Summary of findings for the main comparison. Continuous support compared to usual care (all trials) for women during childbirth.
| Continuous support compared to usual care (all trials) for women during childbirth | ||||||
| Patient or population: women during childbirth Setting: Hospital settings in Australia, Belgium, Botswana, Brazil, Canada, Chile, Finland, France, Greece, Guatamala, Iran, Mexico, Nigeria, South Africa, Thailand, Turkey, USA Intervention: continuous support Comparison: usual care (all trials) | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with usual care (all trials) | Risk with Continuous support | |||||
| Spontaneous vaginal birth | Study population | Average RR 1.08 (1.04 to 1.12) | 14369 (21 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | ||
| 679 per 1000 | 733 per 1000 (706 to 760) | |||||
| Negative rating of/negative feelings about birth experience | Study population | Average RR 0.69 (0.59 to 0.79) | 11133 (11 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | ||
| 177 per 1000 | 122 per 1000 (104 to 140) | |||||
| Postpartum depression | Study population | ‐ | 5716 (2 RCTs) | ⊕⊕⊝⊝ LOW 1 3 | Both trials (Hodnett 2002; Hofmeyr 1991) were widely disparate in populations, the hospital conditions where they were conducted, and the type of support provider. We concluded that combining the trials data would not yield meaningful information. In both trials the direction of effect was the same. Hodnett 2002 used the Edinburgh Postnatal Depression Inventory and reported the frequencies of scores greater than 12. Hofmeyr 1991 used the Pitt Depression Inventory and reported scores indicating mild (less than 20), moderate (20 to 34), and severe (> 34) depressive symptomatology. We combined the frequencies of moderate and severe depressive symptomatology, since Pitt scores > 19 have been considered indicative of postpartum depression (Avan 2010). Continuous support resulted in a large reduction in depressive symptomology in Hofmeyr 1991 (RR 0.18, 95% CI 0.09 to 0.36). There was little or no difference in depressive symptomatology in Hodnett 2002 (RR 0.86, 95% CI 0.73 to 1.02) |
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| see comment | see comment | |||||
| Admission to special care nursery | Study population | Average RR 0.97 (0.76 to 1.25) | 8897 (7 RCTs) | ⊕⊕⊝⊝ LOW 4 5 | ||
| 81 per 1000 | 79 per 1000 (62 to 101) | |||||
| Exclusive or any breastfeeding at any time point, as defined by trial authors | Study population | Average RR 1.05 (0.96 to 1.16) | 5584 (4 RCTs) | ⊕⊕⊝⊝ LOW 1 6 | ||
| 601 per 1000 | 631 per 1000 (577 to 697) | |||||
| Labour length | The mean length of labour in the usual care group ranged from 5.3 to 12.7 hours. | The mean length of labour in the continuous support group was on average 0.69 hours (1.04 to 0.34 hours) shorter |
5429 (13 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | ||
| Caesarean birth | Study population | Average RR 0.75 (0.64 to 0.88) | 15347 (24 RCTs) | ⊕⊕⊝⊝ LOW 1 7 | ||
| 146 per 1000 | 109 per 1000 (93 to 128) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio; | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Most studies contributing data had design limitations. (‐1)
2 Statistical heterogeneity (I² > 60%). Variation in size of effect. (‐1)
3 The two trials were widely disparate in populations, the hospital conditions within which they were conducted, and the type of support provider. (‐1)
4 Most studies contributing data had design limitations and two studies contributing 37.6% weight had serious design limitations. (‐1)
5 Wide confidence interval crossing the line of no effect. (‐1)
6 Statistical heterogeneity (I² > 60%). Variation in direction of effect. (‐1)
7 Heterogeneity I² = 58%. Variation in effect size. (‐1)