Hodnett Ellen D, Gates Simon, Hofmeyr G Justus, Sakala Carol
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
Cochrane Database Syst Rev. 2012 Oct 17;10:CD003766. doi: 10.1002/14651858.CD003766.pub4.
Historically, women have been attended and supported by other women during labour. However, in hospitals worldwide, continuous support during labour has become the exception rather than the routine.
Primary: to assess the effects 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; (2) the provider's relationship to the hospital and to the woman; and (3) timing of onset.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2012).
All published and unpublished randomised controlled trials comparing continuous support during labour with usual care.
We used standard methods of The Cochrane Collaboration Pregnancy and Childbirth Group. Two review authors independently evaluated methodological quality and extracted the data. We sought additional information from the trial authors. We used random-effects analyses for comparisons in which high heterogeneity was present, and we reported results using the average risk ratio (RR) for categorical data and mean difference (MD) for continuous data.
Twenty-two trials involving 15,288 women met inclusion criteria and provided usable outcome data. Results are of random-effects analyses, unless otherwise noted. Women allocated to continuous support were more likely to have a spontaneous vaginal birth (RR 1.08, 95% confidence interval (CI) 1.04 to 1.12) and less likely to have intrapartum analgesia (RR 0.90, 95% CI 0.84 to 0.96) or to report dissatisfaction (RR 0.69, 95% CI 0.59 to 0.79). In addition, their labours were shorter (MD -0.58 hours, 95% CI -0.85 to -0.31), they were less likely to have a caesarean (RR 0.78, 95% CI 0.67 to 0.91) or instrumental vaginal birth (fixed-effect, RR 0.90, 95% CI 0.85 to 0.96), regional analgesia (RR 0.93, 95% CI 0.88 to 0.99), or a baby with a low five-minute Apgar score (fixed-effect, RR 0.69, 95% CI 0.50 to 0.95). There was no apparent impact on other intrapartum interventions, maternal or neonatal complications, or breastfeeding. Subgroup analyses suggested that continuous support was most effective when the provider was neither part of the hospital staff nor the woman's social network, and in settings in which epidural analgesia was not routinely available. No conclusions could be drawn about the timing of onset of continuous support.
AUTHORS' CONCLUSIONS: Continuous support during labour has clinically meaningful benefits for women and infants and no known harm. 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，在世界各地的医院里，分娩期间的持续支持已成为例外而非惯例。
主要目的：评估与常规护理相比，持续一对一的分娩期支持的效果。次要目的：确定持续支持的效果是否受以下因素影响：（1）常规做法和政策；（2）提供者与医院及产妇的关系；（3）开始时间。
我们检索了Cochrane妊娠与分娩组试验注册库（2012年6月30日）。
所有已发表和未发表的随机对照试验，比较分娩期间的持续支持与常规护理。
我们采用了Cochrane协作网妊娠与分娩组的标准方法。两位综述作者独立评估方法学质量并提取数据。我们向试验作者寻求更多信息。对于存在高度异质性的比较，我们采用随机效应分析，并使用分类数据的平均风险比（RR）和连续数据的平均差（MD）报告结果。
22项涉及15288名女性的试验符合纳入标准并提供了可用的结局数据。除非另有说明，结果为随机效应分析。分配到持续支持组的女性更有可能自然阴道分娩（RR 1.08，95%置信区间（CI）1.04至1.12），且更不太可能使用分娩期镇痛（RR 0.90，95%CI 0.84至0.96）或表示不满意（RR 0.69，95%CI 0.59至0.79）。此外，她们的产程更短（MD -0.58小时，95%CI -0.85至-0.31），更不太可能进行剖宫产（RR 0.78，95%CI 0.67至0.91）或器械助产阴道分娩（固定效应，RR 0.90，95%CI 0.85至0.96）、区域镇痛（RR 0.93，95%CI 0.88至0.99），或产下5分钟阿氏评分低的婴儿（固定效应，RR 0.69，95%CI 0.50至0.95）。对其他分娩期干预措施、母婴并发症或母乳喂养没有明显影响。亚组分析表明，当提供者既不是医院工作人员也不是产妇社交网络的一部分时，以及在不常规提供硬膜外镇痛的环境中，持续支持最为有效。关于持续支持开始的时间无法得出结论。
分娩期间的持续支持对女性和婴儿具有临床意义上的益处且无已知危害。所有女性在整个分娩和生产过程中都应获得支持。
