Hodnett E D, Gates S, Hofmeyr G J, Sakala C
University of Toronto, Faculty of Nursing, 155 College Street, Suite 130, Toronto, Ontario, Canada, M5T 1P8.
Cochrane Database Syst Rev. 2007 Jul 18(3):CD003766. doi: 10.1002/14651858.CD003766.pub2.
Historically, women have been attended and supported by other women during labour. However, in recent decades in hospitals worldwide, continuous support during labour has become the exception rather than the routine. Concerns about the consequent dehumanization of women's birth experiences have led to calls for a return to continuous support by women for women during labour.
Primary: to assess the effects, on mothers and their babies, of continuous, one-to-one intrapartum support compared with usual care. Secondary: to determine whether the effects of continuous support are influenced by: (1) routine practices and policies in the birth environment that may affect a woman's autonomy, freedom of movement and ability to cope with labour; (2) whether the caregiver is a member of the staff of the institution; and (3) whether the continuous support begins early or later in labour.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2007).
All published and unpublished randomized controlled trials comparing continuous support during labour with usual care.
We used standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group. All authors participated in evaluation of methodological quality. One author and a research assistant independently extracted the data. We sought additional information from the trial authors. We used relative risk for categorical data and weighted mean difference for continuous data to present the results.
Sixteen trials involving 13,391 women met inclusion criteria and provided usable outcome data. Primary comparison: women who had continuous intrapartum support were likely to have a slightly shorter labour, were more likely to have a spontaneous vaginal birth and less likely to have intrapartum analgesia or to report dissatisfaction with their childbirth experiences. Subgroup analyses: in general, continuous intrapartum support was associated with greater benefits when the provider was not a member of the hospital staff, when it began early in labour and in settings in which epidural analgesia was not routinely available.
AUTHORS' CONCLUSIONS: All women should have support throughout labour and birth.
从历史上看，女性在分娩期间一直由其他女性照料和支持。然而，在近几十年里，全球范围内的医院中，分娩期间的持续支持已成为例外而非惯例。对由此导致的女性分娩体验非人性化的担忧，引发了呼吁在分娩期间恢复女性对女性的持续支持。
主要目标：评估与常规护理相比，一对一持续的产时支持对母亲及其婴儿的影响。次要目标：确定持续支持的效果是否受到以下因素影响：（1）分娩环境中可能影响女性自主权、行动自由和应对分娩能力的常规做法和政策；（2）照料者是否为机构工作人员；（3）持续支持是在分娩早期还是晚期开始。
我们检索了Cochrane妊娠与分娩组试验注册库（2007年2月）。
所有比较分娩期间持续支持与常规护理的已发表和未发表的随机对照试验。
我们采用了Cochrane协作网妊娠与分娩组的标准方法。所有作者参与了方法学质量评估。一位作者和一名研究助理独立提取数据。我们向试验作者寻求更多信息。我们使用分类数据的相对风险和连续数据的加权平均差来呈现结果。
16项涉及13391名女性的试验符合纳入标准并提供了可用的结局数据。主要比较：接受持续产时支持的女性分娩时间可能略短，更有可能自然阴道分娩，使用产时镇痛或对分娩体验表示不满的可能性较小。亚组分析：总体而言，当提供者不是医院工作人员、在分娩早期开始以及在不常规提供硬膜外镇痛的环境中，持续产时支持带来的益处更大。
所有女性在分娩和生产过程中都应获得支持。
