Continuous labor support from labor attendant for primiparous women: A meta-analysis

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 post-partum 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.