How to Keep Normal Labor Normal – Part 4 – Partners

Larimore Family Newsletter – October 2009 Edition
October 2, 2009
Welcome Sarah Elisabeth
October 5, 2009
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How to Keep Normal Labor Normal – Part 4 – Partners

This blog series is designed to help women who are developing a birth plan join together with like-minded birthing professionals so as to have a shorter and safer labor and birth. Today we’ll look at the second “P” of my 10 “P’s” of keeping labor shorter and birth safer – partners.
Although written primarily for professional birth attendants, I hope information will be helpful to lay women planning their birth.
Any emotional, physical, and/or spiritual support during labor appears to be more advantageous than no support.
“Human, physiological support is given to the laboring woman in most cultures surveyed … massage, light touching, abdominal lifting, accupressure, hand-holding, stroking, relaxation, and warm water or lotions all seem to help … but in all cases the woman is rarely left to labor alone.”(35)
“Evidence is accumulating to indicate that environments that provide attentive bedside and nurse services to patients with functional dystocia have a higher incidence of patients who deliver vaginally.”(44)
an>There is no data that a child’s support of his or her mother during labor is helpful to keeping the labor normal; however, “The scant existing evidence indicates that there is no short-term harm to the sibling child who observes the birth, and suggests the possibility of an increase in nurturing behaviors.”(5)
Males (the father of the baby) supporting women during labor may be overemphasized, but still is important, at least to the laboring woman: “In general, fathers were significantly more likely than nurses to be present in the labor room, to offer a comforting item, and to touch their partner … Mothers rated the father’s presence as significantly more helpful than that of the nurses.”(45)
“The father’s presence at the birth strongly increases the mother’s satisfaction with the birthing experience. No evidence of harm exists from allowing the fathers to be actively involved in labor and delivery.”(5)
One nurse midwife in Great Britain encouraged men with this poem, “Roll up for the greatest show on earth, come and view your baby’s birth!  Blood, urine, sweat, and faecal matter, a great treat for a prospective pater.”(38)
Women supporting women in birth, however, may be the most important and underutilized tool that maternity care providers can employ to keep labor normal.
“Continual emotional support has been shown to have a saluatory effect on labor … it is possible that midwives and family physicians differ in the amount of time spent with patients and the amount of emotional support offered in the labor … thus explaining the higher cesarean section rate among family physicians when compared with nurse midwives.”(46)
Doula-supported births were significantly less likely to result in cesarean section (8.2% vs 18%, p=.004), forcep delivery (8.2% vs 26%, p<.001), or use of epidural anesthetic (7.8% vs 55.3%, p<.001).”(5)
“No fewer than 10 randomized trials, including 3336 women, have examined the issue (of active management of labor). Meta-analysis of these trials supports the idea that psychological support (by a female companion) is effective in:

  • reducing analgesia requirements (and their potentially deleterious effects),
  • shortens first and second stage labour,
  • lowers the incidence of cesarean section and operative vaginal delivery, and
  • improves fetal outcome.”(48)

“There have been no randomized trials of the total package of active management (which includes continuous one-on-one midwife and nursing care involving “eyeball-to-eyeball care  with continuous physical touch”)(17) or of the use of strict diagnostic criteria alone, but trials of early amniotomy, early oxytocin, and these interventions combined do not suggest that these interventions are effective in reducing rates of cesarean sections or operative vaginal deliveries.”(47)
“In contrast, the provision of continuous professional support in labour seems to reduce both types of operative delivery. (In other words,) “… the effective ingredient seems to be the presence of a (female) companion in labour … (Therefore,) delivery units should routinely endeavor to provide continuous professional support in labour, but routine use of amniotomy and early oxytocin is not recommended.”(48)
One meta-analysis said, in summary, “Given the clear benefits and no known risks associated with intrapartum support, every effort should be made to ensure that all laboring women receive support, not only from those close to them but also from specially trained care givers (nurses, midwives, or lay women).
This support should include continuous presence, the provision of hands on comfort, and encouragement.
Depending on the circumstances, ensuring the provision of continuous support may necessitate alterations in the current work activities of midwives and nurses, such that they are able to spend less time on ineffective activities and more time providing support.”(48)
“There is no more cost-effective or simple strategy to improve the health of laboring women than using the doula.”(39)
Here’s the entire series:

  1. Philosophy,
  2. Partners,
  3. Professionals,
  4. Pain control,
  5. Procedures,
  6. Patience,
  7. Preparation,
  8. Positions,
  9. Payment, and
  10. Prayer.


[5] Hoffman, Martin, “Parental Discipline and Child’s Moral Development” Journal of Personal Social Psychology 5 (1967): 45-57.
(35) Joint statement endorses family centered birthing.  Am Nurse 1978;10:1, 11.
(36) Rollins AJ, Kaplan JA, Ratkay ME, Goodlin RC, et. al. A homestyle delivery program in a university hospital.  J Fam Pract 1979;9:407-14.
(37) Larimore WL.  Family-centered birthing: a niche for family physicians.  Am Fam Physician 1993;47:1365-6.
(38) Mathews D.  Birth of the midwife/obstetrician.  Lancet 1995;345:532.
(39) Larimore WL, Reynolds JL.  Family practice maternity care in America: ruminations on reproducing an endangered species – family physicians who deliver babies.  J Am Bd Fam Pract 1994;7:1-11.
(40) Klein MC, Kaczorowski J, Robbins JM, Gauthier RJ,  Physicians’ beliefs and behavior during a randomized controlled trial of episiotomy. Can Med Assoc J 1995;153:769-79.
(41) Silverman, S.  Episiotomy – to cut or not to cut?  Is there really a question?  Cybele Report 1985:2-4.
(42) Nesbitt TS.  Rural maternity care: new models of access.  Birth 1996;23:161-5.
(43) Hedstrom LW, Newton N.  Touch in labor: a comparison of cultures and eras.  Birth 1986;13:181-186.
(44) Seitchik, J. In: Young D. Crisis in obstetrics – the management of labor.  Int J Childbirth Education 1987, August: 13-5.
(45) Nicholson J, Gist NF, Klein RP, Standley K. Outcomes of father involvement in pregnancy and birth.  Birth 1983;10:5-9.
(46) Hueston WJ, Rudy MA.  A comparison of labor and delivery management between nurse midwives and family physicians.  J Fam Pract 1993;37:449-454.
(47) Thornton JG, Lilford RJ.  Active management of labour: current knowledge and research issues.  BMJ 1994;309:366-369.
(48) Hodnett ED.  Support from caregivers during childbirth.  In:  Pregnancy and childbirth module (eds. Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP), ‘Cochrane Database of Systematic Reviews’: Review No. 03871, 3 October 1994.  Oxford: Update Software, 1994, Disk Issue 1.

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