title: Continuous emotional support during labor in a US hospital. A randomized controlled trial.
abstract: The continuous presence of a supportive companion (doula) during labor and delivery in two studies in Guatemala shortened labor and reduced the need for cesarean section and other interventions. In a US hospital with modern obstetric practices, 412 healthy nulliparous women in labor were randomly assigned to a supported group (n = 212) that received the continuous support of a doula or an observed group (n = 200) that was monitored by an inconspicuous observer. Two hundred four women were assigned to a control group after delivery. Continuous labor support significantly reduced the rate of cesarean section deliveries (supported group, 8%; observed group, 13%; and control group, 18%) and forceps deliveries. Epidural anesthesia for spontaneous vaginal deliveries varied across the three groups (supported group, 7.8%; observed group, 22.6%; and control group, 55.3%). Oxytocin use, duration of labor, prolonged infant hospitalization, and maternal fever followed a similar pattern. The beneficial effects of labor support underscore the need for a review of current obstetric practices.
authors.affiliation: Department of Pediatrics, Case Western Reserve University, Cleveland, OH.
authors.forename: J
authors.initials: J
authors.lastname: Kennell
authors.forename: M
authors.initials: M
authors.lastname: Klaus
authors.forename: S
authors.initials: S
authors.lastname: McGrath
authors.forename: S
authors.initials: S
authors.lastname: Robertson
authors.forename: C
authors.initials: C
authors.lastname: Hinkley
mesh_terms: D000293:Adolescent; D000328:Adult; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D007743:Labor, Obstetric / Q000523:psychology*; D008875:Middle Aged; D009775:Obstetrics and Gynecology Department, Hospital / Q000706:statistics & numerical data; D010121:Oxytocin / Q000627:therapeutic use; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000523:psychology; D011295:Prenatal Care; D012944:Social Support; D013781:Texas; D013997:Time Factors
chemical_list: D010121:Oxytocin