Continuous support for women during childbirth
RHL practical aspects by Langer A
FIRST CONTACT (PRIMARY CARE) LEVEL
For women who deliver at a primary health-care facility, one-to-one social support should be always a component of the care provided. A lay person (who, if required, is able to follow simple instructions of the health-care personnel attending the delivery) could provide support by comforting, reassuring and praising the woman. Although there is inadequate information on the effectiveness of relatives in providing such support, it is unlikely to be harmful and should be offered, whenever possible.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
Continuous support during labour should be the rule and not the exception. All women should be allowed and encouraged to have support people with them continuously during labour. The provision of social support and a sympathetic environment for women in labour is highly recommended. The effectiveness of social support in reducing overuse of obstetric procedures is modest. Hence, social support should be provided without the expectation that it would lead to a considerable reduction in obstetric interventions. Policy-makers and hospital administrators in countries with high rates of Caesarean section should be aware that continuous support during labour is not an effective intervention to reduce this outcome. Policy-makers, administrators and clinicians should be well informed about evidence-based practices and benefits of continuous support during labour and introduce whatever changes to policies and practices that may be required to modify ineffective or harmful practices and/or to introduce safe and effective interventions.
AT HOME OR IN THE COMMUNITY
In the developing world, a considerable and variable number of deliveries still take place at the community level, either at the pregnant woman’s house or at the traditional birth attendant’s house. In these cases, social support is given as an inherent part of labour and delivery care and, therefore, does not need reinforcement.
This document should be cited as: Langer A. Continuous support for women during childbirth : RHL practical aspects (last revised: 5 September 2007). The WHO Reproductive Health Library; Geneva: World Health Organization.