Professor Ellen Hodnett of the Faculty of Nursing said these results call into question the usefulness of guidelines in Canada, the U.S. and the United Kingdom which recommend such continuous care. "To me, the clear message is if you are serious about wanting to reduce or at least not increase your caesarean delivery rates, don't count on one-to-one support by nurses as the only answer," says Hodnett who is also cross-appointed to the Department of Public Health Sciences, Mount Sinai Hospital and the Centre for Research in Women's Health (CRWH), a partnership of U of T and Sunnybrook and Women's College Health Sciences Centre. The study is published in the Sept. 18 issue of the Journal of the American Medical Association.
Hodnett and other researchers at U of T, The Hospital for Sick Children, Mount Sinai, Sunnybrook and Women's College, McMaster University, Ohio State University and Duke University followed 6,915 pregnant women at 13 hospitals across Canada and the U.S. Approximately half received continuous care from nurses specially trained in techniques to ease labour pain and anxiety. The rest received usual care in which a nurse checked their progress periodically and offered advice but was not present on a continual basis. Researchers found caesarean rates were almost identical between the two groups (12.5 per cent in the continuous care group and 12.6 per cent in the usual care group).
The findings do not mean such one-to-one, continuous care is not beneficial, says Hodnett, the Heather M. Reisman Chair in Perinatal Nursing Research at U of T and Mount Sinai. In fact, the majority of women in the study expressed a preference for that level of care. However, relying on a single intervention is not sufficient to reduce caesarean rates. "We need widespread changes to
Contact: Jessica Whiteside
University of Toronto