Rev. Enferm. UFSM - REUFSM

Santa Maria, RS, v. 9, e61, p. 1-18, 2019

DOI: 10.5902/2179769234170

ISSN 2179-7692

 

Submission: 05/08/2018    Acceptance: 11/10/2019    Publication: 18/11/2019

Revision Article

 

Benefits of the presence of a companion during the process of labor and delivery: integrative review

Benefícios da presença do acompanhante no processo de parto e nascimento: revisão integrativa

Beneficios de la presencia del acompanãnte en el proceso de parto y nacimiento: revisión integradora

 


Iris Elizabete Messa GomesI

Stela Maris de Mello PadoinII

Tassiane Ferreira LangendorfIII

Cristiane Cardoso de PaulaIV

Cibele Avila GomesV

Aline Cammarano RibeiroVI

 

I Nurse. Master in Nursing. Federal University of Santa Maria. Santa Maria, RS, Brazil. Email: irismessagomes@hotmail.com. ORCID: https://orcid.org/0000-0002-0496-5892

II Nurse. PhD in Nursing. Federal University of Santa Maria. Santa Maria, RS, Brazil. Email: stelamaris_padoin@hotmail.com. ORCID: https://orcid.org/0000-0003-3272-054X

III Nurse. PhD in Nursing. Federal University of Santa Maria. Santa Maria, RS, Brazil. Email: tassi.lang@gmail.com. ORCID: https://orcid.org/0000-0002-5902-7449

IV Nurse. PhD in Nursing. Federal University of Santa Maria. Santa Maria, RS, Brazil. Email: cris_depaula1@hotmail.com. ORCID: https://orcid.org/0000-0003-4122-5161

V Medical Student. Scientific Initiation Scholarship Holder. Federal University of Santa Maria. Santa Maria, RS, Brazil. E-mail: cibegomes@gmail.com. ORCID: https://orcid.org/0000-0002-0740-5815

VI Nurse. PhD in Nursing. Federal University of Santa Maria. Santa Maria, RS, Brazil. Email: alinecammarano@gmail.com. ORCID: https://orcid.org/0000-0003-3575-2555

 

 

Abstract: Objective: to analyze the scientific evidence about the benefits of the presence of a companion during labor and delivery. Method: Integrative literature review conducted in April 2018, in the Latin American and Caribbean Health Sciences Literature (LILACS), Nursing Database (BDENF), Public Medline (PubMed) and SCOPUS databases, using specific strategies to each database. Fifteen articles were selected for analysis. Results: practices developed by companions that promoted benefits during the process of labor and delivery were evidenced, such as emotional support, strengthened family bonds and change in professional conduct. Conclusion: in order to ensure the evidence-based practice of the beneficial factors it is necessary to expand institutional and professional actions that enable the effective participation of the companion in the process of labor and delivery.

Descriptors: Medical chaperones; Childbirth; Family; Obstetric nursing; Women's health

 

Resumo: Objetivo: analisar as evidências científicas acerca dos benefícios da presença do acompanhante no processo de parto e nascimento. Método: revisão integrativa da literatura realizada no mês de abril de 2018, nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Base de Dados de Enfermagem (BDENF), Public Medline (PubMed), SCOPUS, utilizando estratégias de busca específicas para cada base. Foram selecionados 15 artigos para análise. Resultados: foram evidenciadas atividades desenvolvidas pelos acompanhantes que promoveram benefícios durante o processo de parto e nascimento como o apoio emocional, os laços familiares fortalecidos e a mudança de conduta profissional. Conclusão: para garantir a prática apoiada na evidência dos fatores benéficos é necessário ampliar ações institucionais e dos profissionais que viabilizem a efetiva participação do acompanhante no processo de parto e nascimento. 

Descritores: Acompanhantes formais em exames físicos; Parto; Família; Enfermagem obstétrica; Saúde da mulher

 

Resumen: Objetivo: analizar las evidencias científicas sobre los beneficios de la presencia del acompañante en el proceso de parto y nacimiento. Método: revisión integradora de la literatura realizada en abril de 2018, en las bases de datos Literatura Latino-Americana y del Caribe en Ciencias de la Salud (LILACS), Base de Datos de Enfermería (BDENF), Public Medline (PubMed), SCOPUS, utilizando estrategias de búsqueda específicas para cada base. Fueron seleccionados 15 artículos para análisis. Resultados: fueron evidenciadas actividades desarrolladas por los acompañantes que promovieron beneficios durante el proceso de parto y nacimiento como el apoyo emocional, el fortalecimiento de los lazos familiares y el cambio de la conducta profesional. Conclusión: para garantizar la práctica basada en la evidencia de los factores beneficiosos es necesario expandir las acciones institucionales y de los profesionales que permitan la participación efectiva del acompañante en el proceso de parto y nacimiento.

Descriptores: Chaperones Médicos; Parto; Familia; Enfermería Obstétrica; Salud de la Mujer


 

Introduction

        The national1 and international2 guidelines on assistance to normal childbirth recommend the presence of the companion during labor and delivery, which is a convergent action to the humanization of health care at this time. This perspective is broadened in discussions and priority in actions of assistance to obstetric health with a view to strengthening the human relationships involved in this process, and such assistance has been focused on performing interventions and procedures.3 Thus, enabling and ensuring the presence of the companion is considered a dignifying practice in the assistance of women during childbirth.4

The presence of a woman's companion of her own choice is recognized as one of the actions to be complied with for good practices in the assistance to normal childbirth,5 ensured in Brazil by Law 11.108,6 which guarantees it as the parturient's right, and by Ordinance 1.459, which established the Stork Network. The latter constitutes a strategy of the Ministry of Health with the purpose of structuring and organizing assistance to maternal and child health in the country, with a view to implementing a care network that includes the right to reproductive planning and to humanized assistance to pregnancy, childbirth and the puerperium. 7

In this scenario, evidences indicate that parturients choose to have a companion during labor and delivery, usually their partner or mother.8-9 Considering the experiences in such moment, the companion promotes support in the emotional and physical spheres, making the woman feel safe, characterizing it as a recommended practice for all parturients.10 This confirms that providing quality obstetric assistance also means reflecting on the involvement of the family in different care contexts.

The physical or emotional support offered by the pregnant woman's companion in the process of labor and delivery is a safe and essential practice to qualify maternal and neonatal health care, in addition to legitimizing women's rights.10 However, it can be observed that the exercise and guarantee of this right do not occur in all labors and deliveries, 8-10 revealing that this practice has been implemented discreetly and has confrontations to overcome.

In view of the above, the question is: "What are the scientific evidences about the benefits of the presence of the companion in the process of labor and delivery?". In order to answer the research question, this study aimed to analyze the scientific evidences about the benefits of the presence of the companion in the process of labor and delivery.

 

Method

In order to achieve the proposed objective, the decision was to develop an integrative literature review research,11 aiming to analyze and synthesize the produced knowledge about the benefits of the presence of the companion in the moment of parturition.

The steps below were followed:11 1. Identifying the theme: presence of the companion in the process of labor and delivery; 2. Building the research question with the PICO strategy12, constituted by P (population): companions, I (intervention): presence of the companion, C (comparison): does not apply and O (outcomes): benefits, therefore the question is: "What are the scientific evidences about the benefits of the presence of the companion in the process of labor and delivery?"; 3. Establishing the inclusion criteria: research articles developed in Brazil (due to the obstetric assistance model provided and the public health policy established in the country), published in Portuguese, English or Spanish, in the period between 2005 and 2017, in view of the creation of the Companion Law.6 The inclusion criteria were applied by two researchers in a double-independent manner, in order to ensure the reliability of the results; 4. Defining the information to be extracted from the studies: reference, objective, design, activities developed, benefits of the presence of the companions; 5. Evidence assessment and analysis (categorization): The method used to classify the strength of evidence proposes three types of questions, namely: 1- Intervention or diagnosis; 2- Prognosis or etiology; 3- Meaning, based on the original study question. In view of the corpus of this research, the classification of evidences from studies with a clinical question directed to meaning was used, with the following hierarchy: I- Metasynthesis of qualitative studies; II- Individual qualitative studies; III- Synthesis of descriptive studies; IV- Individual descriptive studies; V- Experts’ opinion;13 the data analysis was performed in descriptive manner with grouping by similarity of evidence; 6. Discussion and presentation of the knowledge synthesis.

The search was performed in April 2018 in the online databases: Latin American and Caribbean Health Sciences Literature (LILACS), Nursing Database (BDENF), Public Medline (PubMed) and SCOPUS.

For the selection of descriptors to be used in the search, consultations were carried out in the Health Sciences Descriptors (DeCS) and the Medical Subject Headings (MeSH), and keywords were used in order to locate a greater number of evidences. Given the specificities of the databases, different search strategies were used for each one of them, based on the review question and the inclusion criteria (Table 1).

 

Table 1.  Search strategies used and selected productions about the benefits of the presence of the companion in the process of labor and delivery. LILACS, BDENF, PubMed, SCOPUS, 2005-2017. Source: Research data, Santa Maria/RS, 2018

Bases

Search Strategy

Publications

Sample

LILACS

"Acompanhantes" OR "Familia" AND "parto" OR "Cesarea"

669

13

BDENF

"Acompanhantes" OR "Familia" AND "parto" OR "Cesarea"

188

02

Scopus

"cesarean section" OR "natural childbirth" OR "labor, obstetric" AND "medical chaperones" OR "social support" OR "labor companionship”

511

-

PubMed

"Cesarean section" OR "natural childbirth" OR "labor, obstetric" AND "medical chaperones" OR "social support"

375

-

Total

1743

15

 

After the search and application of the inclusion criteria, 15 articles were selected, which composed the research corpus (Figure 1). Their retrieval was performed through the database, and when they were not available, the searched was conducted on the Capes Portal and, later, on the website of the journals.

For the election of the information to be extracted from the articles, a synoptic chart was filled, including the following information: identification of the article, country where the study was performed, subarea of knowledge, objective, methodology of the study, companions, activity developed and benefits. Shortly after, the information considered relevant to reach the objective of the review were analyzed.

Figure 1. Diagram of selection of studies to the review about the benefits of the presence of the companion in the process of labor and delivery. LILACS, BDENF, PubMed, SCOPUS, 2005-2017. Source: Research data, Santa Maria/RS, 2018

The ethical aspects of the productions were respected, ensuring ideas, concepts and definitions of authorship of each article analyzed, which are reliably presented and referenced.

 

Results

The characterization of the analyzed studies regarding the area of knowledge, study design, companions at childbirth and levels of evidence is shown below. It is relevant to note that, regarding the companions at childbirth, some studies have mentioned more than one companion (Table 2).

 

Table 2. Characterization of the analyzed articles about the benefits of the presence of the companion in the process of labor and delivery. LILACS, BDENF, PubMed, SCOPUS, 2005-2017. Source: Research data, Santa Maria/RS, 2018

 

N

%

Year of publication

2011-2017

09

60,0

2005-2010

6

40,0

Methodological approach of the research

Quantitative

2

13,3

Qualitative

13

86,6

Companions

N of studies that included

 

Husband/Partners/Father of the baby/Spouse

Mother

Sister

Mother-in-law

Sister-in-law

Friend

Aunt

Child’s godmother

Others (does not specify who the companion is)

11

10

7

3

4

2

3

1

1

-

-

-

-

-

-

-

-

-

Total:

15

100

 

The time distribution of the studies was grouped in a five-year way and the period of 2011-2017 presented the largest number of productions, with 60% (n = 09). A growth in the number of articles published in recent years can be observed, which demonstrates that the theme has been increasingly explored. In the methodological approach qualitative studies predominated, with 86.6% (n = 13).

Furthermore, the studies have shown who the companions who are present at childbirth are, with prominence of the presence of the husband or partner, in 11 studies. Additionally, other companions mentioned were the father of the baby, the husband, mother, sister, mother-in-law, sister-in-law, friend and others. The information extracted from the studies are presented in Chart 1.

 

Authors

Objective

Activities developed by the companions

Benefits of the presence of the companion

L.E.

Dodou HD, et al.(14)

To investigate the contribution of the companion during labor and delivery, from the perspective of puerperal women.

Holding the hand; offering support; helping during exercises; giving massages.

Bringing safety, physical well-being and confidence; Soothing the pain and the feeling of loneliness.

IV

Frutuoso LD, Brüggemann OM(15)

To know which information the companions have about Law 11.108/2005, their perceptions about the experience in the obstetric center and the support practices with the woman.

Comforting; staying close; Assisting in ambulation and exercises; giving massages; Holding the hand.

Companionship; Appreciating the family bonds and the woman.

IV

Gonzalez AD, et al.(16)

To know the perception of the companion in the process of childbirth.

Support actions for the parturient to stay calm and relaxed; Continuous presence.

Strengthening bonds; promoting confidence and tranquility; Appreciation of the woman.

IV

Alves MC, et al.(17)

To understand the insertion of the companion in the obstetric center and to identify the actions developed to support the parturient during labor, delivery and immediate postpartum.

Continuous presence; Massages; Assisting during the ambulation, the shower, the exercises;

Holding the hand; Explaining procedures; Talking.

Strengthening family bonds; Anticipating the newborn's first contact with the family; comforting.

IV

Palinski JR, et al.(18)

Sought to understand the women's perceptions about the participation of a companion of their choice during the process of labor.

Physical support; constant presence; holding the hand.

Safety; Tranquility.

IV

Oliveira ASS, et al.(19)

To analyze the perception of puerperal women about the presence/participation of the companion during labor and delivery.

Talking; holding the hand; explaining procedures and worrying about the baby.

Soothing the pain, the feeling of loneliness and the fear; confidence; safety; tranquility; possibility of communication.

IV

Teles LMR, et al.(20)

To describe the activities performed by the companion during labor and delivery, and to compare the experience with companion and without companion.

Constant presence; touching; massages; providing comfort; assisting in ambulation, in the shower.

Confidence; encouragement for normal childbirth.

IV

Alexandre AMC, Martins M(21)

To know the experience of fathers regarding their wife’s labor and delivery.

Talking

Strengthening the family and affective bond of the father with the child; Appreciation of the woman; Tranquility; Safety

II

Nakano AMS, et al.(22)

To understand what it means to be a companion of a woman during the labor and delivery process.

Staying close/next; observing everything.

Giving incentive; Reassuring and encouraging the parturient; Comforting

II

Hogab LAK, Pinto CMS(23)

To describe the experience of professional team members regarding the presence of a companion at childbirth.

Continuous presence

Strengthening family bonds; Safety; Making the assistance more affective.

II

Brüggemann OM, Osis MJD, Parpinelli MA(24)

To describe the perception of health professionals about providing assistance to the parturient in the presence of a companion chosen by her, as well as the perception of the companions about such experience.

Holding the hand; constant presence; talking

Security, confidence and collaboration; makes the professional have a more humane and less routine attitude; helps in the progression of labor.

II

Santos ALS, et al.(25)

To understand the puerperal woman's perception about the presence of the companion during labor.

Holding the hand; continuous presence.

Confidence and safety; minimizes the feeling of loneliness.

IV

Teles LMR, et al.(26)

To investigate the importance of the companion during the labor process from the perspective of puerperal women.

Talking; giving massages; continuous presence.

Safety; helps relieve pain; appreciation of women from their partners; Strengthens the family unity; Decreases loneliness; Facilitates the childbirth.

IV

Francisco BS, et al. (27)

To know the perceptions of the father about his experience during the process of birth of their child.

Massages; holding the hand

Anticipates the creation of bond between father and son; appreciation of the woman; Safety.

IV

Souza SRRK, Gualda DMR(28)

To know the experience of women and their companions in the process of childbirth.

Massage; Assistance in exercises; Encouraging; Giving strength; Talking; Continuous Presence.

Comforting; strengthening the family bond; early contact between father and newborn; appreciation of the woman.

II

Chart 1. Synoptic chart of the included productions about the benefits of the presence of the companion in the process of labor and delivery. LILACS, BDENF, PubMed, SCOPUS, 2005-2017. Source: Research data, Santa Maria/RS, 2018

 

Regarding the levels of evidence, studies with evidence strength IV predominated, with 66.6% (n = 10). The analysis and synthesis of the data allowed the categorization of three beneficial factors of the presence of the companion in the process of labor and delivery, as well as the activities developed by the companions to provide such benefits. The activities performed by the companions were evidenced, as well as their beneficial factors: emotional support, strengthened family bonds and change in professional conduct (Table 3).

 

Table 3. Beneficial factors and activities developed by the companions in the process of labor and delivery. LILACS, BDENF, PubMed, SCOPUS and Web of Science, 2005-2017. Source: Research data, Santa Maria/RS, 2018

Beneficial factors

1.  Emotional support

The parturient feels more confident (14,16,19-20,24-25)

Safety during the parturition process (14,18,21,23-27)

Soothes pain and loneliness (14,19,25-26)

Comforts/calms the parturient (15-19,21-22)

Helps in the physiological progression of labor (17,20,23-24,26)

2. Strengthened family bonds

Early contact between father/family and the NB (17,21,27-28)

Strengthening the family connection (15-17,21,26,28)

Appreciation of the woman (15-16,21,27-28)

3. Change in professional conduct

Professionals have more humane and less routine conducts (22-23)

Activities developed

Continuous presence (15-18,20,22-26,28)

Encouraging/facilitating normal childbirth (17,20,23-24,26)

Assistance in exercises (14,17,27-28)

Assistance in ambulation (15,17,20)

Giving massages (14-15,17,20,22,26,27,28)

Assistance in the shower (17,20)

Holding the hand (14-15,17-19,24-25,27)

Talking (17,19,21,24,26,28)

Mediating the communication with the team (17,19,22)

 

Discussion

The findings show that different social actors participate as companions of the pregnant woman during labor and delivery. In the studies, at least one person was mentioned as a companion in those moments, including the child's father, husband, partner, mother, sister, mother-in-law or friends.14-24,26,28 It is possible to assume that the companions are people from the parturient's social network.

The study conducted with 105 puerperal women in a maternity school in Ceará has shown that the presence of the companions is very important, and justified this fact by the emotional support, physical comfort and information support offered by the companions20 and, in this regard, the women’s choice is defined, in most cases, by the bond that the pregnant woman has with the person.25 In some situations, the lack of company or the choice for someone not so close to the woman in the process of labor and delivery is due to the impossibility of their companion of choice being present, for work-related reasons or because they need to watch the other children.14,19

The beneficial factors of the presence of companions can be observed from the emotional support offered, showing that when the woman is with a companion, she becomes more confident for the moment of childbirth.16,19-20,24-25 This is directly connected to the bond that the woman has with the chosen person, which makes her feel free to verbalize feelings she does not feel comfortable telling the professionals.20,24-25

Women feel safer to count on someone close to them to accompany them during childbirth.14,18 The presence of the companion helps in the physiological process of the childbirth, as the woman is confident that everything will work out, since she has someone she trusts with her23-24,26 and that, if something unwanted happens, she will not be alone.14,26

Emotional support was also evident in studies in which the women emphasized that the presence of the companion can soothe the pain and the feeling of loneliness.14,19,25-26 Because it is time in which they are afraid, being near someone reduces the feeling of being alone19 and of going through the process by herself. In addition, when evaluating the experience in the postpartum period, the women realized that, if they were alone, the process of labor and delivery would not have happened in the same way, wondering if they would have made it.14

Comforting the parturient was also listed as a beneficial factor, considering that the anxiety of going through the unknown or being in a strange environment can make the process of labor and delivery a moment of distress and displeasure. The fact of having someone close to the woman at her side brings her calm and tranquility.15-16,18 Additionally, another activity developed by the person who accompanies the moment of labor is talking to the parturient,19,26,28 which brings comfort and tranquility to the woman because, that way, she gets distracted and reassures the feeling of being with someone who knows her and whom she trusts.

Explaining procedures that will be performed was also mentioned as an activity developed by the companion,19,22 since, when in pain, the women have difficulty understanding the guidelines provided by the team, and it is in that moment that the person accompanying her becomes the mediator and translates the information to make it easy for her to understand.

Elucidating the guidance of health professionals to the women in simpler language, that allows the parturient’s understanding,17 becomes a factor that encourages and facilitates normal childbirth because, in addition to bringing her positive feelings, which makes her safer and collaborative, it may also lead to increased endorphin levels, which reduces pain and stress.20, 23-24

Different studies have shown that the continuous presence of the companion can calm, comfort and motivate the woman,15,17-18,20,22,24-25,28 being emphasized as their main attribution,23 and is expressed in the demonstration of affection and companionship.17 In a study conducted in a public maternity hospital in Paraná, with 11 women and 11 companions, the results have shown that the women did not allow the companion to leave, since their presence brought comfort.28 When the companion is another woman, she decides not to leave the parturient alone, based on her previous experiences of childbirth, and evokes maternal attributes in order to make the parturient feel motivated.22

Another factor are the family bonds that strengthen, as the person who is experiencing the moment of childbirth is someone special to the parturient. It is in that moment that there is the first meeting between the woman, the baby and the person she has chosen to accompany her,17 which creates and strengthens the family bonds early.

In studies that have reported the presence of the father in the moment of childbirth, the commitment between him and his partner was reinforced, since childbirth is a moment of extreme intimacy, trust and safety.14,21,24 It is in that moment that there are the first contact with the baby, the first lap and the first cares, allowing the father to feel belonging and participative in that moment.15-16,21,27 The appreciation of the woman by her partner and the positive consequences in the relationship were noticed in the reports that mention that the woman is the only person able to go through the process of labor and delivery.21,27-28

Regarding the beneficial factor of change in professional conduct23-24, it was evident that, when providing assistance in the presence of a companion, the professionals were touched by feelings of emotion and empathy, since the connection provides a more affective relationship.23 The professional adopts a conduct of decentralization, not only aiming at the childbirth and the newborn, but also the family, because along with the parturient there is someone who cares about her.24

The physical support provided to the women in the process of labor and delivery was a prominent activity. The companions, when performing activities such as ambulating with the woman,17,20 giving massages,14-15 accompanying her during the shower17 and performing the exercises instructed by the team27-28 or holding hands14,18-19,24-25 make their presence beneficial, bringing confidence to the woman and positive effects to the progression of labor.

 

 

Conclusion

In addition to guaranteeing the right to a companion, the benefits of being accompanied in the process of labor and delivery promote feelings of safety and confidence. These benefits involve not only the physiological process of the progression of labor, but also the strengthening of family bonds, by enabling the companion to approach and contact the woman and the baby shortly after the birth. 

In the actions of assistance to obstetric health, a knowledge gap evidenced in this review was the change in the conduct of professionals in health care provided, which indicates the need for researches with this object of study. As an implication for the practice, it indicates the need to recognize the companion as an important social actor in the process of labor and delivery. In addition, in order to ensure the practice based on evidence of the beneficial factors, it is necessary to expand institutional and professional actions that can enable the effective participation of the companion in this process. 

For the present review, the analysis of national studies was defined, thus not allowing generalizations and characterizing this aspect as a study limitation. Therefore, it is considered important to develop new reviews that allow broadening the scope of primary studies, including in the international scenario.

References

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Corresponding Author:

Name: Stela Maris de Mello Padoin

E-mail: stelamaris_padoin@hotmail.com

Address: 1000 Roraima Ave., Building 26, Room 1336, University City, Camobi District

Santa Maria, RS, Brazil.

Zip code: 97105-900

 

Authorship contributions

1 – Iris Elizabete Messa Gomes

Conception and planning of the review, collection, analysis and interpretation of data, writing and critical review.

2 – Stela Maris de Mello Padoin

Conception and planning of the review, analysis and interpretation of data, writing and critical review.

3 Tassiane Ferreira Langendorf

Analysis and interpretation of data, writing and critical review.

4 Cristiane Cardoso de Paula

Conception and planning of the review, analysis and interpretation of data, writing and critical review.

5 - Cibele Avila Gomes

Collection, analysis and interpretation of data and writing.

6 - Aline Cammarano Ribeiro

Analysis and interpretation of data, writing and critical review.

 

How to cite this article

Gomes IEM, Padoin SMM, Langendorf  TF, Paula CC, Gomes CA, Ribeiro AC. Benefits of the presence of a companion during the process of labor and delivery: integrative review. Rev. Enferm. UFSM. 2019 [Accessed in: Year Month Day];vol.9 e61: 1-18. DOI:https://doi.org/10.5902/2179769234170



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