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 to 3.4), doubles spontaneous vaginal birth (relative risk (RR) 2.01, 95% CI 1.5 to 2.7) and halves the frequency of oxytocin use (RR 0.44, 95% CI 0.4 to 0.7), forceps use (RR 0.46, 95% CI 0.3 to 0.7), and cesarean delivery rate (RR 0.54, 95% CI 0.4 to 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.
With permission from Excerpta Medica Inc.

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