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May 1, 1991, Vol 265, No. 17 >
ARTICLE | May 1, 1991

Continuous Emotional Support During Labor in a US Hospital: Title and subTitle BreakA Randomized Controlled Trial FREE

John Kennell, MD; Marshall Klaus, MD; Susan McGrath, PhD; Steven Robertson, PhD; Clark Hinkley, MD
[+] Author Affiliations

Reprint requests to Department of Pediatrics, Rainbow Babies and Childrens Hospital, 2103 Adelbert Rd, Cleveland, OH 44106 (Dr Kennell).


JAMA. 1991;265(17):2197-2201. doi:10.1001/jama.1991.03460170051032
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References

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)

REFERENCES

1 +
Sosa R, Kennell J, Klaus M, Robertson S, Urrutia J.  The effect of a supportive companion on perinatal problems, length of labor, and mother-infant interaction . N Engl J Med. 1980;;303:597-600.
2 +
Klaus MH, Kennell JH, Robertson SS, Sosa R.  Effects of social support during parturition on maternal and infant morbidity . BMJ. 1986;;293: 585-587.
3 +
Halpin GJ, Rose E, Shapiro E.  Trends in cesarean section rates . N Engl J Med. 1989;;86:867-873.
4 +
Stafford RS.  Alternative strategies for controlling rising cesarean section rates . JAMA. 1990;; 263:683-687.
5 +
Notzon FC.  International differences in the use of obstetric interventions . JAMA. 1990;;263:3286-3291.
6 +
Shiono PH, Fielden JG, McNellis D, Rhoads GG, Pearse WH.  Recent trends in cesarean birth and trial of labor rates in the United States . JAMA. 1987;;257:494-497.
7 +
Keirse MJNC, Enkin M, Lumley J.  Social and professional support during labor . In: Chalmers I, Enkin M, Kearse MJNC, eds. Effective Care in Pregnancy and Child Birth . New York, NY: Oxford University Press; 1989;;2:805-814.
8 +
Bertsch TD, Nagashima-Whalen L, Dykeman S, Kennell JH, McGrath S.  Labor support by first-time fathers: direct observations . J Psychosom Obstet Gynecol. 1990;;11:251-260.
9 +
Lomas J, Anderson TM, Domnick-Pierre K, Vayda E, Enkin MW, Hannah WJ.  Do practice guidelines guide practice? the effect of a consensus statement on the practice of physicians . N Engl J Med. 1989;;321:1306-1311
10 +
Lederman RP, Lederman E, Work BA Jr, McCann DS.  Anxiety and epinephrine in multiparous women in labor: relationship to duration of labor and fetal heart rate pattern . Am J Obstet Gynecol. 1985;;153:870-877.
11 +
Zuspan FP, Cibils LA, Pose SV.  Myometrial and cardiovascular responses to alterations in plasma epinephrine and norepinephrine . Am J Obstet Gynecol. 1962;;84:841-851.
12 +
Barton MD, Killam AP, Meschia G.  Response of ovine uterine blood flow to epinephrine and norepinephrine . Proc Soc Exp Biol Med. 1974;;145:996-1003.
13 +
Adamsons K, Mueller-Heubach E, Myers RE.  Production of fetal asphyxia in the rhesus monkey by administration of catecholamines to the mother . Am J Obstet Gynecol. 1971;;109:248-262.
14 +
Myers RE.  Maternal psychological stress and fetal asphyxia: a study in the monkey . Am J Obstet Gynecol. 1975;;122:47-59.
15 +
Fusi L, Maresh MJA, Steer PJ, Beard RW.  Maternal pyrexia associated with the use of epidural analgesia in labor . Lancet. 1989;;1:1250-1252.
16 +
Thorp JA, Parisi VM, Boylan PC, Johnston DA.  The effect of continuous epidural analgesia on cesarean section for dystocia in nulliparous women . Am J Obstet Gynecol. 1989;;162:670-675.
17 +
Stafford RS.  Cesarean section use and source of payment: an analysis of California hospital discharge abstracts . Am J Public Health. 1990;;80: 313-315.
18 +
Newton ER, Higgins CS.  Factors associated with hospital-specific cesarean birth rates . J Reprod Med. 1989;;34:407-411.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Sosa R, Kennell J, Klaus M, Robertson S, Urrutia J.  The effect of a supportive companion on perinatal problems, length of labor, and mother-infant interaction . N Engl J Med. 1980;;303:597-600.
2 +
Klaus MH, Kennell JH, Robertson SS, Sosa R.  Effects of social support during parturition on maternal and infant morbidity . BMJ. 1986;;293: 585-587.
3 +
Halpin GJ, Rose E, Shapiro E.  Trends in cesarean section rates . N Engl J Med. 1989;;86:867-873.
4 +
Stafford RS.  Alternative strategies for controlling rising cesarean section rates . JAMA. 1990;; 263:683-687.
5 +
Notzon FC.  International differences in the use of obstetric interventions . JAMA. 1990;;263:3286-3291.
6 +
Shiono PH, Fielden JG, McNellis D, Rhoads GG, Pearse WH.  Recent trends in cesarean birth and trial of labor rates in the United States . JAMA. 1987;;257:494-497.
7 +
Keirse MJNC, Enkin M, Lumley J.  Social and professional support during labor . In: Chalmers I, Enkin M, Kearse MJNC, eds. Effective Care in Pregnancy and Child Birth . New York, NY: Oxford University Press; 1989;;2:805-814.
8 +
Bertsch TD, Nagashima-Whalen L, Dykeman S, Kennell JH, McGrath S.  Labor support by first-time fathers: direct observations . J Psychosom Obstet Gynecol. 1990;;11:251-260.
9 +
Lomas J, Anderson TM, Domnick-Pierre K, Vayda E, Enkin MW, Hannah WJ.  Do practice guidelines guide practice? the effect of a consensus statement on the practice of physicians . N Engl J Med. 1989;;321:1306-1311
10 +
Lederman RP, Lederman E, Work BA Jr, McCann DS.  Anxiety and epinephrine in multiparous women in labor: relationship to duration of labor and fetal heart rate pattern . Am J Obstet Gynecol. 1985;;153:870-877.
11 +
Zuspan FP, Cibils LA, Pose SV.  Myometrial and cardiovascular responses to alterations in plasma epinephrine and norepinephrine . Am J Obstet Gynecol. 1962;;84:841-851.
12 +
Barton MD, Killam AP, Meschia G.  Response of ovine uterine blood flow to epinephrine and norepinephrine . Proc Soc Exp Biol Med. 1974;;145:996-1003.
13 +
Adamsons K, Mueller-Heubach E, Myers RE.  Production of fetal asphyxia in the rhesus monkey by administration of catecholamines to the mother . Am J Obstet Gynecol. 1971;;109:248-262.
14 +
Myers RE.  Maternal psychological stress and fetal asphyxia: a study in the monkey . Am J Obstet Gynecol. 1975;;122:47-59.
15 +
Fusi L, Maresh MJA, Steer PJ, Beard RW.  Maternal pyrexia associated with the use of epidural analgesia in labor . Lancet. 1989;;1:1250-1252.
16 +
Thorp JA, Parisi VM, Boylan PC, Johnston DA.  The effect of continuous epidural analgesia on cesarean section for dystocia in nulliparous women . Am J Obstet Gynecol. 1989;;162:670-675.
17 +
Stafford RS.  Cesarean section use and source of payment: an analysis of California hospital discharge abstracts . Am J Public Health. 1990;;80: 313-315.
18 +
Newton ER, Higgins CS.  Factors associated with hospital-specific cesarean birth rates . J Reprod Med. 1989;;34:407-411.

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