Effectiveness of nurses as providers of birth labor support in North American hospitals: a randomized controlled trial.
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.
Hodnett
Ellen D
ED
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
Lowe
Nancy K
NK
Hannah
Mary E
ME
Willan
Andrew R
AR
Stevens
Bonnie
B
Weston
Julie A
JA
Ohlsson
Arne
A
Gafni
Amiram
A
Muir
Holly A
HA
Myhr
Terri L
TL
Stremler
Robyn
R
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