Date of Award

Spring 2021

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Jodi Freeman

Abstract

Introduction: The medical field has improved drastically within the past 100 years leading to positive outcomes in many aspects of labor it also led to the downfall of labor companions.1 Doulas, a type of trained continuous support person who specializes specifically in peripartum support, are a well-documented resource for laboring women. Research shows that despite only 6% of the population utilizing their services, the multiple interventions that doulas use decrease labor time and result in fewer interventions, including epidural use, oxytocin, and cesarean section delivery.2, 3, 4, 5 Use of epidural analgesia has been shown to increase the need for instrumental assistance in vaginal delivery, increase length of labor, and limit a woman’s ability to effectively push during labor due to its analgesic effects.2, 6

Methods: A literature search was performed in November 2019 using various search engines including EBSCO, PubMed, and ClinicalKey. This search encompassed various keyword terms surrounding continuous support labor and limiting variables which led to seven final articles for review.

Results: Results of the review were encouraging as many saw statistically and clinically significant improvement in labor time and resulted in fewer cesarean deliveries when compared to women who labored without a continuous support person.7, 8, 10, 11, 12, 13

Discussion: Due to the nature of the study the methods to reduce labor pain, labor time, and number of Cesarean sections is difficult to assess as ethical concerns pertaining to pain relief and desire for Cesarean delivery are not able to be controlled by researchers. Various methods to understand the differences have been employed with encouraging results. Labor pain perception and rates of cesarean seem to be significantly decreased with the presence of a doula, however more research must be done to better understand the relationship between continuous labor support and labor outcomes.

Conclusion: Not enough reliable data has been analyzed to establish a cause-effect relationship between the presence of a support person and the outcomes being evaluated in this review. This is partially due to the ethical concerns surrounding restriction of epidural use, which may be remedied by utilizing a matched retrospective case-control study which would allow freedom of choice to all participants while still providing accurate data for evaluation.

Additional Files

Capstone Recording Tia.mp4 (7251 kB)

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The Effect of Continuous Labor Support on Various Labor Outcomes

Introduction: The medical field has improved drastically within the past 100 years leading to positive outcomes in many aspects of labor it also led to the downfall of labor companions.1 Doulas, a type of trained continuous support person who specializes specifically in peripartum support, are a well-documented resource for laboring women. Research shows that despite only 6% of the population utilizing their services, the multiple interventions that doulas use decrease labor time and result in fewer interventions, including epidural use, oxytocin, and cesarean section delivery.2, 3, 4, 5 Use of epidural analgesia has been shown to increase the need for instrumental assistance in vaginal delivery, increase length of labor, and limit a woman’s ability to effectively push during labor due to its analgesic effects.2, 6

Methods: A literature search was performed in November 2019 using various search engines including EBSCO, PubMed, and ClinicalKey. This search encompassed various keyword terms surrounding continuous support labor and limiting variables which led to seven final articles for review.

Results: Results of the review were encouraging as many saw statistically and clinically significant improvement in labor time and resulted in fewer cesarean deliveries when compared to women who labored without a continuous support person.7, 8, 10, 11, 12, 13

Discussion: Due to the nature of the study the methods to reduce labor pain, labor time, and number of Cesarean sections is difficult to assess as ethical concerns pertaining to pain relief and desire for Cesarean delivery are not able to be controlled by researchers. Various methods to understand the differences have been employed with encouraging results. Labor pain perception and rates of cesarean seem to be significantly decreased with the presence of a doula, however more research must be done to better understand the relationship between continuous labor support and labor outcomes.

Conclusion: Not enough reliable data has been analyzed to establish a cause-effect relationship between the presence of a support person and the outcomes being evaluated in this review. This is partially due to the ethical concerns surrounding restriction of epidural use, which may be remedied by utilizing a matched retrospective case-control study which would allow freedom of choice to all participants while still providing accurate data for evaluation.

 
 

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