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ARTICLE |

Continuous Emotional Support During Labor in a US Hospital:  A Randomized Controlled Trial

John Kennell, MD; Marshall Klaus, MD; Susan McGrath, PhD; Steven Robertson, PhD; Clark Hinkley, MD
JAMA. 1991;265(17):2197-2201. doi:10.1001/jama.1991.03460170051032.
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The continuous presence of a supportive companion (doula) during labor and delivery in two studies in Guatemala shortened labor and reduced the need for cesarean section and other interventions. In a US hospital with modern obstetric practices, 412 healthy nulliparous women in labor were randomly assigned to a supported group (n = 212) that received the continuous support of a doula or an observed group (n = 200) that was monitored by an inconspicuous observer. Two hundred four women were assigned to a control group after delivery. Continuous labor support significantly reduced the rate of cesarean section deliveries (supported group, 8%; observed group, 13%; and control group, 18%) and forceps deliveries. Epidural anesthesia for spontaneous vaginal deliveries varied across the three groups (supported group, 7.8%; observed group, 22.6%; and control group, 55.3%). Oxytocin use, duration of labor, prolonged infant hospitalization, and maternal fever followed a similar pattern. The beneficial effects of labor support underscore the need for a review of current obstetric practices.

(JAMA. 1991;265:2197-2201)

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