To the Editor: Dr Hodnett and colleagues1 reported that labor support by nurses did not affect either the rate of cesarean delivery or other medical and social outcomes. In this trial, however, the experimental group had support by a nurse only 80% of the time, which is not the same as continuous support. The 80% minimum was chosen by the authors to conform to the usual nursing practices of allowing time for meals and rest breaks. Unfortunately, this violates an essential component of continuous emotional support during labor.
A meta-analysis involving 5 continuous trials and 6 trials with intermittent support concluded that only the trials where the support was continuous showed significant improvements in outcome.2 Continuous emotional support has been emphasized as the essential component in the training and certification of doulas by the international organization, Doulas of North America.3
Furthermore, there may have been changes in hospital personnel and in obstetric practices during the period of the investigation. It would be difficult to ensure that a consistent protocol was followed in 13 different hospitals. It is also possible that nurses caring for patients in the control group unconsciously copied aspects of care for women in the support group. There are other significant differences between the support by nurses and by doulas. One doula stays with the same mother throughout the entire labor even if it lasts for 24 hours, in contrast with the nurse changing with each shift. The doula also remains with the mother for 1 to 2 hours after delivery to help her and her partner interact with the infant, answer their questions, and assist with the beginning of breastfeeding.
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
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