The Cesarean Section Rate

To the Editor.—  I read with interest Dr Stafford's¹ review of six strategies for controlling the rising cesarean section rate. I write this letter to suggest that there is another effective strategy that should be considered. In the past decade, several studies have examined the effect of birth companions on duration of labor^2-4 and cesarean section rates.^3-5 The findings have been remarkably consistent. Women who experience the constant presence of a supportive companion during parturition have shorter labors (eg, 7.7 vs 15.5 hours, P<.001)⁴ and fewer complications, including a lower rate of cesarean sections (eg, 8.1% vs 18.1%, P<.003).⁵ The birth companions in these studies provided both emotional and physical support; they rubbed mothers' backs, held their hands, and shared information as well as encouragement. Social support during parturition is one of several interventions that should be considered to reduce the cesarean section rate and