The best-supported thing in labor is someone who stays
Continuous one-to-one support through labor. Fifty-five fewer women per thousand rate their birth negatively, and no evidence of harm.
Several things in this section have been tested in randomised trials. This is the one where the trials are most numerous, most consistent, and pointed most directly at how a woman rates her own birth.
A Cochrane review pooled 27 randomised trials, with 26 trials and 15,858 women contributing usable data, from 17 countries. It compared continuous one-to-one support through labor against usual care.
| Outcome | Relative effect | In women per 1,000 |
|---|---|---|
| Rating the birth negatively | RR 0.69 (0.59 to 0.79), 11 trials, 11,133 women | 55 fewer (37 to 73 fewer) |
| Any pain relief in labor | RR 0.90 (0.84 to 0.96), 15 trials, 12,433 women | 75 fewer (30 to 120 fewer) |
| Epidural or regional pain relief | RR 0.93 (0.88 to 0.99), 9 trials, 11,444 women | 48 fewer (7 to 83 fewer) |
| Instrumental vaginal birth | RR 0.90 (0.85 to 0.96), 19 trials, 14,118 women | 20 fewer (8 to 30 fewer) |
| Low 5-minute Apgar score | RR 0.62 (0.46 to 0.85), 14 trials, 12,615 babies | 6 fewer (2 to 9 fewer) |
| Length of labor | about 41 minutes shorter |
The review also found a higher rate of spontaneous vaginal birth, RR 1.08 (1.04 to 1.12), from 21 trials and 14,369 women, and a lower cesarean rate, RR 0.75 (0.64 to 0.88), from 24 trials and 15,347 women. Those two are given here as relative figures only, because the review's absolute numbers for them could not be obtained, and it would be wrong to attach an invented baseline to them.
The reviewers' own summary of the safety question: We found no evidence of harms of continuous labour support.
Certainty in the individual results was rated low to moderate.
WHO's third recommendation is that a companion of choice is recommended for all women throughout labour and childbirth.
ACOG says that evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor
, and lists the benefits described in randomised trials as shortened labor, decreased need for analgesia, fewer operative deliveries, and fewer reports of dissatisfaction with the experience of labor.
"Who will be with me continuously, and what happens at shift change?"
"Can my companion stay with me through everything, including if I need an operating room?"