This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

A Randomized Controlled Trial

John Kennell, MD; Marshall Klaus, MD; Susan McGrath, PhD; Steven Robertson, PhD; Clark Hinkley, MD

JAMA. 1991;265(17):2197-2201.

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.

(JAMA. 1991;265:2197-2201)

Author Affiliations
From the Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio (Drs Kennell and McGrath); the Department of Pediatrics, Childrens Hospital, Oakland Calif (Dr Klaus); the Department of Human Development and Family Studies, Cornell University, Ithaca, NY (Dr Robertson); and the Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex (Dr Hinkley).

Footnotes
Reprint requests to Department of Pediatrics, Rainbow Babies and Childrens Hospital, 2103 Adelbert Rd, Cleveland, OH 44106 (Dr Kennell).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Effects of Fathers' Attendance to Labor and Delivery on the Experience of Childbirth in Turkey
Gungor and Beji
West J Nurs Res 2007;29:213-231.
ABSTRACT  

Benefits of a Doula Present at the Birth of a Child
Stein et al.
Pediatrics 2004;114:1488-1491.
FULL TEXT  

Delirium Doulas: An Innovative Approach to Enhance Care for Critically Ill Older Adults
Balas et al.
Crit Care Nurse 2004;24:36-46.
FULL TEXT  

A Native American Community with a 7% Cesarean Delivery Rate: Does Case Mix, Ethnicity, or Labor Management Explain the Low Rate?
Leeman and Leeman
Ann Fam Med 2003;1:36-43.
ABSTRACT | FULL TEXT  

Mind-Body Medicine: State of the Science, Implications for Practice
Astin et al.
J Am Board Fam Med 2003;16:131-147.
ABSTRACT | FULL TEXT  

'Mighty Glad to Gasp in the Gas': Perceptions of Pain and the Traditional Timing of Obstetric Anesthesia
Wolf
Health (London) 2002;6:365-387.
ABSTRACT  

Do Labor Medications Affect Breastfeeding?
Walker
J Hum Lact 1997;13:131-137.
ABSTRACT  

Social Status, Mother-infant Time Together, and Breastfeeding Duration
Kiehl et al.
J Hum Lact 1996;12:201-206.
ABSTRACT  

Correlates of Multigravida Women's Binge Drinking During Pregnancy: A Longitudinal Study
Pascoe et al.
Arch Pediatr Adolesc Med 1995;149:1325-1329.
ABSTRACT  

Site-to-Site Variation in the Factors Affecting Cesarean Section Rates
Hueston
Arch Fam Med 1995;4:346-351.
ABSTRACT  

The Importance of Social Interaction: A New Perspective on Social Epidemiology, Social Risk Factors, and Health
Bloomberg et al.
Health Educ Behav 1994;21:447-463.
ABSTRACT  

Amniotomy in Labor
Teoh et al.
NEJM 1993;329:886-887.
FULL TEXT  

Relationship Between Malpractice Claims and Cesarean Delivery
Localio et al.
JAMA 1993;269:366-373.
ABSTRACT  

Continuous Emotional Support During Labor
Barton
JAMA 1991;266:1509-1509.
ABSTRACT  

Continuous Emotional Support During Labor
Gevirtz and Marx
JAMA 1991;266:1509-1509.
ABSTRACT  

REDUCING CESAREAN SECTION RATES: TWO APPROACHES
JWatch General 1991;1991:5-5.
FULL TEXT  

Doula at the Bedside of the Patient in Labor
Rosen
JAMA 1991;265:2236-2237.
ABSTRACT