New Cochrane Review Reaffirms Huge Benefits For Continuous Labour Support

New Cochrane Review Reaffirms Huge Benefits For Continuous Labour Support

What if there was one way to shorten labour, reduce the risk of a c-section and increase the likelihood of a positive birth?

We’d all likely jump on it, right?

Well as it turns out, this one way is readily available, free of side effects, and scientifically proven to reduce the likelihood of a negative birth experience.

And it’s been proven, time and time again in studies around the world.

What is it?

Continuous Labour Support Makes Birth Positive

It’s continuous labour support, such as the support provided by birth doulas.

Yet, only 6% of women report using a doula for their birth according to Childbirth Connection.

This is why the new Cochrane review is important. It provides us with statistics based on 27 studies involving 15,858 women.

What Is Continuous Labour Support?

Continuous labour support is when a person provides ongoing support through at least all of active labour and birth.

Often birth doulas extend support from early labour through a couple hours after birth.

The Cochrane review included studies in which continuous labour support was provided by anyone, including those with a professional background (e.g. nurse or doula) and those without any additional training (e.g. friends, family, etc.).

A support person might provide emotional support, information about birth and options, assist with comfort measures, or help the birthing woman communicate her wishes to others.

What Is A Cochrane Review?

According to the official Cochrane Collaboration website, the definition of a Cochrane review is:

“…systematic reviews of primary research in human health care and health policy, and are internationally recognized as the highest standard in evidence-based health care resources. They investigate the effects of interventions for prevention, treatment, and rehabilitation.”

In simpler terms, a Cochrane review compiles the data from multiple peer-reviewed and evidenced-based studies.

By looking at information from multiple studies on the same subject, a review is able to provide the most accurate information.

Why Is There A Scientific Review About Labour Support?

Birth is a normal bodily process and we have access to the best of modern obstetrics to ensure women and babies are safe. Why would we need studies about labour support?

Even though birth is normal and often unfolds well, it turns out that many women aren’t having the best birth outcomes. Find out how how obstetric care affects birth in Hospital Birth – Is It The Safest Option For Healthy Women?

Some hospitals have a c-section rate as high as 50-70% which is far higher than the World Health Organization’s recommendation of 10-15%.

More women than you likely imagine experience traumatic births. And many women simply don’t experience the positive birth they hoped to have.

Current birth statistics, surveys about birth experiences, and personal stories tell us it’s important we do better for birthing women. It’s important we find out how to best protect and support pregnant women and their babies.

This recent Cochrane review, an update to previous ones, is important to help maternity care providers, hospitals, health systems, insurance plans, doulas, educators and more, so they can make informed decisions and policies to support the women in their care.

It’s also vital information for parents. We have an option available which has no side effects but can drastically improve our birth outcomes. All parents deserve to know about this option.

What Is A Doula?

Doulas are trained professionals experienced in providing non-medical physical and emotional support before, during and after birth.

Doulas provide continuous labour support like that defined in this most recent Cochrane review.

Their continuous support may look like:

  • Providing prenatal support and education
  • Massage and other physical comfort measures
  • Helping you facilitate optimal fetal positioning
  • Suggest and support you in position changes
  • Provide ongoing emotional support and encouragement
  • Support you in making informed birthing decisions
  • Provide support as you communicate your birthing preferences
  • Help establish and keep a birthing environment you desire (e.g. aromatherapy, lighting, etc.)
  • Provide practical support such as encouraging you to stay hydrated and nourished
  • Support the partner as they support the mother.

Basically, a doula stays with you throughout the duration of your labour as a professional support and guide.

Just a couple generations ago, birth was a women’s only event. Birthing mothers were supported by female relatives, midwives, and friends.

It’s only recently in human history that only dad and a medical team became the norm for birth support, and it hasn’t provided us with better outcomes.

You can read What Is A Doula? Why Pregnant Women Love Doulas! to learn more about the role of a doula.

Are The Benefits Of Continuous Labour Support Important?

Most women and their healthcare providers have the same goal – a safe birth. The interesting thing about safe birth is it can seem a bit relative.

If baby is born with a high APGAR score, regardless of her mother’s experience, is that all that matters?

Certainly, a healthy baby is an important common goal. However, is it the only important thing?

When we look at a mother’s physical, emotional and mental health, both short and long term, it seems that defining a healthy birth can be complex.

You can read more about this complexity in Is a Healthy Baby All That Matters During Childbirth?

We also know birth outcomes impacts babies. Medical interventions aren’t without risk. There are times where the benefits of these interventions outweigh the risks.

However, evidence shows continuous labour support reduces the risk of some interventions and also increases the likelihood a mother will have a positive birth experience.

Women with continuous labour support were less likely to:

  • Need any medicinal pain relief, like oral or IV analgesics
  • Receive an epidural or spinal
  • Have an instrument assisted birth (e.g. vacuum or forceps)
  • Give birth via c-section
  • Have a baby with a low 5-minute APGAR score (rating of baby’s overall status after birth)
  • Report a negative birth experience.

In short, women with continuous labour support have less interventions, their babies are more likely to show signs of transitioning well at five minutes post birth, and they are more likely to report a positive birthing experience.

Women with continuous labour support are more likely to have spontaneous vaginal births and shorter labours. When you read shorter labours, it makes you wonder why everyone isn’t yelling about the importance of continuous labour support?

And perhaps what’s most notable about continuous labour support is it has measurable benefits with no harmful side effects.

“If a doula were a drug, it would be unethical not to use it.” Dr. John H. Kennell

Does A Doula Provide Better Continuous Labour Support Than Others?

This Cochrane review included all continuous labour support people, from doulas, to someone in your social circle, to hospital staff. It was clear any continuous labour support was beneficial to birthing women.

However, when all the data was looked at closely, there were measurable benefits to using a doula (a professional labour support person) versus someone from your social circle or a hospital employee.

Having a doula:

  • Reduced the risk of a c-section by 39%. The review showed birth support reduced the risk of c-sections, but when broken down by provider type, it was doula support and not a friend, relative or employee that reduced the risk of c-sections.
  • Reduced the risk of reporting a negative birth experience by 35%.
  • Increased the likelihood of a spontaneous vaginal birth by 15%.
  • Reduced the risk of augmenting labour with synthetic oxytocin. It wasn’t a significant decrease, but it was notable and worth more research to find out why.

Continuous labour support from anyone, such as a friend or relative, did reduce the risk of reporting a negative birth experience.

Are These Outcomes Important?

More research is needed to see what long term impact birth experience can have on mother and baby. However, what is notable about these results is it does show continuous labour support can reduce the risk of c-sections, which we know can have short and long term impacts on a woman’s health.

When a c-section is necessary, the benefits outweigh the risks. However, when it isn’t medically necessary, a woman’s future fertility, pregnancies and health is put at risk.

The current c-section rate is so high many researchers and policymakers are researching why and what can be done to reduce this risk.

What’s clear is we need to improve birth outcomes for mothers and babies. What isn’t always clear is the best way to do this.

However, this Cochrane review gives a pretty clear answer as to how to reduce overall risks and increase positive births without adding any additional risks and that is by utilising birth doulas.

If you’re interested in seeing what doulas are available in your area, check out the BellyBelly Marketplace (Australia and US only).

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Maria Pyanov CPD, CCE CONTRIBUTOR

Maria Silver Pyanov is a mama of four energetic boys and one unique little girl. She is also a doula and childbirth educator. She's an advocate for birth options, and adequate prenatal care and support. She believes in the importance of rebuilding the village so no parent feels unsupported.


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