Medical studies confirm benefits of labor support.

While it seems intuitive that companionship and support will improve the experience of birth, until recently there was no documentation of this effect in the medical literature. Three relevant studies confirm what we have known all along--that the use of labor support means a better outcome for the mother and the child.

Sosa et al. (1980) examined the effects of a supportive companion (untrained lay woman) on labor. While the study planned to look at mother-infant interaction, the authors found that many more of the mothers removed from the study due to medical problems (of mother or infant) were from the control group of women without support.

Hodnett and Osborn (1989) compared the obstetric outcomes and memories of support received during labor of women with and without an experienced monitrice (in addition to routine nursing care). They found that "professional intrapartum support can exert significant direct effects, even under favorable circumstances."

Kennell et al. (1991) examined the medical effects of support during labor, comparing women who had the support of doulas with women who were observed and women who received routine care. They found a "consistent pattern of outcomes favorable to mothers and infants."

Specifically, women with labor support experienced:

* Shorter labors. Sosa et al. found the average length of labor for women who had support to be 8.7 hours, compared to an average of 19.3 hours for women in the unsupported group. Kennell et al. also found that women with support had shorter labors on average than women who were observed or without support. Hodnett and Osborn felt that length of labor could not be accurately assessed because of the use of oxytocics and anesthesia.

* Reduced use of pain medication. Hodnett and Osborn found that women with support were significantly more likely to have no intrapartum pain relief medication (38% vs. 18%). Kennell et al. found that, among the participants who had spontaneous vaginal deliveries, epidural anesthesia was used in 7.8% of the women in the supported group, in contrast to 22.6% of the women in the observed group and 55.3% of the women in the control group.

* Fewer cesarean sections. Sosa et al. discovered that while 19% of the mothers with support had cesareans, 27% of the women from the control group had cesareans. Kennell et al. found that 18% of the control group and 13% of the observed group required a cesarean section for delivery, in contrast to 8% of the women in the supported group. Also, "indications for cesarean section differed across the three groups, with the control group having more cesarean deliveries for |failure to progress' than either the supported or observed group."

* Improved neonatal outcomes. In the Kennell et al. study, one quarter (24%) of the infants born to mothers in the control group had to remain in the hospital for more than 48 hours because of medical concerns, in contrast to 10.4% of the infants of mothers with support and 17% of the infants of observed mothers.

* Better mother-infant interaction. Sosa et al. found that, when observed 30 minutes after birth, mothers who had received support during labor stroked their babies more often and talked to and smiled more at their babies than mothers who had no support.

* Admission to hospital farther along in labor. Only in the Hodnett and Osborn study was the monitrice a participant in early labor at home. The authors found that women who had a monitrice entered the hospital at greater mean cervical dilation that did women in the control group (3.6 cm vs. 2.2 cm), "suggesting that the additional support enabled them to labor longer or more effectively at home."

* Fewer episiotomies. Hodnett and Osborn found that 32% of the women with support completed labor with an intact perineum, versus only 9% of the control group.

Two other findings from the Hodnett and Osborn study that are worth noting: 1) In contrast to the monitrice, there was a near absence of physical comfort measures provided by the nurses. And 2) With a monitrice present, partners provided less instruction and information to their laboring spouse, but no less emotional or physical comfort.

While these studies are all encouraging, each has its limitations. The Sosa et al. study was done in a Guatemalan hospital where space was extremely limited, so women in the control group were entirely separated from family members once they were admitted. The Kennell et al. study was performed in a public hospital where women labored in a 12-bed ward that had insufficient privacy to allow family to be present. But despite the differing methodologies and settings, all of the studies showed consistently better outcomes for mothers and infants when the laboring woman had the benefit of a birth assistant.

References:

Sosa, R., Kernell, J., Klaus, M., Robertson, S. and Urrutia. J. The effects of a supportive companion on perinatal problems, length of labor, and mother-infant interaction. N Engl J Med 1980; 303:597-600. Hodnett, E.D. and Osborn, R.W. A randomized trial of the effects of monitrice support during labor: Mothers' views two to four weeks postpartum. Birth 1989; 16(4):177-183. Kennell, J., Klaus, M., McGrath, S., Robertson, S, and Hinkley, C. Continuous emotional support during labor in a U.S. Hospital. JAMA 1991; 265(17):2197-2201.