title: Effectiveness of nurses as providers of birth labor support in North American hospitals: a randomized controlled trial.
abstract: BACKGROUND
  North American cesarean delivery rates have risen dramatically since the 1960s, without concomitant improvements in perinatal or maternal health. A Cochrane Review concluded that continuous caregiver support during labor has many benefits, including reduced likelihood of cesarean delivery.
  
  
  OBJECTIVE
  To evaluate the effectiveness of nurses as providers of labor support in North American hospitals.
  
  
  METHODS
  Randomized controlled trial with prognostic stratification by center and parity. Women were enrolled during a 2-year period (May 1999 to May 2001) and followed up until 6 to 8 postpartum weeks.
  
  
  METHODS
  Thirteen US and Canadian hospitals with annual cesarean delivery rates of at least 15%.
  
  
  METHODS
  A total of 6915 women who had a live singleton fetus or twins, were 34 weeks' gestation or more, and were in established labor at randomization.
  
  
  METHODS
  Patients were randomly assigned to receive usual care (n = 3461) or continuous labor support by a specially trained nurse (n = 3454) during labor.
  
  
  METHODS
  The primary outcome measure was cesarean delivery rate. Other outcomes included intrapartum events and indicators of maternal and neonatal morbidity, both immediately after birth and in the first 6 to 8 postpartum weeks.
  
  
  RESULTS
  Data were received for all 6915 women and their infants (n = 6949). The rates of cesarean delivery were almost identical in the 2 groups (12.5% in the continuous labor support group and 12.6% in the usual care group; P =.44). There were no significant differences in other maternal or neonatal events during labor, delivery, or the hospital stay. There were no significant differences in women's perceived control during childbirth or in depression, measured at 6 to 8 postpartum weeks. All comparisons of women's likes and dislikes, and their future preference for amount of nursing support, favored the continuous labor support group.
  
  
  CONCLUSIONS
  In hospitals characterized by high rates of routine intrapartum interventions, continuous labor support by nurses does not affect the likelihood of cesarean delivery or other medical or psychosocial outcomes of labor and birth.
authors.affiliation: Faculty of Nursing and Maternal-Child Nursing Research Unit, Centre for Research in Women's Health, University of Toronto, 50 St George St, Toronto, Ontario, Canada M5S 3H4. ellen.hodnett@utoronto.ca
authors.forename: Ellen D
authors.initials: ED
authors.lastname: Hodnett
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Lowe
authors.forename: Mary E
authors.initials: ME
authors.lastname: Hannah
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Willan
authors.forename: Bonnie
authors.initials: B
authors.lastname: Stevens
authors.forename: Julie A
authors.initials: JA
authors.lastname: Weston
authors.forename: Arne
authors.initials: A
authors.lastname: Ohlsson
authors.forename: Amiram
authors.initials: A
authors.lastname: Gafni
authors.forename: Holly A
authors.initials: HA
authors.lastname: Muir
authors.forename: Terri L
authors.initials: TL
authors.lastname: Myhr
authors.forename: Robyn
authors.initials: R
authors.lastname: Stremler
mesh_terms: D002170:Canada / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003696:Delivery Rooms / Q000592:standards*; D036861:Delivery, Obstetric / Q000451:nursing* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric; D008297:Male; D009721:Nurse Midwives; D024802:Nurse's Role; D009741:Nursing Staff, Hospital; D007744:Obstetric Labor Complications / Q000453:epidemiology; D009773:Obstetric Nursing / Q000379:methods* / Q000592:standards; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D011644:Puerperal Disorders / Q000453:epidemiology; D014481:United States / Q000453:epidemiology