What is meant by one-to-one support in labour: Analysing the concept Georgina Sosa, MSc, BA (Hons), RM, RGN (Midwife, PhD student) n , Kenda Crozier, PhD, MSc, BSc, RN, RM (Senior Lecturer in Midwifery), Jill Robinson, PhD, BSC (Hons), Cert Ed, RMN (Co-Director, Education in Health Research Institute) Faculty of Health, University of East Anglia, United Kingdom article info Article history: Received 15 September 2010 Received in revised form 22 June 2011 Accepted 9 July 2011 Keywords: One-to-one Labour support 1:1 Continuous support abstract Background: the term one-to-one support in labour is used in a range of research reports and policy documents internationally without a clear consensus on definition. Aim: the aim of this paper is to examine the variety of meanings and to clarify the concept of one-to- one support in labour. Method: Walker and Avant provide a useful guide for the analysis of concepts and this has been used as a starting point from which to build our discussion. We systematically examined the literature to answer the ‘who, what, when, where, and how’ for providing one-to-one support in labour. Findings: our paper examines the evidence for one-to-one support in the light of the range of meanings that have been attributed to the concept. Multiple meanings for the concept have created confusion and there is a need for greater clarity, which may be used in directing research, practice, and policy. Conclusions: in spite of strong evidence for the benefits of one-to-one support in labour, the utility of the evidence base is limited by the failure to specify what is meant by one-to-one support leading to a lack of comparability/applicability. There is a need for research that focuses more clearly on articulating what happens during labour between the woman and the range of people who support her, in services that are deemed to offer one-to-one support. & 2011 Elsevier Ltd. All rights reserved. Introduction In the research and policy literature, the term one-to-one support has been used in a variety of ways. In the UK policy literature, the concept has become synonymous with high standards of midwifery care (Department of Health (DH), 2004; Maternity Care Working Party, 2007; National Institute for Clinical Excellence (NICE), 2007; Royal College of Obstetrics and Gynaecology (RCOG) et al., 2008). Internationally, it has been the focus of research comparing mater- nal outcomes for different models of care and skill mix. Globally, it has been recognised that a vital requirement for reducing maternal mortality and morbidity is that women and their newborns have skilled care at birth and access to emergency care when complications develop (World Health Organisation (WHO), 2002; WHO et al., 2004; WHO, 2006, United Nations, 2010). It is envisaged that globally by 2015, 90% of births should be assisted by skilled assistants. 1 In the UK, women do have access to skilled assistance in the form of a midwife with the support of the obstetric and anaesthetic team, but in itself the evidence from the Confidential Enquires into Maternal and Child Health (CEMACH) suggests this is not sufficient. Sub standard care includes failure to recognise deviations from the normal, thus failing to refer to the appropriate professional, failure to perform basic observations such as temperature, pulse and blood pressure, a lack of experience and insight into the seriousness of the mother’s condition particularly in complex pregnancies, leading to the wrong emergency response in several cases (Lewis, 2007). These clinical practice issues are reiterated in a more recent report by the Centre for Maternal and Child Enquiries (CMACE) with training recommendations to go ‘back to basics’(Oates et al., 2011, p. 16). Surveys in the UK showed that 35% (RCM and Netmums, 2009) and 22% (Care Quality Commission, 2010) of women reported that they had been left alone when they felt worried during labour or shortly after giving birth. The King’s Fund, (Sandall et al., 2011, p. vi) suggests that, while numbers of staff are important, it is the effective deployment of the ‘right staff’ Contents lists available at ScienceDirect journal homepage: www.elsevier.com/midw Midwifery 0266-6138/$ - see front matter & 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.midw.2011.07.001 n Corresponding author. E-mail address: Georgina.Sosa@uea.ac.uk (G. Sosa). 1 A skilled attendant is an accredited health professional such as a midwife, doctor or nurse who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the (footnote continued) immediate postnatal period, and in the identification, management and referral of complications in women and newborns (WHO et al., 2004: 1). Please cite this article as: Sosa, G., et al., What is meant by one-to-one support in labour: Analysing the concept. Midwifery (2011), doi:10.1016/j.midw.2011.07.001 Midwifery ] (]]]]) ]]]–]]]