Companionship to modify the clinical birth environment : effects on progress and perceptions of labour, and breastfeeding

To measure the effects of supportive companionship on labour and various aspects of adaptation to parenthood, and thus by inference the adverse effects of a clinically orientated labour environment on these processes. Randomized controlled trial. A community hospital familiar to most of the participants, with a conventional, clinically-orientated labour ward. Nulliparous women in uncomplicated labour. Supportive companionship from volunteers from the community with no medical nor nursing experience, concentrating on comfort, reassurance and praise. Duration of labour, use of analgesia, perceptions of labour and breastfeeding success. Companionship had no measurable effect on the progress of labour. Diastolic blood pressure and use of analgesia were modestly but significantly reduced. The support group were more likely to report that they felt that they had coped well during labour (60 vs 24%, P less than 0.00001). Their mean labour pain scores (26.0 vs 44.2, P less than 0.00001) and state anxiety scores (28.2 vs 37.8, P less than 0.00001) were lower than those of the control group. Compared with the control group (n = 75), at 6 weeks women in the support group (n = 74) were more likely to be breastfeeding exclusively (51 vs 29%, P less than 0.01); and to be feeding at flexible intervals (81 vs 47%, P less than 0.0001). Labour in a clinical environment may undermine women's feelings of competence, perceptions of labour, confidence in adapting to parenthood and initiation of successful breastfeeding. These effects may be reduced by the provision of additional companionship during labour aimed to promote self-esteem.