J. Zhang et al., CONTINUOUS LABOR SUPPORT FROM LABOR ATTENDANT FOR PRIMIPAROUS WOMEN -A METAANALYSIS, Obstetrics and gynecology, 88(4), 1996, pp. 739-744
Objective: To evaluate the available literature on the effects of cont
inuous labor support among primiparous women. Data Sources: We did a M
edline search using the key words ''labor support,'' ''doula,'' and ''
monitrice.'' Papers published in English from 1965 to May 1995 were el
igible for this review. We also cross-checked all the references in th
e selected reports. Methods of Study Selection: We identified seven ra
ndomized clinical trials published during that period; four of these w
ere eligible for our meta-analysis. Data Extraction and Synthesis: Met
a-analysis of four studies conducted among young, low-income, primipar
ous women who gave birth on a busy labor floor in the absence of a com
panion suggested that continuous labor support by a labor attendant sh
ortens 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, 9
5% CI 0.4-0.7), forceps use (RR 0.46, 95% CI 0.3-0.7), and cesarean de
livery rate (RR 0.54, 95% CI 0.4-0.7). Women with labor support also r
eported higher satisfaction and a better postpartum course. Conclusion
: Labor support may have important positive effects on obstetric outco
mes among young, disadvantaged women. Further studies on benefit relat
ive to cost are needed before a broad-scale program is advocated.