1. Beal, Judy A. DNSc, PNP, RN
  2. Wood, Sylvia H. MSN, CNM, RN

Article Content

Rosen, P. (2004).Journal of Midwifery and Women's Health, 49(1), 24-3.


This article provides a very well-delineated review of the literature regarding the types of caregivers who can provide effective support to women in labor. All studies included in this review had to compare groups that received support with groups that did not receive support, and also had to clearly define the persons providing support. In addition, the independent variable had to be the use of continuous or almost continuous support in labor, and maternal and/or infant outcomes were also to be reported. As a result, eight articles were found that provided information about five groups of caregivers: (1) unfamiliar, untrained laywomen, (2) unfamiliar, trained lay-women, (3) female relatives, (4) nurses, and (5) monitrices, or lay midwives acting solely as labor support persons.


The author reports that the most consistent beneficial effect on childbirth outcomes was found in the support given by untrained laywomen, starting in early labor and continuing into the postpartum period. Although some studies cited were small and done outside the United States, benefits were also noted in women supported by unfamiliar trained lay-women (doulas), female relatives, and montrices, or lay midwives acting as labor support persons. Randomized controlled trials reviewed regarding labor support given by nurses, however, found no significant differences in maternal and/or infant outcomes. Lack of time, poor staffing, educational preparation, and organizational culture are given as reasons why health professionals may not be the best people to provide continuous labor support.


In conclusion, the author states that the provision of continuous labor support does have an impact on a woman's satisfaction with her childbirth experience. The author suggests that since potential barriers exist with each type of support person examined, a combination of support people may work best to provide women with the individualized support they need.


Comment by Sylvia Wood