Continuous labor support from labor attendant for primiparous women: a meta-analysis

Obstet Gynecol. 1996 Oct;88(4 Pt 2):739-44. doi: 10.1016/0029-7844(96)00232-3.


Objective: To evaluate the available literature on the effects of continuous labor support among primiparous women.

Data sources: We did a Medline search using the keywords "labor support," "doula," and "monitrice." Papers published in English from 1965 to May 1995 were eligible for this review. We also cross-checked all the references in the selected reports.

Methods of study selection: We identified seven randomized clinical trials published during that period; four of these were eligible for our meta-analysis.

Data extraction and synthesis: Meta-analysis of four studies conducted among young, low-income, primiparous women who gave birth on a busy labor floor in the absence of a companion suggested that continuous labor support by a labor attendant shortens the duration of labor by 2.8 hours (95% confidence interval [CI] 2.2-3.4), doubles spontaneous vaginal birth (relative risk [RR] 2.01, 95% CI 1.5-2.7) and halves the frequency of oxytocin use (RR 0.44, 95% CI 0.4-0.7), forceps use (RR 0.46, 95% CI 0.3-0.7), and cesarean delivery rate (RR 0.54, 95% CI 0.4-0.7). Women with labor support also reported higher satisfaction and a better postpartum course.

Conclusion: Labor support may have important positive effects on obstetric outcomes among young, disadvantaged women. Further studies on benefit relative to cost are needed before a broad-scale program is advocated.

Publication types

  • Meta-Analysis

MeSH terms

  • Delivery, Obstetric
  • Female
  • Humans
  • Labor, Obstetric*
  • Parity
  • Patient Satisfaction
  • Poverty
  • Pregnancy
  • Randomized Controlled Trials as Topic
  • Social Support*
  • Time Factors