CONTINUOUS LABOR SUPPORT FROM LABOR ATTENDANT FOR PRIMIPAROUS WOMEN -A METAANALYSIS

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.