Good point Inges!

Perhaps this article is one deserved of a letter to the editor with a
methodological critique.

Declan

Declan Devane,
Doctoral Student,
School of Nursing and Midwifery Studies,
University of Dublin Trinity College,
Trinity Centre for Health Sciences Education,
St. James's Hospital,
Dublin 8.
Tel: 087 659 6923
Email: [log in to unmask]

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-----Original Message-----
From: A forum for discussion on midwifery and reproductive health
research. [mailto:[log in to unmask]]On Behalf Of Inge
Loos
Sent: 19 September 2002 11:23
To: [log in to unmask]
Subject: Effectiveness of Nurses as Providers of Birth Labor Support in
North American Hospitals


Isn't it funny, with a two day training  nurses should be able to deliver
effective labor care . What was Hodnetts intention for this study? The
importance of experience in midwifery is obviously unknown.
Kind regards
Inge Loos RM BNS Stud. MNS
[log in to unmask]



Effectiveness of Nurses as Providers of Birth Labor Support in North
American Hospitals

A Randomized Controlled Trial

   Ellen D. Hodnett, RN, PhD; Nancy K. Lowe, RN, CNM, PhD; Mary E. Hannah,
MDCM; Andrew R. Willan, PhD; Bonnie Stevens, RN, PhD; Julie A. Weston, RN,
MSc; Arne Ohlsson, MD; Amiram Gafni, PhD; Holly A. Muir, MD; Terri L. Myhr,
MSc; Robyn Stremler, RN, MSc(A); for the Nursing Supportive Care in Labor
Trial Group
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.
JAMA. 2002;288:1373-1381