Context North American cesarean delivery rates have risen dramatically since
the 1960s, without concomitant improvements in perinatal or maternal health.
A Cochrane Review concluded that continuous caregiver support during labor
has many benefits, including reduced likelihood of cesarean delivery.
Objective To evaluate the effectiveness of nurses as providers of labor support
in North American hospitals.
Design Randomized controlled trial with prognostic stratification by center
and parity. Women were enrolled during a 2-year period (May 1999 to May 2001)
and followed up until 6 to 8 postpartum weeks.
Setting Thirteen US and Canadian hospitals with annual cesarean delivery rates
of at least 15%.
Participants A total of 6915 women who had a live singleton fetus or twins, were
34 weeks' gestation or more, and were in established labor at randomization.
Intervention Patients were randomly assigned to receive usual care (n = 3461) or
continuous labor support by a specially trained nurse (n = 3454) during labor.
Main Outcome Measures The primary outcome measure was cesarean delivery rate. Other outcomes
included intrapartum events and indicators of maternal and neonatal morbidity,
both immediately after birth and in the first 6 to 8 postpartum weeks.
Results Data were received for all 6915 women and their infants (n = 6949).
The rates of cesarean delivery were almost identical in the 2 groups (12.5%
in the continuous labor support group and 12.6% in the usual care group; P = .44). There were no significant differences in other
maternal or neonatal events during labor, delivery, or the hospital stay.
There were no significant differences in women's perceived control during
childbirth or in depression, measured at 6 to 8 postpartum weeks. All comparisons
of women's likes and dislikes, and their future preference for amount of nursing
support, favored the continuous labor support group.
Conclusions In hospitals characterized by high rates of routine intrapartum interventions,
continuous labor support by nurses does not affect the likelihood of cesarean
delivery or other medical or psychosocial outcomes of labor and birth.