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Database - Alliance francophone pour l'accouchement respecté (AFAR)

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https://afar.info/id=2207

Created on : 13 Sep 2008
Modified on : 07 Jan 2018

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Bibliographical entry (without author) :

Effects of psychosocial support during labour and childbirth on breastfeeding, medical interventions, and mothers’ wellbeing in a Mexican public hospital: a randomised clinical trial. Br J Obstet Gynaecol. 1998 Oct;105(10):1056-63.

Author(s) :

Langer A, Campero L, Garcia C, Reynoso S.

Year of publication :

1998

URL(s) :

http://www.ncbi.nlm.nih.gov/pubmed/9800927

Résumé (français)  :

OBJECTIF: Evaluer les effets du soutien psychologique durant le travail, l’expulsion et le post partum immédiat par une femme accompagnante (une doula).
MOYENS: Les effets de l’intervention ont été évalués par une étude clinique randomisée. L’accompagnement social d’une doula a été apporté aux femmes d’un groupe d’étude, pendant que des femmes d’un groupe témoin recevaient des soins de routine.
LIEU: Un grand hôpital de niveau III de Mexico City.
PARTICIPANTES: 724 femmes à grossesse unique, n’ayant pas précédemment donné naissance par voies basses, à moins de 6cm de dilatation, sans indication de césarienne, ont été désignées pour être accompagnées par une doula ou pour recevoir les soins de routine.
RESULATS OBSERVES: méthode d’allaitement, durée du travail, interventions médicales, état de la mère, et santé du nouveau né.
METHODES: Des enquêteurs à l’aveugles ont enregistré des données cliniques lors de rencontres avec les mères durant le post partum immédiat et chez elles 40 jours après la naissance. Les temps à faible ou à haut risques ont été pris en compte pour tous les résultats pertinents.
RESULTATS: La fréquence d’allaitement exclusif un mois après la naissance est significativement plus haute dans le groupe d’intervention (RR 1.64; I-C: 1.01-2.64), tout comme le comportement visant à une promotion de l’allaitement. Cependant, le programme ne conclut pas à un effet significatif sur l’allaitement dans son ensemble. Les femmes du groupe d’intervention eu l’impression de mieux contrôler leur accouchement, et la durée de leur travail a été plus courte que dans le groupe témoin. (4.56 heures contre 5.58 heures; RR 1.07 CI (95%) = 1.52 to -0.51). Il n’y a pas eu d’effet non plus sur les interventions médicales, l’anxiété de la mère, l’estime de soi, la perception de la douleur, la satisfaction, et l’état du nouveau né.
CONCLUSIONS: Le soutien psychologique apporté par les doulas a un effet positif sur l’allaitement et sur la durée du travail. Il a un impact plus limité sur les interventions médicales, peut-être à cause des gestes systématiques imposés par les protocoles hospitaliers, du contexte culturel, de la courte durée du temps d’observation, et du profil des doulas. Il est important d’inclure le soutien psychologique comme composante de la stratégie promotion de l’allaitement.
<hr>
PIP: Des études dans de nombreux pays ont prouvé la contribution positive des doulas (femmes ayant l’expérience de la naissance) qui prodiguent un accompagnement physique, émotionnel et informatif aux femmes avant, pendant et juste après l’accouchement. L’étude présente, conduite dans un <i>Mexican Institute of Social Security public hospital</i> (hôpital public mexicain de niveau III), explore l’hypothèse selon laquelle le soutien psychologique d’une doula augmente le taux d’allaitement exclusif et long en améliorant l’état émotionnel de la mère, en raccourcissant la durée du travail, et en diminuant le nombre d’interventions médicales.

Abstract (English)  :

OBJECT: To evaluate the effects of psychosocial support during labour, delivery and the immediate postpartum period provided by a female companion (doula). DESIGN: The effects of the intervention were assessed by means of a randomised clinical trial. Social support by a doula was provided to women in the intervention group, while women in the control arm received routine care.
SETTING: A large social security hospital in Mexico City. PARTICIPANTS: Seven hundred and twenty-four women with a single fetus, no previous vaginal delivery, < 6 cm of cervical dilatation, and no indications for an elective caesarean section were randomly assigned to be accompanied by a doula, or to receive routine care. OUTCOME MEASURES: Breastfeeding practices, duration of labour, medical interventions, mother’s emotional conditions, and newborn’s health.
METHODS: Blinded interviewers obtained data from the clinical records, during encounters with women in the immediate postpartum period, and at their homes 40 days after birth. Relative risks and confidence intervals were estimated for all relevant outcomes.
RESULTS: The frequency of exclusive breastfeeding one month after birth was significantly higher in the intervention group (RR 1.64; I-C: 1.01-2.64), as were the behaviours that promote breastfeeding. However, the programme did not achieve a significant effect on full breastfeeding. More women in the intervention group perceived a high degree of control over the delivery experience, and the duration of labour was shorter than in the control group (4.56 hours vs 5.58 hours; RR 1.07 CI (95%) = 1.52 to -0.51). There were no effects either on medical interventions, mothers’ anxiety, self-esteem, perception of pain and satisfaction, or in newborns’ conditions.
CONCLUSIONS: Psychosocial support by doulas had a positive effect on breastfeeding and duration of labour. It had a more limited impact on medical interventions, perhaps because of the strict routine in hospital procedures, the cultural background of the women, the short duration of the intervention, and the profile of the doulas. It is important to include psychosocial support as a component of breastfeeding promotion strategies.
<hr>
PIP: Studies in numerous countries have documented the positive contributions of doulas--women experienced in childbirth who provide continuous physical, emotional, and informational support to women before, during, and just after childbirth. The present study, conducted in a Mexican Institute of Social Security public hospital, explored the hypothesis that psychosocial support from a doula increases exclusive and full breast feeding by improving the mother’s emotional status, shortening the duration of labor, and decreasing medical intervention. 724 women with no previous vaginal delivery and no indications for cesarean section delivery were randomly assigned to be accompanied by a doula (n = 361) or to receive routine care (n = 363). Blinded interviewers obtained outcome data from the clinical records, encounters with mothers in the immediate postpartum period, and home visits 40 days after delivery. The frequency of exclusive breast feeding 1 month after birth was significantly higher in the intervention group than the control group (12% vs. 7%; relative risk (RR), 1.64; 95% confidence interval (CI), 1.01-2.64). However, the program did not achieve a significant effect on full breast feeding (37% and 36%, respectively). The duration of labor was shorter in the intervention group than the control group (4.56 vs. 5.58 hours; RR, 1.07; 95% CI, -1.52-0.51). A significantly larger proportion of women in the intervention group than the control group perceived a high level of control over labor (79.8% vs. 77.1%; RR, 1.14; 95% CI, 1.03-1.27). There were no effects on medical interventions, maternal anxiety, self-esteem, perception of pain, maternal satisfaction, or newborn Apgar scores. Although the prevalence of exclusive breast feeding was low in both groups, these findings suggest that psychosocial support during labor and the immediate postpartum period should be part of a comprehensive strategy to promote breast feeding.

Sumário (português)  :

Comments :

Traduction de Margot Winterhalter

Argument (français) :

Le soutien psychologique apporté par les doulas a un effet positif sur l’allaitement et sur la durée du travail. Il a un impact plus limité sur les interventions médicales.

Argument (English):

Psychosocial support by doulas had a positive effect on breastfeeding and duration of labour. It had a more limited impact on medical interventions.

Argumento (português):

Keywords :

➡ psychology ; birth attendant ; doula ; breastfeeding ; dilation

Author of this record :

Bernard Bel — 13 Sep 2008
➡ latest update : Bernard Bel — 07 Jan 2018

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