Birth Support

Natural childbirth and psychoprophylaxis

A 1979 historical analysis concluded that modern methods of preparation for labor have diverse and complex origins. It credited the English obstetrician Grantly Dick-Read, author of Natural Childbirth (London, 1933) and Childbirth Without Fear (New York, 1944), with the most substantive contributions, although many training manuals are presented as outlines of the Lamaze method. The same analysis found that none of the early authors it examined presented data that allow cause-and-effect conclusions about outcomes.

A historian of medicine describes Dick-Read as a controversial British physician whose bestselling books argued that relaxation and education, not drugs, were the keys to freeing women from pain in childbirth. Around 1950 he made an educational film that taught his method to doctors and to a first generation of Western women dissatisfied with heavily medicated, hospitalized maternity care.

Lamaze and the named class methods

A nursing textbook dates the Lamaze method to 1951 in France, where Fernand Lamaze combined relaxation, classes, continuous emotional support and breathing techniques, and places its arrival in the United States in the late 1950s. The 1979 analysis compared Lamaze's 1958 text with the Soviet source published in English in 1960 and reported that he deleted and modified substantial portions of the regimen.

A 2015 comparison of two class-based methods reports that the American obstetrician Robert Bradley developed the Bradley Method in 1947, in objection to artificial conditions in hospitals, and that Marie Mongan first described HypnoBirthing in a 1989 book. The founders' own accounts reach the reader through the organizations that teach the methods, so these dates reflect what the methods say about themselves.

Midwives, doulas and postpartum customs

The International Confederation of Midwives (ICM) defines midwifery as the profession of midwives, grounded in a body of knowledge, skills and professional attitudes. The sources reviewed for this page do not give a dated, verified history of the word doula or of the doula role, and the professional-body pages opened describe present-day standards rather than origins.

Postpartum customs are described in the research literature as traditional practices. A systematic review of studies from China and Chinese immigrant communities discusses the traditional postpartum confinement practice known as doing the month, but it does not date the custom or trace its development.

What the umbrella term covers

Birth support is used on this page as an organizing term, not as a name any one professional body defines. The sources reviewed describe distinct things: a regulated clinical profession (midwifery), a non-clinical companion role (the doula), class-based education (Lamaze, Bradley and similar branded courses), comfort measures and settings (water immersion, midwifery units), and postnatal customs. Each has its own page-level literature, and the term should not be read as implying a shared training standard or shared evidence.

Regulated and non-regulated titles

The ICM definition describes a midwife as a person who completed a midwifery education programme based on ICM competencies, recognized in the country where it is located, and who holds the qualifications to be registered or licensed and to use the title. The ICM also notes that in some countries the title is not protected and that nurses, doctors and midwifery associates, who do not hold the full midwife competencies, may provide parts of maternal and newborn care. The ICM page opened does not mention doulas.

DONA International, a doula certifying organization, limits the scope of birth doulas to emotional, physical and informational support and states that doulas will not diagnose or treat in any modality. Birth doulas do not take vital signs, check fetal heart tones or perform vaginal examinations. Postpartum doulas are likewise limited to emotional, physical and educational support. This is one organization's standard from a page dated 2015, and the sources reviewed do not establish that every doula organization uses the same wording.

Related Machipedia pages

Several neighboring topics have their own Machipedia pages. Childbirth Preparation covers antenatal classes in general, and Hypnobirthing covers a self-hypnosis course. Prenatal Massage and Prenatal Yoga cover bodywork and movement during pregnancy, and Acupressure covers a technique that national guidance mentions for labor pain. Womb Healing, Mayan Abdominal Massage and Parenting Approaches cover related traditions and themes that lie outside the sourced scope of this family page.

Clinical care and support roles

The ICM scope of practice describes the midwife as a responsible and accountable professional who works in partnership with women, conducts births on the midwife's own responsibility, and cares for the newborn. The scope includes preventive measures, detection of complications and access to medical care, and it names antenatal education and preparation for parenthood as part of the midwife's work. A midwife may practice in the home, community, hospital or clinic.

A doula, in the Cochrane review of continuous labor support, is a provider who is not a staff member of the facility and not part of the woman's social network, present solely to provide continuous support. NICE guidance for England recommends that maternity services support one-to-one care in labor for all women and that a woman in established labor not be left alone except for short periods or at her request.

Education and preparation

Class-based methods differ in format. The nursing textbook describes Lamaze International classes as covering pregnancy, labor, birth and postpartum care, with an emphasis on shared decision making, and reports that attendance involves about eight weeks of sessions. The same textbook describes the Bradley Method as a longer course of about twelve weeks built around a trained coach, often the partner, with preparation for unmedicated or low-intervention birth.

Lamaze International teaches six healthy birth practices: letting labor begin on its own, moving and changing positions in labor, having continuous support from a loved one, friend or doula, avoiding interventions that are not medically necessary, avoiding birth on the back, and keeping the birthing person and baby together. The textbook notes that these non-intervention recommendations apply mainly to low-risk births.

Comfort measures and settings

NICE advises that breathing exercises, a shower or bath, and massage may reduce pain in the latent first stage of labor, and that a woman who chooses breathing, relaxation or massage techniques taught to birth companions should be supported in that choice. NICE does not recommend offering aromatherapy, yoga, acupressure or hypnosis for labor pain but advises supporting a woman who wants to use them. It recommends offering the opportunity to labor in water and, from a 2025 update, to consider birth in water after discussing the evidence.

NICE and the National Health Service (NHS) in England describe four birth settings: home, a freestanding midwifery unit, a midwifery unit alongside a hospital obstetric unit, and an obstetric unit. The NHS describes midwifery units as more homelike than a ward, attended by midwives and unable to offer epidurals, with transfer needed if complications develop.

What organizations say these approaches are for

Lamaze International describes its practices as ways to promote and support physiologic birth and to build parents' confidence. The ICM describes midwifery as supporting the normal biological, psychological, social and cultural processes of pregnancy, childbirth and the postnatal period, and its scope of practice includes promotion of normal birth. The World Health Organization (WHO) presents its 2018 intrapartum guideline as a woman-centred, holistic and rights-based package intended to produce a positive childbirth experience.

The Bradley Method is described by the nursing textbook as preparing couples to support unmedicated, low-intervention births. Its association states a high rate of spontaneous unmedicated births among its participants, but the 2015 comparison reports that the author could not obtain an explanation of how the figure was derived and that no well-designed studies of the method exist. These are the methods' own claims, not trial results.

Postnatal customs

The systematic review of doing the month reports that the practice is considered, within the tradition, to help mothers recover during the postpartum period. The review states that research had not provided evidence confirming such benefits and examined the question of postpartum depression specifically.

Continuous support in labor

A 2017 Cochrane review included 27 trials, 26 with usable data from 15,858 women in 17 countries, comparing continuous one-to-one support with usual care. Women allocated to continuous support were more likely to have a spontaneous vaginal birth (average risk ratio 1.08) and less likely to have a caesarean birth (0.75), with labor about 0.69 hours shorter. The reviewers graded much of the evidence as low quality, noted that no study blinded women and personnel, and found no studies in low-income settings.

The review reported no evidence of harms of continuous labor support. Its subgroup analyses suggested larger effects on caesarean birth when the provider was in a doula role and where epidural analgesia was not routine, but the authors describe those analyses as exploratory. The results apply to continuous one-to-one support during labor and do not show what a doula contributes before or after labor. ACOG states that continuous one-to-one emotional support, such as from a doula, is associated with improved outcomes for women in labor.

Midwife-led continuity of care

A 2016 Cochrane review of 15 trials with 17,674 women compared midwife-led continuity models with other models of care. Women in midwife-led models were less likely to have regional analgesia, instrumental vaginal birth or preterm birth, and more likely to have a spontaneous vaginal birth; the reviewers graded these primary outcomes as high quality. There was no difference in caesarean birth, and the reviewers concluded that adverse outcomes were at least comparable. This finding concerns a model of care organized around a known midwife, not a general result for all midwife attendance.

Education, relaxation and water immersion

A 2007 Cochrane review of antenatal education found nine trials with 2,284 women and no consistent results, concluding that the effects of general antenatal education for childbirth or parenthood remain largely unknown. It does not assess named methods such as Lamaze or Bradley.

A 2016 Cochrane review of hypnosis for labor pain included nine trials with 2,954 women. Hypnosis was associated with less use of pharmacological pain relief (risk ratio 0.73), but the evidence was very low quality and most other outcomes showed no clear difference. A 2018 Cochrane review of water immersion in 15 trials with 3,663 women, all conducted in hospital labor wards, found little or no difference in mode of birth in the first stage and a small reduction in regional analgesia, with limited evidence for the second stage. These results concern single techniques only.

Postpartum confinement customs

The 2023 systematic review of 16 quantitative studies, 15 cross-sectional and one randomized, found conflicting evidence about doing the month and postpartum depression: four studies reported lower risk, two reported the opposite, and ten found no significant association. The authors concluded that the practice had not shown a significant protective effect. The finding is limited to Chinese populations and to postpartum depression.

When medical care is needed

Birth support does not replace obstetric or midwifery care. The NHS advises contacting the midwife or maternity unit urgently if the waters break, if there is vaginal bleeding, if the baby is moving less than usual, if labor may have started before 37 weeks, if a contraction lasts longer than two minutes, or if there are six or more contractions in ten minutes. It advises calling emergency services if the baby seems to be arriving with a strong urge to push. This page does not give instructions for births or procedures.

Place of birth

NICE advises that low-risk multiparous women be told that planning birth at home or in a midwifery unit is associated with fewer interventions and no difference in outcome for the baby compared with an obstetric unit. For low-risk first-time mothers, it advises that planning birth at home carries a small increase in the risk of an adverse outcome for the baby, and its tables put this at about four more serious medical problems per 1,000 births. The NHS cites 9 per 1,000 for home births versus 5 per 1,000 in hospital for a first baby.

ACOG states that hospitals and accredited birth centers are the safest settings for birth, while affirming that each woman has the right to make a medically informed decision. It lists appropriate selection of candidates, an attending midwife or physician within an integrated and regulated health system, ready access to consultation, and timely transport to a hospital as critical factors, and it treats fetal malpresentation, multiple gestation or prior cesarean delivery as absolute contraindications to planned home birth.

Scope, training and limits of the evidence

Training and oversight differ across the family. Midwifery education is linked to ICM standards and, where the title is protected, to registration; doula standards of practice published by one certifying body exclude clinical tasks. The sources reviewed do not describe uniform training or credentialing for doulas or childbirth educators across countries, and this page does not cover statutory rules.

Evidence on water immersion comes from hospital settings and not from midwifery-led settings, and NICE advises discussing that evidence on birth in water was inconclusive on the risk of the baby dying. Trials of continuous support and education vary in quality, and a result for one method should not be carried to another. A person with a medical condition, a complicated pregnancy or a worry about labor can discuss options with the midwife or doctor providing care.