Zhang J, Bernasko J W, Leybovich E, Fahs M, Hatch M C
Department of Community Medicine, Mount Sinai School of Medicine, New York, New York, USA.
Obstet Gynecol. 1996 Oct;88(4 Pt 2):739-44. doi: 10.1016/0029-7844(96)00232-3.
To evaluate the available literature on the effects of continuous labor support among primiparous women.
We did a Medline search using the keywords "labor support," "doula," and "monitrice." Papers published in English from 1965 to May 1995 were eligible for this review. We also cross-checked all the references in the selected reports.
We identified seven randomized clinical trials published during that period; four of these were eligible for our meta-analysis.
Meta-analysis of four studies conducted among young, low-income, primiparous women who gave birth on a busy labor floor in the absence of a companion suggested that continuous labor support by a labor attendant shortens the duration of labor by 2.8 hours (95% confidence interval [CI] 2.2-3.4), doubles spontaneous vaginal birth (relative risk [RR] 2.01, 95% CI 1.5-2.7) and halves the frequency of oxytocin use (RR 0.44, 95% CI 0.4-0.7), forceps use (RR 0.46, 95% CI 0.3-0.7), and cesarean delivery rate (RR 0.54, 95% CI 0.4-0.7). Women with labor support also reported higher satisfaction and a better postpartum course.
Labor support may have important positive effects on obstetric outcomes among young, disadvantaged women. Further studies on benefit relative to cost are needed before a broad-scale program is advocated.
