Effectiveness of Nurses as Providers of Birth Labor Support in North American Hospitals: A Randomized Controlled Trial

Abstract

How effective is support by staff nurses specially trained in labor support? An answer to this question is of special importance in view of the marked rise in cesarean delivery rates noted in North America since the 1960s. A Cochrane Review has found that continuous caregiver support during labor makes cesarean delivery less likely. In the present controlled trial, 6915 women with a live singleton fetus or twins, seen at 34 weeks' gestation or later at 13 US and Canadian hospitals, were randomized when in established labor to either usual care or continuous support from a trained nurse. All centers had annual cesarean delivery rates of 15% or higher. In the study group, women received continuous support for at least 80% of the time from randomization to delivery. Well over 90% of women in both groups received appropriate intrapartum nursing care. The median interval from admission to delivery was 8.1 hours and from randomization to delivery, 6.6 hours. Rates of cesarean delivery were nearly identical in the two groups: 12.5% with continuous labor support and 12.6% with usual care. With continuous support, continuous electronic fetal monitoring was somewhat less likely. There were no other significant differences in maternal events or in immediate neonatal outcomes. All infants were born alive; there were three neonatal deaths. Differences in perceived control during childbirth differed very little in the two groups when women were questioned 6 to 8 weeks postpartum, and there was no significant difference in the frequency of breast-feeding. A wish for continuous labor support in future labors was expressed by 63% of women having this type of care and by 47% of control women. Although continuous intrapartum nursing support may have many advantages, it cannot by itself be relied on to lower rates of cesarean delivery or other intrapartum interventions.