There is no evidence of medical harm found for unrestricted access by mothers to birth companions of her choice—fathers, partners, children, family members, or friends—at birth.

Family support seems to be more important for siblings attending the birth than actually witnessing the birth itself. There are some recommendations for the inclusion of children at birth to ensure a positive experience for everyone involved.

Mothers reported less satisfaction with birth support when the support provider was a nurse or a doctor compared with a partner or doula.

The perception of support during labor is a key ingredient in a woman’s ultimate satisfaction with her birth experience.

A woman’s perception of support during labor is more important than her experience of pain or her satisfaction with pain relief methods in her overall satisfaction.

No evidence of harm has been identified when women have unrestricted access to continuous emotional and physical support from a trained caregiver.

The perception of support during labor is more important in determining a woman’s satisfaction with her birth experience than her experience of pain or her satisfaction with methods of pain relief.

Compared with a similar population receiving comparable clinical care, continuous labor support reduces the likelihood of utilizing pain medication or analgesia in labor, increases the likelihood of spontaneous birth without assistive devices (e.g., forceps, vacuum extractors), increases satisfaction with the birth experience, and reduces the likelihood of severe postpartum pain.

Women receiving continuous labor support are more likely to have spontaneous vaginal birth (Goer … Romano, 2012, p. 436).

Compared with a similar population receiving comparable but intermittent support, continuous labor support results in fewer newborn admissions to a neonatal intensive care unit.

Continuous one-to-one female labor support by providers who are not hospital staff and in environments more likely to provide physiologic care provides more beneficial effects.

Intrapartum nurses provide minimal supportive care due to systemic and cultural factors (Goer … Romano, 2012, pp. 438–441), for example, high nurse-to-patient ratio.

Fathers may not be able to provide adequate labor support (Goer … Romano, 2012, p. 444).

Recognizing that studies have shown that similar positive outcomes can be achieved when other experienced women who are not medically trained provide supportive care, the birthing family shall be free to choose attendants at will.

Women are likely to report longer and more frequent antepartum visits that resulted in increased education and counseling.

There appeared to be a decreased incidence of antepartum and/or intrapartum hypertension that resulted in fewer antepartum admissions and fewer inductions of labor.

Women reported increased access to food and drink in labor and limited use of intravenous fluids in labor.

Midwives were more likely to encourage ambulation in labor and to use nonsupine positions for birth.

Amniotomy was performed less frequently and there were fewer episodes of abnormal fetal heart rate in labor.

Continuous electronic fetal monitoring, external and internal, was used less frequently.

Women who preferred nonpharmacologic pain relief were more likely to achieve their goals and reported effective pain management in labor. They also had reduced need for analgesia including epidural anesthesia.

Surgical intervention were less likely and women were as likely or more likely to experience spontaneous vaginal births with fewer or equivalent instrument-assisted births.

Midwifery care in labor and birth reduces the likelihood of genital tract trauma (Goer … Romano, 2012, pp. 467–468).

Midwives rely less on restrictive or invasive intrapartum procedures including:

With one exception, which may be explained by systemic factors, midwifery care results in equivalent or superior newborn outcomes compared with physician management (Goer … Romano, 2012, pp. 472–474).

Midwife-led care produces equally good or better maternal and infant outcomes as physician-led or shared care, with lower procedure and medication rates (Goer … Romano, 2012, pp. 476–477).

Both midwifery care and midwife-led models of care appear to be safe and beneficial for medically and sociodemographically moderate-risk and high-risk women and their infants (Goer … Romano, 2012, pp. 478–481).