Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
De Soysa Maternity Hospital, Colombo, Sri Lanka.
PLoS One. 2024 Jul 23;19(7):e0298852. doi: 10.1371/journal.pone.0298852. eCollection 2024.
Continuous labor support is widely acknowledged for potentially enhancing maternal and neonatal outcomes, the physiological labor process, and maternal satisfaction with the labor experience. However, the existing literature lacks a comprehensive analysis of the optimal characteristics of labor companions, particularly in comparing the effects of trained versus untrained and familiar versus unfamiliar labor companions across diverse geographical regions, both pre-and post-millennial. This meta-analysis addresses these research gaps by providing insights into the most influential aspects of continuous labor support.
A thorough search of PubMed, Google Scholar, Science Direct, International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, Research4Life, and Cochrane Library was conducted from 25/06/2023 to 04/07/2023. Study selection utilized the semi-automated tool Rayyan. The original version of the Cochrane Risk of Bias tool was used to assess the quality of Randomized Controlled Trials (RCTs) while funnel plots gauged the publication bias. Statistical analysis employed RevMan 5.4, using Mantel-Haenszel statistics and random effects models to calculate risk ratios with 95% confidence intervals. Subgroup analyses were performed for different characteristics, including familiarity, training, temporal associations, and geographical locations. The study was registered in INPLASY (Registration number: INPLASY202410003).
Thirty-five RCTs were identified from 5,346 studies. The meta-analysis highlighted significant positive effects of continuous labor support across various outcomes. The highest overall effect without subgroup divisions was the improvement reported in the 5-minute Apgar score < 7, with an effect size of 1.52 (95% Confidence Interval (CI) 1.05, 2.20). Familiar labor companions were better at reducing tocophobia, with an effect size of 1.73 (95% CI 1.49, 2.42), compared to unfamiliar companions, with an effect size of 1.34 (95% CI 1.14, 1.58). Untrained labor companions were the better choice in reducing tocophobia and the cesarean section rate compared to trained companions. For the analysis of tocophobia, the pooled effect sizes were 1.34 (95% CI 1.14, 1.57) and 1.84(95% CI 1.60, 2.12) in trained versus untrained subgroup comparisons. For the cesarean rate, they were represented as 1.22 (95% CI 1.05, 1.42) and 2.16 (95% CI 1.37, 3.40), respectively. The pooled effect size for the duration of labor was 0.16 (95% CI 0.06, 0.26) for the subgroup of RCTs conducted before 2000 and 0.53 (95% CI 0.30, 0.77) for the subgroup of RCTs conducted after 2000. A significant subgroup difference (<0.1) was found in relation to the duration of labor, cesarean section rate, oxytocin for labor induction, analgesic usage, and tocophobia in the subgroup analysis of geographical regions.
The beneficial effects of a labor companion are well-established in the literature. However, studies systematically assessing the characteristics of labor companions for optimal beneficial effects are lacking. The current study provides insights into the familiarity, training, temporal association, and geographical settings of labor companions, highlighting the differing impact of these characteristics on measured outcomes by evaluating the current randomized controlled trials on the topic. There is insufficient evidence to define the 'best labor companion' owing to the heterogeneity of labor companions and outcome assessment across different studies. We encourage well-designed further research to fill the research gap.
持续的分娩支持被广泛认为可以潜在地改善母婴结局、生理分娩过程和产妇对分娩体验的满意度。然而，现有文献缺乏对分娩陪伴者最佳特征的全面分析，特别是在比较不同地理区域、前后千年的训练有素和未经训练以及熟悉和不熟悉的分娩陪伴者对产妇的影响方面。这项荟萃分析通过提供对连续分娩支持最具影响力方面的见解来解决这些研究空白。
从 2023 年 6 月 25 日至 2023 年 7 月 4 日，我们对 PubMed、Google Scholar、Science Direct、国际临床试验注册平台（ICTRP）、ClinicalTrials.gov、Research4Life 和 Cochrane 图书馆进行了全面搜索。使用半自动工具 Rayyan 进行研究选择。原始版本的 Cochrane 偏倚风险工具用于评估随机对照试验（RCT）的质量，而漏斗图则衡量了发表偏倚。使用 RevMan 5.4 进行统计分析，采用 Mantel-Haenszel 统计和随机效应模型计算风险比及其 95%置信区间。进行了不同特征的亚组分析，包括熟悉度、培训、时间关联和地理位置。该研究已在 INPLASY（注册号：INPLASY202410003）中注册。
从 5346 项研究中确定了 35 项 RCT。荟萃分析强调了连续分娩支持在各种结局方面的显著积极影响。没有亚组划分的总体影响最高的是 5 分钟 Apgar 评分<7 的改善，效应大小为 1.52（95%置信区间 1.05，2.20）。与不熟悉的同伴相比，熟悉的分娩同伴在降低恐惧症方面表现更好，效应大小为 1.73（95%置信区间 1.49，2.42），而不熟悉的同伴的效应大小为 1.34（95%置信区间 1.14，1.58）。与训练有素的同伴相比，未受过训练的分娩同伴在降低恐惧症和剖宫产率方面是更好的选择。对于恐惧症的分析，在训练有素与未受过训练的亚组比较中， pooled effect sizes 分别为 1.34（95%置信区间 1.14，1.57）和 1.84（95%置信区间 1.60，2.12）。对于剖宫产率，它们分别表示为 1.22（95%置信区间 1.05，1.42）和 2.16（95%置信区间 1.37，3.40）。在 2000 年前进行的 RCT 亚组中，劳动时间的 pooled effect size 为 0.16（95%置信区间 0.06，0.26），而在 2000 年后进行的 RCT 亚组中，为 0.53（95%置信区间 0.30，0.77）。在地理区域的亚组分析中，劳动时间、剖宫产率、催产素用于引产、镇痛使用和恐惧症方面存在显著的亚组差异（<0.1）。
文献中已经充分证实了分娩陪伴者的有益效果。然而，缺乏系统评估分娩陪伴者特征以实现最佳有益效果的研究。本研究通过评估当前关于该主题的随机对照试验，深入了解分娩陪伴者的熟悉度、培训、时间关联和地理设置，突出了这些特征对测量结果的不同影响，从而为分娩陪伴者的特征提供了一些见解。由于不同研究中分娩陪伴者和结果评估的异质性，没有足够的证据来定义“最佳分娩陪伴者”。我们鼓励进行精心设计的进一步研究，以填补研究空白。
