Resources for evidence-based practice, January/February 2004.

Featured review: Hodnett, E. D., Gates, S., Hofmeyr, G. J., & Sakala, C. Continuous support for women during childbirth. The Cochrane labor support review has been entirely reconstructed with the following new elements: reviewer team, title, protocol, large randomized controlled trials (RCTs), and subgroup analyses. It also includes expanded background and discussion sections. The new review summarizes experiences of nearly 13,000 women who participated in 15 RCTs. Women who received continuous labor support were less likely than women who did not have continuous labor support to have regional analgesia or any analgesia/anesthesia, give birth with vacuum extraction or forceps, give birth by cesarean, and report dissatisfaction or negatively rate their experience. A subgroup analysis examined the impact of the type of person providing continuous support. Effects were stronger when the person was not a regular member of the hospital staff and was an outsider present expressly to provide support. Compared to women without continuous support, those with support from nonhospital caregivers were 26% less likely to give birth by cesarean section, 41% less likely to have an instrumental birth, 28% less likely to use any analgesia or anesthesia, and 36% less likely to be dissatisfied with their childbirth experience. Comment: Continuous labor support has no known downsides and can help women have a satisfying childbirth experience and avoid risks associated with cesareans and other major interventions. The organization of care in modern maternity units appears to limit the effectiveness of labor support provided by members of the hospital staff. It is a priority to clarify whether this basic component of safe and effective maternity care also offers economic advantages. Full text of the review is available without charge from http://www.maternitywise.org/ prof/laborsupport.