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Fifteen randomized controlled trials, involving 12 791 women, have assessed the effects on mothers and their babies of continuous, one-to-one intrapartum support compared with usual care. The addition of the largest study so far (1), to the systematic review provided further evidence to support previous findings: one-to-one support offered by a lay person or a professional—either accompanied or unaccompanied by a relative—to women during labour and delivery has a positive effect on medical interventions during labour and on mothers’ emotional well-being. However, the addition of this very large and rigorous trial also contributed to a revision of some of the previous results. For example, according to the results of some individual trials and former meta-analyses, the duration of labour was decreased in women who received support during labour. But after adding the results of the Hodnett et al. study, this positive effect on duration of labour disappeared.

Hodnett et al. developed a new protocol for this Cochrane review. Although the primary objective remained unchanged-i.e. to assess the effects on mothers and babies of continuous, one-to-one emotional support compared with usual care, in any setting-secondary objectives were added to discriminate better the effects of support under different conditions. To this end, new sub-group analyses were conducted to assess the effects of routine practices (i.e. epidural anaesthesia and continuous fetal monitoring) and policies (i.e. presence of companions chosen by the woman in the labour room), characteristics of the providers of labour support (i.e. whether the birth companions were employees of the health institution or non staff members), and the timing of onset of continuous support (i.e. whether the support began prior to the onset of active labour or later). Also, the authors expanded the discussion about possible mechanisms of action.

The research, implemented mostly in high-income countries (Belgium, Canada, UK, USA) but also in low- and middle-income ones (Botswana, Guatemala, Mexico, and South Africa) has demonstrated that women who have continuous, one-to-one support are less likely to have regional analgesia/anaesthesia, operative vaginal birth, caesarean section (all these differences were statistically significant, although only marginally) and to report dissatisfaction with the childbirth experience (RR=0.73, 95% CI 0.65-0.83). They are also more likely to have a spontaneous vaginal delivery. Social support also contributes to the number of mothers who rate their delivery experience more favourably. The positive effects are, in general, stronger when other sources of support are not available, epidural anaesthesia is not routinely used, when the one-to-one support is provided by someone who is not an employee of the hospital, and when support starts early in labour. These results are particularly relevant for middle-income countries, where most women deliver in hospitals that provide highly medicalized delivery care and companions are not allowed to be present in the labour room. No negative effects of continuous support were found in any of the 15 trials included in this review.

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