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To the Editor: Dr Hodnett and colleagues¹ reported that labor support by nurses did not affect either the rate of cesarean delivery or other medical and social outcomes. In this trial, however, the experimental group had support by a nurse only 80% of the time, which is not the same as continuous support. The 80% minimum was chosen by the authors to conform to the usual nursing practices of allowing time for meals and rest breaks. Unfortunately, this violates an essential component of continuous emotional support during labor.

A meta-analysis involving 5 continuous trials and 6 trials with intermittent support concluded that only the trials where the support was continuous showed significant improvements in outcome.² Continuous emotional support has been emphasized as the essential component in the training and certification of doulas by the international organization, Doulas of North America.³

Furthermore, there may have been changes in hospital personnel and . . . [Full Text of this Article]

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