Objective To evaluate the available literature on the effects of continuous labor support among primiparous women.
Data Sources We did a Medline search using the key words “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.
Methods of Study Selection We identified seven randomized clinical trials published during that period; four of these were eligible for our meta-analysis.
Data Extraction and Synthesis 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.
Conclusion 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.
Address reprint requests to: Jun Zhang, PhD, Department of Community Medicine, Box 1043, Mount Sinai School of Medicine, New York, NY 10029-6574
© 1996 The American College of Obstetricians and Gynecologists