Evaluation of Continuous Support in Labor

Paper

Friday, July 23, 2004

This presentation is part of : Maternity Nursing

Della Anne Campbell, CNA-BC, APN-C, College of Nursing, Seton Hall University, South Orange, NJ, USA, Michele Lynn Falk, BA, MSW, Department of OB/GYN, Saint Peter's University Hospital, New Brunswick, NJ, USA, and Marian Frances Lake, RNC, MPH, CCRC, Obstetrics, Gynecology and Reproductive Sciences, University of Medicine & Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.

Learning Objective #1: Demonstrate an understanding of the significance of having continuous and uninterrupted support during labor
Learning Objective #2: Articulate an awareness of other variables that may influence labor and birth outcomes

Objective: Research demonstrates that continuous labor support from a non-medical female trained in emotional and physical supportive techniques (doula) can improve perinatal outcome. The service cost of a professional doula may be prohibitive for low-income women. The objective of this study was to compare labor outcomes in women accompanied by an unpaid, trained female friend or family member (doula group)with women not accompanied by this additional support person in labor (no doula group).

Design: Nulliparous women seen in a prenatal clinic in New Jersey were prospectively enrolled and randomized to the doula or no doula group between 1998 and 2002. Doula group members (parturient and doula) were taught traditional doula supportive techniques during 2 teaching sessions. No further interaction occurred in the no doula group after randomization. All enrollment and teaching was done by a research assistant who was a certified doula. Outcome data were abstracted from medical records.

Variables: Primary outcome variables were length of labor and type of delivery. Secondary outcome variables included type and amount of analgesia and anesthesia, birthweight and Apgar scores.

Findings: Six hundred (600) women were enrolled and randomized. Delivery information was available for 291 in the doula group and 295 in the no-doula group. Preliminary intent to treat analysis revealed a significantly shorter length of labor (p= 0.02) in the doula group. Despite a trend toward lower cesarean section and vacuum/forcep delivery rates in the doula group, differences did not reach statistical significance. No significant differences were found in dilatation at time of analgesia or anesthesia during labor, birthweight, or one and five minute apgar scores. More comprehensive data analysis is continuing.

Conclusions: Empowering low-income pregnant women with the option to choose a female friend who will act as her doula during labor, along with other family members, shortens the labor process.

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