Continuous Emotional Support During Labor in a US Hospital
A Randomized Controlled Trial
- John Kennell, MD;
- Marshall Klaus, MD;
- Susan McGrath, PhD;
- Steven Robertson, PhD;
- Clark Hinkley, MD
- 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).
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)
Footnotes
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Reprint requests to Department of Pediatrics, Rainbow Babies and Childrens Hospital, 2103 Adelbert Rd, Cleveland, OH 44106 (Dr Kennell).
