytocin durin5 labour

6

16

182 $is@ $atio BI, 4i>ed, =6H CI


0.3; 0.8=, 0.==U

&ubtotals only


routinely available

3 10683 $is@ $atio BI, 4i>ed, =6H CI 1.00 0.=3, 1.02U


routinely available

; &pontaneous va5inal birth

1=



1.02 0.=;, 1.11U

&ubtotals only;.1 !pidural anal5esia

routinely available

1; 1282 $is@ $atio BI, 4i>ed, =6H CI 1.0 1.01, 1.08U

;.2 !pidural anal5esia not

routinely available

Caesarean birth

8

22



1.11 1.08, 1.1U

&ubtotals only

.1 !pidural anal5esia

routinely available

1 1;08 $is@ $atio BI, 4i>ed, =6H CI 0.=; 0.38, 1.02U


84/170

.2 !pidural anal5esia not

routinely available

20 $is@ $atio BI, 4i>ed, =6H CI 0.6 0.;, 0.83U


85/170

.; +n@nown availability of

epidural anal5esia

6 "dmission to special care nursery

1

; $is@ $atio BI, 4i>ed, =6H CI


1. 0.1, 1;.=3U

&ubtotals only


routinely available

6 3;30 $is@ $atio BI, 4i>ed, =6H CI 0.=3 0.36, 1.1;U


routinely available


2

2



0.28 0.03, 0.33U

&ubtotals only


routinely available

1 8=16 $is@ $atio BI, 4i>ed, =6H CI 0.3= 0.6, 1.06U


routinely available




11 $is@ $atio BI, 4i>ed, =6H CI &ubtotals only

.1 !pidural anal5esia

routinely available

= 100 $is@ $atio BI, 4i>ed, =6H CI 0.0 0.8, 0.U

.2 !pidural anal5esia not

routinely available

2 $is@ $atio BI, 4i>ed, =6H CI 0.66 0.3, 0.8;U

3 %reastfeedin5 at 1ed, =6H CI &ubtotals only


routinely available

2 621 $is@ $atio BI, 4i>ed, =6H CI 0.== 0.=6, 1.0;U


routinely available

1 1= $is@ $atio BI, 4i>ed, =6H CI 1.16 0.=6, 1.0U

Comarison 8/ Continuous suort versus usual $are % oli$y a#out routine E6*

.o/ of .o/ of'ut$ome or su#grou title studies arti$iants Statisti$al met)od Effe$t sie


1.1 &ettin5 had routine !4 8 3630 $is@ $atio BI, 4i>ed, =6H CI 0.= 0.=8, 0.==U

1.2 &ettin5 did not have

routine !4

8 2138 $is@ $atio BI, 4i>ed, =6H CI 0.=8 0.=0, 1.02U

1.; 'olicy about routine !4

not @nown


2

16



0.3= 0.30, 0.==U

&ubtotals only

2.1 &ettin5 had routine !4 3;0 $is@ $atio BI, 4i>ed, =6H CI 1.0 0.=3, 1.11U


routine !4

128 $is@ $atio BI, 4i>ed, =6H CI 0.== 0.=8, 1.01U


not @nown


1=



1.02 0.=, 1.03U

&ubtotals only

;.1 &ettin5 had routine !4 3 =1 $is@ $atio BI, 4i>ed, =6H CI 1.0; 1.01, 1.08U

;.2 &ettin5 did not have

routine !4

1=1; $is@ $atio BI, 4i>ed, =6H CI 1.11 1.08, 1.1U


86/170

;.; 'olicy about routine !4

not @nown

Caesarean birth

22



1.0 1.01, 1.1;U

&ubtotals only


87/170

.1 &ettin5 had routine !4 = 1012; $is@ $atio BI, 4i>ed, =6H CI 0.=2 0.3;, 1.01U

.2 &ettin5 did not have

routine !4

3 26 $is@ $atio BI, 4i>ed, =6H CI 0.88 0.66, 0.=U

.; 'olicy about routine !4

not @nown


6

26=6 $is@ $atio BI, 4i>ed, =6H CI


1.08 0.3, 1.;;U

&ubtotals only6.1 &ettin5 had routine !4 ; 0 $is@ $atio BI, 4i>ed, =6H CI 0.= 0.3, 1.11U


routine !4

; 2= $is@ $atio BI, 4i>ed, =6H CI 0.3 0.21, 1.12U


not @nown


1

2



1.=3 0.8, 6.13U

&ubtotals only

8.1 &ettin5 had routine !4 1 8=16 $is@ $atio BI, 4i>ed, =6H CI 0.3= 0.6, 1.06U


routine !4


)e5ative ratin5 of/ne5ativeviews

about birth e>perience

.1 &ettin5 had routine !4

11

8



&ubtotals only

0.8 0.80, 0.8U

.2 &ettin5 did not haveroutine !4

110 $is@ $atio BI, 4i>ed, =6H CI 0.80 0.6;, 0.83U

.; 'olicy about routine !4

not @nown

; 1= $is@ $atio BI, 4i>ed, =6H CI 0.3 0.86, 1.03U

3 %reastfeedin5 at 1ed, =6H CI


&ubtotals only

0.= 0.=2, 1.02U


routine !4


Comarison ;/ Continuous suort versus usual $are % variations in rovider $)ara$teristi$s

.o/ of .o/ of'ut$ome or su#grou title studies arti$iants Statisti$al met)od Effe$t sie


1.1 &upport people were

hospital staff

8 =162 $is@ $atio BI, 4i>ed, =6H CI 0.= 0.=8, 0.==U

1.2 &upportpeople were not

hospital staff and not chosen

by woman

1=0 $is@ $atio BI, 4i>ed, =6H CI 0.=1 0.38, 0.=U

1.; &upportpeople were not

hospital staff and were chosen

by woman


16



0.= 0.33, 1.00U

&ubtotals only


hospital staff

8 =681 $is@ $atio BI, 4i>ed, =6H CI 1.08 1.01, 1.11U


88/170



by woman

; 1013 $is@ $atio BI, 4i>ed, =6H CI 0.8= 0.60, 0.=U


89/170



by woman


8

1=



0.== 0.=8, 1.01U

&ubtotals only

;.1 &upport people were

hospital staff

= 1031; $is@ $atio BI, 4i>ed, =6H CI 1.0; 1.01, 1.08U

;.2 &upportpeople were not


by woman

6 10 $is@ $atio BI, 4i>ed, =6H CI 1.0 0.==, 1.16U

;.; &upportpeople were not


by woman

Caesarean birth

6

22

1=;6 $is@ $atio BI, 4i>ed, =6H CI


1.12 1.0, 1.1U

&ubtotals only

.1 &upport people were

hospital staff

= 1038 $is@ $atio BI, 4i>ed, =6H CI 0.=6 0.36, 1.06U

.2 &upportpeople were not


by woman

2;;0 $is@ $atio BI, 4i>ed, =6H CI 0.2 0.80, 0.38U

.; &upportpeople were nothospital staff and were chosen

by woman


8



0.3; 0.8=, 1.01U

&ubtotals only


hospital staff

; 23 $is@ $atio BI, 4i>ed, =6H CI 0.== 0.3, 1.1U



by woman

2 32= $is@ $atio BI, 4i>ed, =6H CI 0.38 0.88, 1.12U



by woman


2

2



1.0 0.8, 2.=;U

&ubtotals only


hospital staff

1 668 $is@ $atio BI, 4i>ed, =6H CI 0.38 0.;, 1.02U



by woman

1 1= $is@ $atio BI, 4i>ed, =6H CI 0.1 0.0=, 0.;;U



by woman

0 0 $is@ $atio BI, 4i>ed, =6H CI 0.0 0.0, 0.0U



11 $is@ $atio BI, 4i>ed, =6H CI &ubtotals only

.1 &upport people were

hospital staff

316 $is@ $atio BI, 4i>ed, =6H CI 0.3 0.;, 1.0;U

.2 &upportpeople were nothospital staff and not chosen

by woman

; 1;26 $is@ $atio BI, 4i>ed, =6H CI 0.88 0.6, 0.U

.; &upportpeople were not


by woman

103 $is@ $atio BI, 4i>ed, =6H CI 0.6 0.61, 0.8U

3 %reastfeedin5 at 1ed, =6H CI &ubtotals only

postpartum


90/170


91/170

3.1 &upport people

were hospital staff

1 66= $is@ $atio BI, 4i>ed, =6H CI 0.= 0.=2, 1.02U



by woman




by woman

0 0 $is@ $atio BI, 4i>ed, =6H CI 0.0 0.0, 0.0U

nalysis 11 Comparison 1 Continuous support versus usual care ? all

trials& +utcome 1 ny analgesiaanaesthesia

Review: Continuous support for women during childbirth

Comparison: 1 Continuous support versus usual care - all trials

Outcome: 1 Any analgesia/anaesthesia

tudy or subgroup Continuous support

!sual care Ris"Ratio

#eight Ris" Ratio$-

n/% n/%&'Random'()*

C+&'Random'()*

$orhason-,ello ..( 0/( (/( )21 * .2(0 3 .24' 121

Campbell ..6 04/(1 6./() 12( * .2(6 3 .2(.' 12.

&odnett .. .44/0)0 1)(/061 1)24 * .2( 3 .2(6' .2((

$adi 1((( /) 01/)6 2( * .24 3 .2)' .2(4

7anger 1(( ()/61 ./6 124 * .2( 3 .2(' 12.)

8agnon 1((4 101/.( 10/.0 1.2. * .2(4 3 .2)' 121.

,reart - ,elgium ))/1 6/1 026 * .2) 3 .26)' 121

,reart - 9rance 1(( 1/6) 1(/666 1.24 * .2(. 3 .2.' 12.1

&ofmeyr 1((1 )/( )6/(4 )2 * .2( 3 .246' 12)

ennell 1((1 (/1 1)./.. 42( * .2) 3 .20(' .26(

&emmin"i 1((.a )/01 / 2. * 12.1 3 .241' 1200

&emmin"i 1((.b 0)/1 )/. )2. * .2) 3 .266' 121.

;uenyong .1 1/) 1)/)6 12. * .20 3 .200' 126.

laus 1(6 /16 1./0( .2 * .2. 3 .2.4' 120

>otal 3; CIF 953< 92@+2 ?4)*


92/170

nalysis 12 Comparison 1 Continuous support versus usual care ? all trials&

+utcome 2 Regional analgesiaanaesthesia



Outcome: Regional analgesia/anaesthesia



#eight Ris" Ratio$-

n/% n/%&'Random'()*

C+&'Random'()*

$c8rath .. 10)/0 10(/1(6 1.2 * .2) 3 .24)' .2(6

Campbell ..6 04/(1 6./() 1026 * .2(6 3 .2(.' 12.

&odnett .. 0(/0)0 06/061 1626 * .2(4 3 .2(0' 12..

otal 3; CIF ;747 ;727 255/5 5/3: [ 5/@+2 ?1*


93/170

nalysis 1: Comparison 1 Continuous support versus usual care ? all trials& +utcome :

%ynthetic o7ytocin during labour



Outcome: ynthetic oDytocin during labour



#eight Ris" Ratio$-

n/% n/%&'Random'()*

C+&'Random'()*

,reart - ,elgium ))/1 60/1( 024 * .20 3 .260' 121.

,reart - 9rance 1(( /6)0 41/666 121 * 12.) 3 .2(6' 121)

,reart - 8reece 0/4 1(/6) 12. * 12.4 3 .2(4' 121

,ruggemann ..4 1.0/1.) 1.4/1.4 1421 * .2(( 3 .2(6' 12.

Campbell ..6 1/(1 100/() 2 * .2(0 3 .24(' 1211

8agnon 1((4 /.( (6/.0 621 * .2 3 .264' 12.0

&odnett .. 1.0./0)0 (0/061 1020 * 1211 3 12.' 121(

&ofmeyr 1((1 16/( 14/(4 121 * .2(( 3 .2)' 12)

ashanian .1. 11/). 1(/). 121 * .2) 3 .21' 12.(

ennell 1((1 6/1 06/.. 26 * .240 3 .2).' 12.(

laus 1(6 0/16 4/0( .20 * .216 3 .2.6' .200

$adi 1((( 4/) 14/)6 .24 * .200 3 .2.' .2(6

$orhason-,ello ..( )1/( )6/( 2 * .2(1 3 .260' 12

otal 3; CIF 947; 9:8; 255/5 5/37 [ 5/32, 2/58 ]

' (( =!sual care>

&eterogeneity:


94/170

nalysis 1; Comparison 1 Continuous support versus usual care ? all trials& +utcome; 'abour length



Outcome: 0 7abour length

tudy or subgroup Continuous support!sual care

$eanEifference#eight

$eanEifference

% $ean=E> % $ean=E> +F'Random'()*C++F'Random'()*C+

$orhason-,ello ..( ( 024 =124> ( )2 =124> 1(20 *

-.26. 3 -.2' -.2 5 Campbell ..6 (1 1.20 =02> () 1124 =02>

26 * -12. 3 -2.0' -.2)6 5 8agnon 1((4 .( (21 =021> .0 (20 =024>

421 * -.2. 3 -121)' .2)) 5 ,reart - ,elgium 1(( 1 624 =)24> 1( 62 =02.4>

02) * -.2) 3 -126' .26 5 ,reart - 9rance 1(( 6)0 6244 =2)4> 666 42.4 =26>

1(2 * -.2. 3 -.2)' -.2. 5 ,reart - 8reece 1(( 4 6264 =24)> 6) 62 =2(>

1.2 * .20 3 -.2.' .2( 5 ennell 1((1 1 420 =2> .. 20 =02>

21 * -12.. 3 -1244' -.2 5 &ofmeyr 1((1 ( (26 =2(> (4 1.2 =02(>

2 * -.26. 3 -124' .264 5 7anger 1(( 61 02)6 =204> 6 )2) =204>

121 * -12. 3 -12)' -.2)1 5 &emmin"i 1((.a 0 2 =62> 1 1. =62>

.24 * -124. 3 -024' 1204 5 ;uenyong .1 ) 112 =)26> 0) 120 =42>

.2( * -.266 3 -20.' 2. 5 &emmin"i 1((.b 1 )21 =2> . )24 =24>

020 * -.26. 3 -1246' .2)6 5

>otal 3; CIF 4933 4997 255/5 %5/;< [ %5/


95/170

=1

Copyright 2012 The Cochrane Collaboration !ublished by "ohn #iley $ %ons& 'td


96/170

nalysis 1

&eterogeneity:


97/170

nalysis 1= Comparison 1 Continuous support versus usual care ? all trials&

+utcome = .nstrumental vaginal birth



Outcome: 6 +nstrumental vaginal birth

tudy or subgroup Continuous

su

!sual

car

Ris" Ratio

$-&'9iDed'()* C+

Ris" Ratio

$-&'9iDed'()* C+

ashanian .1. ./). ./) .2. 3 .2.'

,ruggemann ..4 )/1.) )4/1.4 .2() 3 .24'

Campbell ..6 1/(1 /() .26. 3 .21'

&odnett .. )01/0)0 )61/061 .2(4 3 .24'

Eic"inson .. 10/0(( 16(/0( .24 3 .24'

$adi 1((( /) (/) .2 3 .2.)'

otal 3; CIF 754< 7535 5/35 [ 5/@+2 ?)*


98/170

nalysis 1> Comparison 1 Continuous support versus usual care ? all trials& +utcome >Caesarean birth



Outcome: 4 Caesarean birth



#eight Ris" Ratio$-

n/% n/%&'Random'()*

C+&'Random'()*

ashanian .1. 0/). 1/). 12 * .2 3 .21' .2(6

$orhason-,ello ..( 4/.) 6/( 62 * .2( 3 .26' .2)(

$c8rath .. ./0 0(/1(6 620 * .2)0 3 .2)' .21

,ruggemann ..4 11/1.) 1/1.4 2( * .2( 3 .20' 2.

Campbell ..6 ))/(1 )/() 420 * 12.) 3 .24)' 120

&odnett .. 0/0)0 04/061 112. * .2(( 3 .24' 121

Eic"inson .. 41/0(( )/0( 2 * .2 3 .26' 121.

$adi 1((( /) 4/) 12 * .20) 3 .21' 1266

&eterogeneity:


99/170

nalysis 1D Comparison 1 Continuous support versus usual care ? all trials& +utcome D!erineal trauma

Review: Continuous support for women during

childbirth Comparison: 1 Continuous support

versus usual care - all trials Outcome: erineal

trauma

tudy or subgroup Continuous support !sual care Ris"Ratio

#eight Ris" Ratio$-

n/% n/%&'Random'()*

C+&'Random'()*

,ruggemann (0/1.) ()/1. 1621 * 12.1 3 .2(' 1211

&odnett .. 1/0)0 16./061 42. * .2( 3 .2(0' 12.

Campbell ..6 0(/(1 4)/() .2. * .2( 3 .24' .2(4

8agnon 1((4 16/.4 166/.. 162( * .2( 3 .2(' 12.4

>otal 3; CIF 85;7 859: 255/5 5/37 [ 5/34, 2/52 ]

' (6 =!sual care>

&eterogeneity:


100/170

nalysis 1E Comparison 1 Continuous support versus usual care ? all trials&+utcome E 'ow


101/170


+utcome 10 dmission to special care nursery



Outcome: 1. Admission to special care nursery


Ris" Ratio$-

n/% n/%&'Random'()*

C+&'Random'()*

ashanian .1. ./). ./). .2. 3 .2.' .2. 5

,ruggemann ..4 )/1.) 6/1.4 .2) 3 .24' 24.

&odnett .. 06/0)0 )0/061 .2(4 3 .2' 121)

otal 3; CIF 882: 88@+2 ?4*



102/170


+utcome 11 !rolonged neonatal hospital stay



Outcome: 11 rolonged neonatal hospital stay


Ris" Ratio$-

n/% n/%&'Random'()*

C+&'Random'()*

ashanian .1. ./). ./) .2. 3 .2.' .2. 5

Campbell ..6 14/(1 10/() 12 3 .26' 20)

ennell 1((1 /1 0/.. .261 3 .24' 12.1

>otal 3; CIF ;;: ;8; 5/@+2 ?6*


103/170


+utcome 12 !ostpartum report of severe labour pain



Outcome: 1 ostpartum report of severe labour pain



#eight Ris" Ratio$-

n/% n/%&'Random'()*

C+&'Random'()*

7anger 1(( 61/)6 0/) 121 * 12.0 3 .2()' 1210

,reart - ,elgium 61/11( )/11 .2 * 1214 3 .2(.' 12)

,reart - 9rance 1(( 1)4/6)6 1(/660 020 * 1210 3 .2(' 120.

&ofmeyr 1((1 )/( 46/(6 02 * .24 3 .2)(' .2(

>otal 3; CIF 244: 24:: 255/5 2/55 [ 5/@+2 ?4*


104/170

nalysis 11: Comparison 1 Continuous support versus usual care ? all trials& +utcome

1: -egative rating ofnegative feelings about birth

e7perience



Outcome: 1 %egative rating of/negative feelings about birth eDperience



#eight Ris" Ratio$-

n/% n/%&'Random'()*

C+&'Random'()*

$orhason-,ello ..( 1./( 1(6/( 120 * .2)) 3 .206' .26)

,ruggemann ..4 4/1.) 14/1.4 2) * .20 3 .21' .2(4

Campbell ..6 ()/( 1(4/6) 120 * .2)6 3 .204' .266

&odnett .. (6/1 114/4)1 1.2) * .2. 3 .261' 12.0

Eic"inson .. 4)/0(( 40/0( (24 * 12.. 3 .240' 12)

otal 3; CIF ;;@+2 ?6*

0Copyright 2012 The Cochrane Collaboration !ublished by "ohn #iley $ %ons& 'td


105/170

nalysis 11; Comparison 1 Continuous support versus usual care ? all trials&

+utcome 1; 4ifficulty mothering



Outcome: 10 EiGculty mothering

tudy or subgroup Continuous support !sual care Ris" Ratio Ris"

n/% n/% $-&'9iDed'()* C+ $-&'9iDed'()*

Campbell ..6 11/( /6) .26 3 .210'

&odnett .. 4/6 )/46) 12.. 3 .2('

&ofmeyr 1((1 01/4) 64/4) .261 3 .20('

.21 .2 .2) 1 ) 1.

9avours support 9avours usual care

nalysis 11

&eterogeneity:


106/170



107/170

nalysis 11= Comparison 1 Continuous support versus usual care ? all trials&

+utcome 1= !ostpartum depression



Outcome: 16 ostpartum depression

tudy or subgroup Continuous support !sual care Ris" Ratio Ris"

&odnett ..

n/%

0)/16

n/%

44/4)1

$-&'9iDed'()* C+ $-&'9iDed'()*C+

&ofmeyr 1((1 /40 00/4 .21 3 .2.('

.2) .24 1 12)

9avours support 9avoursusual care

Continuous support for women during childbirth (Review)>2



108/170

nalysis 11> Comparison 1 Continuous support versus usual care ? all trials& +utcome

1> 'ow postpartum self?esteem



Outcome: 14 7ow postpartum self-esteem

tudy or subgroup Continuous support !sual care Ris" Ratio #eight Ris"

7anger 1((

n/%

)/6

n/%

./1

$-&'9iDed'()* C+

1..2. *

$-&'9iDed'()*C+

>otal 3; CIF ::9 :29 255/5 2/55 [ 5/77, 2/:5 ]

' . =!sual care>

&eterogeneity: not applicable

:



109/170

nalysis 21 Comparison 2 Continuous support versus usual care ? policy regarding

presence of companion& +utcome 1 ny

analgesiaanaesthesia


Comparison: Continuous support versus usual care - policy regarding presence of companion



su

!sual

car

Ris" Ratio

+F'9iDed'()* C+

#eight Ris"Ratio

1 Other supportpermitted

04/.. 6./.. 024 * .2() 3 .2('

&odnett .. .44/0)0 1)(/061 (126 * .2( 3 .2(6'

8agnon 1((4 101/.( 10/.0 12 * .2(4 3 .2)'

,reart - ,elgium ))/1 6/1 .2 * .24 3 .264'

,reart - 9rance 1(( 1/6)6 1(/660 126 * .2( 3 .24('

&emmin"i 1((.a )/01 / .2 * 12.1 3 .241'

&emmin"i 1((.b 0)/1 )/ .2 * .2) 3 .266'

Su#total 3; CIF 8@+2 ?.2.*

Other support not permitted

$orhason-,ello ..( 0/( (/( )26 *

.2(0 3 .24' 121 5 $adi 1((( /) 01/)6

2( * .24 3 .2)' .2(4 5 7anger 1(( ()/61 ./6

4421 * .2( 3 .2(' 12.) 5 &ofmeyr 1((1 11/( 1)/(4

.24 * .244 3 .24' 12)( 5 ;uenyong .1 1/) 1)/)6

.2 * .20 3 .200' 126. 5 ennell 1((1 (/1 1)./..

112 * .2) 3 .20(' .26( 5 laus 1(6 /16 1./4(

.2 * .2. 3 .2.4' 12) 5

Su#total 3; CIF 24;; 2:8: 255/5 5/32 [ 5/@+2 ?*

;



110/170

nalysis 22 Comparison 2 Continuous support versus usual care ? policy regarding

presence of companion& +utcome 2 %ynthetic o7ytocin during

labour



Outcome: ynthetic oDytocin during labour


su

!sual

car

Ris" Ratio

+F'9iDed'()* C+

#eight Ris"Ratio


Campbell ..61/(1 100/() (20 * .2(0 3 .24('

1211 5&odnett .. 1.0./0)0 (0/061 0(24 * 1211 3 12.'

8agnon 1((4 /.( (6/.0 )2) * .2 3 .264'

,reart - ,elgium1((

))/1 60/1( 2( * .20 3 .260'121. 5

,reart - 9rance 1(( /6)0 41/666 12) * 12.) 3 .2(6'

Su#total 3; CIF 8785 87;; 255/5 2/58 [ 5/33, 2/25 ]

' 1614=!sual care>

&eterogeneity: Chi2 ? 1.24' df ? 0 = ?

.2.>@+2 ?61*

Other suppor t notpermitted

ashanian .1. 11/). 1(/). .21 *

.2) 3 .21' 12.( 5 $orhason-,ello ..( )1/( )6/(

.2) * .2(1 3 .260' 12 5 ,ruggemann ..4 1.0/1.) 1.4/1.4

621 * .2(( 3 .2(6' 12. 5 $adi 1((( 4/) 14/)6

.21 * .200 3 .2.' .2(6 5@+2 ?60*


111/170

Continuous support for women during childbirth (Review)>@+2 ?0*


ashanian .1. 06/). /). ) 121 3 12.'

,ruggemann ..4 01/1.) /1.4 1 121. 3 .24'

$adi 1((( 0/) 0./)6 0 124 3 12.)'

.2) .24 1 12)

9avours usual 9avours

BContinued. . .

Continuous support for women during childbirth (Review)>=



113/170

B. . . Continuedtudy or subgroup Continuous suppor !sual care Ris" Ratio #eigh Ris"

n/% n/% +F'9iDed'()* C+ +F'9iDed'()*

&eterogeneity: Chi2 ? 1214' df ? ( = ? .2.>@+2 ?6*


114/170

B. . . Continuedtudy or subgroup Continuous suppor !sual care Ris" Ratio #eigh Ris"

n/% n/% +F'9iDed'()* C+ +F'9iDed'()*

&eterogeneity: Chi2 ? 112)' df ? 1. = ?

.2(>@+2 ?16*


ashanian .1. 0/). 1/). 12( *

.2 3 .21' .2(6 5 $orhason-,ello ..( 4/.) 6/(

12 * .2( 3 .26' .2)( 5 ,ruggemann ..4 11/1.) 1/1.4

2) * .2( 3 .20' 2. 5 $adi 1((( /) 4/)6

12 * .20) 3 .21' 1266 5 &eterogeneity: Chi2 ? 6211' df ?

1. = ? .2..0>@+2 ?6*

D



115/170

nalysis 2@+2 ?*

Other suppor t notpermitted

ashanian .1. ./). ./).

.2. 3 .2.' .2. 5 ,ruggemann ..4 )/1.) 6/1.4

.2) 3 .24' 24. 5 &eterogeneity: Chi2 ? 626.' df ?

= ? .2.(>@ +2 ?))*


116/170

Continuous support for women during childbirth (Review)>E



117/170

nalysis 2= Comparison 2 Continuous support versus usual care ? policy regarding

presence of companion& +utcome = !ostpartum depression



Outcome: 6 ostpartum depression


su

!sual

car

Ris" Ratio

+F'9iDed'()* C+

#eight Ris"Ratio


0)/16 44/4)1 1..2. * .26 3 .24'

Su#total 3; CIF 4' +2 ?()*

.2) .24 1 12)

9avours support 9avoursusual care

Continuous support for women during childbirth (Review)D0



118/170

nalysis 2> Comparison 2 Continuous support versus usual care ? policy regarding

presence of companion& +utcome > -egative rating ofnegative feelings

about birth e7perience



Outcome: 4 %egative rating of/negative feelings about birth eDperience


su

!sual

car

Ris" Ratio

+F'9iDed'()* C+

#eight Ris"Ratio

1 Other support

Campbell ..6 ()/( 1(4/6) ).2 * .2)6 3 .204'

&odnett .. (6/1 114/4)1 .26 * .2. 3 .261'

Eic"inson .. 4)/0(( 40/0( 162) * 12.. 3 .240'

,reart - ,elgium 0/1 ./11 62 * .24( 3 .20('

,reart - 9rance 1(( ./6)6 )/660 620 * .24 3 .2)0'

Su#total 3; CIF 8::; 8:58 255/5 5/75 [ 5/94, 5/7< ]

' 0) =!sual care>

&eterogeneity: Chi2 ? 102).' df ? 0 = ?

.2.1>@+2 ?4*


$orhason-,ello ..( 1./( 1(6/( (24 *

.2)) 3 .206' .26) 5 ,ruggemann ..4 4/1.) 14/1.4

126 * .20 3 .21' .2(4 5@+2 ?0)*


119/170

nalysis 2D Comparison 2 Continuous support versus usual care ? policy regarding

presence of companion& +utcome D reastfeeding at 1?2 months

postpartum



Outcome: ,reastfeeding at 1- months postpartum


su

!sual

car

Ris" Ratio

+F'9iDed'()* C+

#eight Ris"Ratio


11/( 1/. 1..2. * .2(4 3 .2('

Su#total 3; CIF 4::3 4445 255/5 5/37 [ 5/34, 2/54 ]

' 1 =!sual care>

&eterogeneity: not applicable


&ofmeyr 1((1 )/40 )1/4) 102) *

121) 3 .2()' 120. 5 7anger 1(( 66/0 04/1

)2) * 12.0 3 .2()' 121 5

Su#total 3; CIF 85< :39 255/5 2/5; [ 5/3@+2 ?.2.*


120/170

nalysis :1 Comparison : Continuous support versus usual care ? availability of

epidural analgesia& +utcome 1 ny

analgesiaanaesthesia


Comparison: Continuous support versus usual care - availability of epidural analgesia



su

!sual

car

Ris" Ratio

+F'9iDed'()* C+

#eight Ris"Ratio

1 Hpidural analgesia routinely available

&emmin"i 1((.a )/01 / .2 * 12.1 3 .241'

ennell 1((1 (/1 1)./.. .24 * .2) 3 .20('

&emmin"i 1((.b 0)/1 )/. .2 * .2) 3 .266'

8agnon 1((4 101/.( 10/.0 12 * .2(4 3 .2)'

7anger 1(( ()/61 ./6 026 * .2( 3 .2('

,reart - 9rance 1(( 1/6)6 1(/660 12) * .2( 3 .24('

,reart - ,elgium1((

))/1 6/11 .2 * .24 3 .264'121) 5

&odnett .. .44/0)0 1)(/061 624 * .2( 3 .2(6'

Campbell ..6 04/.. 6./.. 02) * .2() 3 .2('

Su#total 3; CIF ;887 ;882 255/5 E 5/37 [ 5/39, 5/3< ]

' 006( =!sual care>

&eterogeneity: Chi2 ? 42' df ?

=B.2....1>@+2 ?4(*

Hpidural analgesia not routinely available

$adi 1((( /) 01/)6 )2. *

.24 3 .2)' .2(4 5 $orhason-,ello ..( 0/( (/(

).21 * .2(0 3 .24' 121 5 laus 1(6 /16 1./4(

120 * .2. 3 .2.4' 12) 5 &ofmeyr 1((1 11/( 1)/(4

62. * .244 3 .24' 12)( 5 ;uenyong .1 1/) 1)/)6

42) * .20 3 .200' 126. 5

Su#total 3; CIF 9@+2 ?.2.*


121/170

D:



122/170

tudy or subgroup Continuous support !sual care Ris" Ratio #eight Ris

n/% n/% +F'9iDed'()* C+ +F'9iDed

Hpidural analgesia routinely available

nalysis :2 Com

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