Supporting Women in Labor: Analysis of Different Types of Caregivers

Patricia Rosen, CNM, MSN


J Midwifery Womens Health. 2004;49(1) 

In This Article

Conclusions and Recommendations

Although continuous support initiated early in labor appears to improve childbirth outcomes, it remains unclear who should provide this support. The trials conducted to date suggest that female support persons hired by a woman and unaffiliated with the hospital may be better able to assist a couple in making informed decisions and amending their birth plan as needed.[3] And although the presence of friends or relatives may place pressure on women to perform "well" and thereby result in increased anxiety,[18] labor support by a female relative seems to represent a low-cost, preventative measure consistent with traditional cultural practices in Botswana[5]; further research may demonstrate that it is also consistent with Western cultural practices.

Potential barriers exist with each type of support person. For example, a nurse, midwife, or physician may not have the time or interest to provide continuous support during labor. In addition, whether the caregiver is an employee of the institution and has additional responsibilities or loyalties[35] may influence the quality of his/her labor support. A husband or partner, on the other hand, may lack the knowledge, skills, or personal detachment to provide all the support a woman needs. And another outsider, such as a monitrice, lay woman, female relative, or friend, may be seen as a threat to the institution and have a negative influence on the care given.[35]

Kayne et al.[3] suggest that a combination of support people may work best. Partners, family members, or doulas may be all equally capable of providing adequate labor support. Or their abilities may complement one another's. Furthermore, women may expect different kinds of support depending on the stage of labor.[36] For example, during early labor, a woman may need information about what to expect and reassurance of the normalcy of her condition. During active labor, she may require physical care in addition to information and reassurance.[6] In second stage, she may need primarily praise and encouragement. If a woman panics at any time, the "take-charge routine" may best be assumed by someone in a position of authority, such as the nurse or midwife. Most studies have not measured the perceived helpfulness of particular support actions, or the relative importance, quality, or frequency of each type of support at different points in labor. Notably, the study of labor support involves only a short period of time during a woman's pregnancy and childbirth experience; further research of social support in the prenatal and postpartum periods may provide valuable insight.

Labor support should be evaluated on the basis of its effectiveness to meet women's objectives as well as those of obstetric providers. Although social support may help protect women from the potentially harmful effects of stress during childbirth by enhancing adaptive coping behaviors, this buffering effect may occur only when the woman sees the support person as valuable, desirable, and useful.[37] Prenatally, every woman should be encouraged to choose her source of labor support[35] based on knowledge of herself, her coping style, and her relationship with potential support people. Women also should decide what labor support will entail, because certain types of support (such as touch or massage) may be acceptable and appealing to some and not to others.[3,18] Throughout pregnancy and childbirth, clear communication must exist between clients, support persons, and hospital staff.

Overall, satisfaction with the birth experience is highly associated with continuous,[8] individualized,[38,39] and emotional[40] support. The most important element of labor support may be the woman's knowledge that she will not be left alone.[35,41] Female support persons who attend a woman early in labor and who include breastfeeding awareness and promotion in a postpartum visit may have a positive influence on childbirth outcomes. All persons planning to provide labor support must be capable of being fully present to the woman, accepting her attitudes and behaviors, and offering her ongoing praise and encouragement as she strives to have a safe and satisfying birth experience.


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