In Botswana it is customary, when a woman conceives her first child, for her mother or another female relative to care for her at her parents' home through the last trimester and for at least a month after birth. A traditional birth attendant attends the woman during labor to provide constant support and encouragement. After birth, the mother and child are isolated from most other persons including the father to protect against infection. Today, many women give birth in hospital where their own mothers may not attend them, and may be alone for long periods because of a shortage of midwives. This study randomly assigned 109 primigravid women in uncomplicated labor to an experimental group who, in addition to standard hospital care, had a female relative present throughout labor (53) or to a control group managed according to the usual hospital routine (56). The two groups were demographically and clinically similar in all respects.
The women provided support from a female relative generally did better than those given routine hospital care. They received significantly less analgesia, were less likely to have the membranes ruptured artificially, and received fewer oxytocic drugs in early labor. They also were more likely than the women in the control group to have a normal delivery. The rate of spontaneous vaginal delivery was 91 percent in the study group and 71 percent in the control group. Both vacuum extractions and operative deliveries were more prevalent in the control group. Perineal trauma was comparable in the two groups of women.
These findings agree with those of other randomized trials in the U. S. and Guatemala, showing that fewer obstetrical interventions are needed when a companion is present throughout labor. This itself is a low-cost intervention that lacks adverse effects and saves time and money. It is especially appropriate in developing countries where it is still traditional practice for a companion to be present, and may also prove useful in developed countries where the male partner tends to be involved.
European Institute of Health and Medical Sciences, University of Surrey, Surrey, U.K.