A comparison of intermittent and continuous support during labor: A meta-analysis,

Our goal was to contrast the influence of intermittent and continuous support provided by doulas during labor and delivery on 5 childbirth outcomes. Data were aggregated across 11 clinical trials by means of meta-analytic techniques. Continuous support, when compared with no doula support, was significantly associated with shorter labors (weighted mean difference –1.64 hours, 95% confidence interval –2.3 to –.96) and decreased need for the use of any analgesia (odds ratio .64, 95% confidence interval .49 to .85), oxytocin (odds ratio .29, 95% confidence interval .20 to .40), forceps (odds ratio .43, 95% confidence interval .28 to .65), and cesarean sections (odds ratio .49, 95% confidence interval .37 to .65). Intermittent support was not significantly associated with any of the outcomes. Odds ratios differed between the 2 groups of studies for each outcome. Continuous support appears to have a greater beneficial impact on the 5 outcomes than intermittent support. Future clinical trials, however, will need to control for possible confounding influences. Implications for labor management are discussed. (Am J Obstet Gynecol 1999;180:1054-9.)