Effectiveness of nurses as providers of birth labor support in North American hospitals: a randomized controlled trial.
نویسندگان
چکیده
CONTEXT North American cesarean delivery rates have risen dramatically since the 1960s, without concomitant improvements in perinatal or maternal health. A Cochrane Review concluded that continuous caregiver support during labor has many benefits, including reduced likelihood of cesarean delivery. OBJECTIVE To evaluate the effectiveness of nurses as providers of labor support in North American hospitals. DESIGN Randomized controlled trial with prognostic stratification by center and parity. Women were enrolled during a 2-year period (May 1999 to May 2001) and followed up until 6 to 8 postpartum weeks. SETTING Thirteen US and Canadian hospitals with annual cesarean delivery rates of at least 15%. PARTICIPANTS A total of 6915 women who had a live singleton fetus or twins, were 34 weeks' gestation or more, and were in established labor at randomization. INTERVENTION Patients were randomly assigned to receive usual care (n = 3461) or continuous labor support by a specially trained nurse (n = 3454) during labor. MAIN OUTCOME MEASURES The primary outcome measure was cesarean delivery rate. Other outcomes included intrapartum events and indicators of maternal and neonatal morbidity, both immediately after birth and in the first 6 to 8 postpartum weeks. RESULTS Data were received for all 6915 women and their infants (n = 6949). The rates of cesarean delivery were almost identical in the 2 groups (12.5% in the continuous labor support group and 12.6% in the usual care group; P =.44). There were no significant differences in other maternal or neonatal events during labor, delivery, or the hospital stay. There were no significant differences in women's perceived control during childbirth or in depression, measured at 6 to 8 postpartum weeks. All comparisons of women's likes and dislikes, and their future preference for amount of nursing support, favored the continuous labor support group. CONCLUSIONS In hospitals characterized by high rates of routine intrapartum interventions, continuous labor support by nurses does not affect the likelihood of cesarean delivery or other medical or psychosocial outcomes of labor and birth.
منابع مشابه
Sublingual versus Vaginal Misoprostol for the Induction of Labor at Term: A Randomized, Triple-Blind, Placebo-Controlled Clinical Trial
Background: We sought to compare the effectiveness and safety of sublingual versus vaginal misoprostol for the termination of pregnancy with a live full-term fetus.Methods: This randomized, triple-blind, placebo-controlled clinical trial was performed on 200 primiparous women with normal, singleton, full-term pregnancies candidated for the induction of labor. Sublingual and vaginal tablets cont...
متن کاملEffectiveness of Kangaroo Mother Care in the Management of Twin Low-Birth-Weight Neonates: A Non-Randomized, Open, Controlled Trial
Background: Twin low-birth-weight (LBW) neonates are exposed to the increased risk of mortality and morbidity due to poor prognosis. The present study aimed to evaluate the effectiveness of kangaroo mother care (KMC) in the management of twin LBW neonates. Methods: This prospective, observational study was conducted on 150 neonates with the birth weight of
متن کاملEffectiveness of family empowerment program on level of adherence to treatment regimens in stroke patients; a randomized controlled trial
Background: Different physical and mental complications in patients with stroke, and the chronic nature of the disease, require the presence of their family as the primary source of constant care and support at home. However, for many reasons, such as not receiving adequate support from the medical staff, families face many failures in managing the care programs. Aim: to investigate the effects...
متن کاملComparison of intramuscular progesterone with oral nifedipine for treating threatened preterm labor: A randomized controlled trial
Background: Threatened preterm labor (TPL) is the leading cause of hospitalization during pregnancy. Tocolytic agents are the primary therapeutic options for TPL. The aim of this study is to compare intramuscular progesterone with oral nifedipine as a tocolytic agent. Methods: This randomized controlled trial was carried out in a teaching hospital (Shahid Akbarabadi) in Tehran, Iran, from De...
متن کاملEffect of Valerian on Anxiety of Nurses Working in the ICUs: A randomized controlled trial
Background and Objectives: Several studies have shown that nurses working in the ICUs experience high levels of anxiety. Anxiety can not only negatively affect them, but may decrease the quality of care provided by them. The present study aimed to assess the effect of Valerian on anxiety among nurses working in the ICUs of Zanjan teaching hospitals. Materials and Methods: In this clinical tr...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- JAMA
دوره 288 11 شماره
صفحات -
تاریخ انتشار 2002