{ "release_id": "c7fb95f1d15a7d13", "id": "maternal:continuous-labour-support", "owner": "maternal", "kind": "intervention", "slug": "continuous-labour-support", "name": "Continuous support and a companion in labour", "aliases": [ "Companion of choice in labour", "Doula support" ], "atlases": [ "maternal" ], "summary_plain": "Continuous support means that someone stays with the woman through labour, such as a partner, a friend, a relative, a midwife or a doula, a trained helper. WHO recommends that every woman can have a companion of her choice. A 2017 Cochrane review of trials in 17 countries found, mostly with low-quality evidence, that women with continuous support were more likely to have a spontaneous vaginal birth and less likely to have a caesarean birth. The authors found no evidence of harm.", "summary_technical": "Service. Two records of different kinds sit on this page. First, WHO 2018 Recommendation 3, a companion of choice for all women throughout labour and childbirth (category Recommended). Second, the Cochrane review of continuous support (Bohren et al., 2017; PMID 28681500), 26 trials with usable data and 15,858 women, none in low-income settings, most outcomes rated low quality. The WHO recommendation is guidance, the Cochrane figures are trial results, and the two have separate claims. A WHO companion can be anyone the woman chooses; the review covered support by staff, doulas and people chosen by the woman.", "editorial_state": "draft", "last_substantive_edit": "2026-10-14", "last_evidence_check": "2026-10-14", "next_review_due": null, "identifiers": [], "navigation": { "maternal": { "life-stage": [ "childbirth" ], "care-area": [ "labour-and-birth" ] } }, "payload": { "subtype": "service", "mechanism": null, "components": null }, "content_digest": "c04749b9d0e1e17f91ae1983d8e29d0f3e3f357469011c17bdfeaca1be27fe62", "review": { "content_digest": "c04749b9d0e1e17f91ae1983d8e29d0f3e3f357469011c17bdfeaca1be27fe62", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "claims": [ { "release_id": "c7fb95f1d15a7d13", "id": "maternal:claim-cochrane-continuous-support", "owner": "maternal", "subject_entity_id": "maternal:continuous-labour-support", "category": "effect", "statement": "A 2017 Cochrane review of 26 trials with usable data, involving 15,858 women in 17 countries, compared continuous one-to-one support during labour with usual care. Women given continuous support were more likely to have a spontaneous vaginal birth (average risk ratio 1.08, 95% confidence interval 1.04 to 1.12; low-quality evidence) and less likely to report negative feelings about their childbirth experience (average risk ratio 0.69, 95% CI 0.59 to 0.79; low-quality evidence) or to use any intrapartum analgesia (average risk ratio 0.90, 95% CI 0.84 to 0.96). Their labours were shorter (mean difference -0.69 hours, 95% CI -1.04 to -0.34; low-quality evidence), and they were less likely to have a caesarean birth (average risk ratio 0.75, 95% CI 0.64 to 0.88; low-quality evidence) or an instrumental vaginal birth (risk ratio 0.90, 95% CI 0.85 to 0.96). The authors found no evidence of harms of continuous labour support.", "context": { "id": "maternal:ctx-cochrane-continuous-support-women-in-labour", "label": "Women in labour in randomised trials of continuous one-to-one support against usual care (Cochrane 2017)", "recipient": "maternal", "population": "Women in labour who were randomised to continuous, one-to-one support during labour from a trained or untrained person (staff member, doula, or person chosen by the woman) or to usual care, in 17 countries. 13 trials were in high-income settings, 13 in middle-income settings and none in low-income settings. Use this context for outcomes measured in the women; the review also reports one outcome in babies that this record does not summarise.", "care_setting": "Not stated in the source", "geography": "17 countries: 13 trials in high-income settings and 13 in middle-income settings; no studies in low-income settings", "life_stage_note": "Labour", "life_stage_terms": null, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Follow-up differs by trial and outcome; the abstract does not give it.", "eligibility": { "inclusion": [ "Randomised and cluster-randomised trials comparing continuous support during labour with usual care; 27 trials, 26 with usable data" ], "exclusion": [ "Quasi-randomised and cross-over designs" ] } }, "evidence_stage": "synthesis", "certainty": "not_assessed", "certainty_method": null, "limitations": "The review rates much of its evidence as low quality, because no study clearly blinded women and personnel, and because of inconsistency or imprecision, so the claim certainty is left not assessed. Subgroup analyses are described by the authors as exploratory and hypothesis-generating. No conclusions could be drawn about low-income settings. The review also reports babies' outcomes (a low five-minute Apgar score and admission to special care nursery, the latter with no apparent impact), which belong to a newborn context and are not summarised here. Only the PubMed abstract was read, because the PMC copy is not in the Open Access subset. The WHO 2018 recommendation of a companion of choice is a separate claim, with its own context.", "editorial_state": "draft", "checked_at": "2026-10-14", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Abstract, OBJECTIVES, sentence 1, and MAIN RESULTS, sentences 1 and 2: scope", "applicability_note": "PubMed abstract.", "snapshot": { "id": "maternal:pubmed-28681500-2026-10-14", "retrieved_at": "2026-10-14T18:19:21Z", "content_hash": "95486bd7af6eda41101998b316f1725d4fb96a1f041187dcfdff3a867c7f8722", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:pubmed-10-1002-14651858-cd003766-pub6", "source_type": "publication", "title": "Continuous support for women during childbirth", "canonical_url": "https://doi.org/10.1002/14651858.CD003766.pub6", "identifiers": [ { "scheme": "doi", "value": "10.1002/14651858.CD003766.pub6", "normalized_value": "10.1002/14651858.cd003766.pub6", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmid", "value": "28681500", "normalized_value": "28681500", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmcid", "value": "PMC6483123", "normalized_value": "PMC6483123", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2017-07-06", "publisher": "The Cochrane database of systematic reviews", "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities. 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Short factual quotations under 25 words, with the citation.", "public_text": "quote" } }, { "evidence_role": "supports", "locator": "Abstract, MAIN RESULTS, sentences 3, 4 and 6: outcomes for women", "applicability_note": "PubMed abstract.", "snapshot": { "id": "maternal:pubmed-28681500-2026-10-14", "retrieved_at": "2026-10-14T18:19:21Z", "content_hash": "95486bd7af6eda41101998b316f1725d4fb96a1f041187dcfdff3a867c7f8722", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:pubmed-10-1002-14651858-cd003766-pub6", "source_type": "publication", "title": "Continuous support for women during childbirth", "canonical_url": "https://doi.org/10.1002/14651858.CD003766.pub6", "identifiers": [ { "scheme": "doi", "value": "10.1002/14651858.CD003766.pub6", "normalized_value": "10.1002/14651858.cd003766.pub6", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmid", "value": "28681500", "normalized_value": "28681500", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmcid", "value": "PMC6483123", "normalized_value": "PMC6483123", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2017-07-06", "publisher": "The Cochrane database of systematic reviews", "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities. 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The full text and the version of record were not fetched.", "reuse_basis": "PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.", "public_text": "quote" } } ], "review": { "content_digest": "e762031a568ef52fad402aa67758e2ec717a1713733bd9bafb8c8ce6f329a542", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "api_path": "api/v1/claims/maternal--claim-cochrane-continuous-support.json" }, { "release_id": "c7fb95f1d15a7d13", "id": "maternal:claim-who-2018-3-companion", "owner": "maternal", "subject_entity_id": "maternal:continuous-labour-support", "category": "recommendation", "statement": "WHO 2018 recommends that a companion of the woman's choice be present for all women throughout labour and childbirth (Recommendation 3, category Recommended). The companion can be anyone she chooses, from family or friends to a trained doula. WHO adds that it is important that women's wishes are respected, including those who prefer not to have a companion, and that health care facilities need to take into account that finding a companion may be hard for some women and consider steps to ensure that support is always available.", "context": { "id": "maternal:ctx-who-2018-women-in-labour", "label": "All women throughout labour and childbirth (WHO 2018 Recommendation 3)", "recipient": "maternal", "population": "All women in labour. The recommendation covers the whole of labour and childbirth and is not limited by risk or setting. The companion can be any person the woman chooses, such as a partner, a friend or relative, a community member or a doula, and WHO adds that her wishes must be respected, including a wish not to have a companion.", "care_setting": "Not stated in the source", "geography": "Global (WHO guidance intended to inform national and local policy).", "life_stage_note": "Labour and childbirth", "life_stage_terms": null, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Not applicable (recommendation context)", "eligibility": { "inclusion": [ "Any woman in labour" ], "exclusion": [] } }, "evidence_stage": "guidance", "certainty": "not_assessed", "certainty_method": null, "limitations": "The WHO category (Recommended) is not a GRADE strength label, so the claim certainty is left not assessed. The evidence behind the recommendation, which WHO gives in the full guideline, was not read for this record. This claim is about the recommendation, not about the Cochrane review of continuous support, which has its own claim. WHO notes that finding a companion may be harder for marginalised or vulnerable women or for women who live far from a facility.", "editorial_state": "draft", "checked_at": "2026-10-14", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Recommendation 3: text and category (summary table and section 3.1.3)", "applicability_note": "WHO 2018 guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.", "snapshot": { "id": "maternal:who-9789241550215-pdf-2026-10-14", "retrieved_at": "2026-10-14T18:24:42Z", "content_hash": "3895901d999cb044cb342e27322d1387503fdb487690600101ec59fb007c3272", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2018-intrapartum", "source_type": "guideline", "title": "WHO recommendations: intrapartum care for a positive childbirth experience", "canonical_url": "https://www.who.int/publications/i/item/9789241550215", "identifiers": [ { "scheme": "isbn", "value": "978-92-4-155021-5", "normalized_value": "9789241550215", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2018-02-07", "publisher": "World Health Organization", "edition": "2018. Electronic ISBN 978-92-4-155021-5. The who.int publication page shows 7 February 2018, which the atlas uses for WHO sources and decisions; the WHO IRIS record 10665/260178 lists an issue date of 2018-02-14. Both are kept. The English PDF was read from IRIS (bitstream ba043cf7-cba4-484d-bf7e-ec79c4102d54); the first IRIS link on the page returned a 4625-byte thumbnail image, logged as mg-who-9789241550215-thumb.jpg.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated on the copyright page of the PDF. Only short quotations with attribution are used, and neither the PDF nor the pages are committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "supports", "locator": "Recommendation 3, Remarks: who the companion can be; respect for women's wishes; difficulty finding a companion", "applicability_note": "WHO 2018 guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.", "snapshot": { "id": "maternal:who-9789241550215-pdf-2026-10-14", "retrieved_at": "2026-10-14T18:24:42Z", "content_hash": "3895901d999cb044cb342e27322d1387503fdb487690600101ec59fb007c3272", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2018-intrapartum", "source_type": "guideline", "title": "WHO recommendations: intrapartum care for a positive childbirth experience", "canonical_url": "https://www.who.int/publications/i/item/9789241550215", "identifiers": [ { "scheme": "isbn", "value": "978-92-4-155021-5", "normalized_value": "9789241550215", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2018-02-07", "publisher": "World Health Organization", "edition": "2018. Electronic ISBN 978-92-4-155021-5. The who.int publication page shows 7 February 2018, which the atlas uses for WHO sources and decisions; the WHO IRIS record 10665/260178 lists an issue date of 2018-02-14. Both are kept. The English PDF was read from IRIS (bitstream ba043cf7-cba4-484d-bf7e-ec79c4102d54); the first IRIS link on the page returned a 4625-byte thumbnail image, logged as mg-who-9789241550215-thumb.jpg.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated on the copyright page of the PDF. Only short quotations with attribution are used, and neither the PDF nor the pages are committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } } ], "review": { "content_digest": "6fc239a23eaa7f94e42cd0ac8653790d52c1714c3a7564d920b7c03e69d37904", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "api_path": "api/v1/claims/maternal--claim-who-2018-3-companion.json" } ], "decisions": [ { "type": "recommendation", "id": "maternal:rec-who-2018-3", "direction": "for", "intervention_id": "maternal:continuous-labour-support", "context_id": "maternal:ctx-who-2018-women-in-labour", "guideline_snapshot_id": "maternal:who-9789241550215-pdf-2026-10-14", "guideline_id": "maternal:guideline-who-2018-intrapartum-care", "issuer_id": "maternal:who", "jurisdictions": [ "GLOBAL" ], "jurisdiction_note": "Global (WHO guidance intended to inform national and local policy).", "strength_label": "Recommended", "strength_system": "WHO 2018 intrapartum care guideline. Each recommendation falls in one of four categories (Recommended, Not recommended, Recommended only in specific contexts, Recommended only in the context of rigorous research), assigned from the GRADE evidence-to-decision criteria. These are not GRADE strength labels.", "effective_date": "2018-02-07", "effective_date_note": "The who.int page date, 7 February 2018 (2018-02-07), is the effective date under the atlas rule for WHO decisions. The WHO IRIS record lists an issue date of 2018-02-14. Both dates are kept.", "superseded_by": null, "supersession_status": null, "claim_id": "maternal:claim-who-2018-3-companion" } ], "milestones": [], "relationships": { "outgoing": [ { "predicate": "recommended_for", "label": "WHO 2018 Recommendation 3: a companion of choice for all women throughout labour and childbirth", "clinical_claim_not_fact": true, "family": "clinical", "other_entity_id": "maternal:labour-and-birth", "other_entity_in_atlas": true, "claim_id": "maternal:claim-who-2018-3-companion", "evidence": null, "primary": false, "role": null, "valid_from": null, "valid_to": null }, { "predicate": "part_of", "label": "Filed under this front", "clinical_claim_not_fact": false, "family": "navigation", "other_entity_id": "maternal:front-care-programmes-and-follow-up", "other_entity_in_atlas": true, "claim_id": null, "evidence": null, "primary": true, "role": null, "valid_from": null, "valid_to": null } ], "incoming": [] }, "page_path": "interventions/continuous-labour-support/", "context_path": "api/v1/context/maternal--continuous-labour-support.md" }