# PERINATAL EFFECTS OF SUPPORT FOR COUPLES DURING LABOR

> **NIH NIH R01** · CASE WESTERN RESERVE UNIVERSITY · 1994 · $406,372

## Abstract

Because epidural analgesia is extremely effective for controlling the
pain of labor, it is now administered almost routinely to laboring women
in many U.S. hospitals.  According to Howell, Chalmers, and others, the
widespread use of epidural analgesia has occurred in spite of a lack of
randomized controlled trials (RCT) to examine its adverse effects for
both women and their infants.  This proposed RCT will examine the
perinatal effects of epidural analgesia compared to the perinatal effects
of a second, less-invasive technique for the management of labor pain --
continuous support by an experienced female labor companion (doula).  The
study will investigate the effects of these two obstetric pain management
techniques on:  (1) the incidence of cesarean delivery, 2) obstetric
interventions during labor and delivery, 3) obstetric complications, 4)
perinatal problems in the fetus and neonate, 5) labor length, 6) newborn
behavior, 7) mothers' subjective experiences during labor and delivery,
including perceptions of pain, and 8) mothers' attitudes toward their
infants and their breastfeeding plans.  Nulliparous women (n=750) with
low-risk pregnancies admitted to Ben Taub Hospital (Houston) in active
labor will be randomly assigned to one of three pain management groups:
1) doula support, 2) epidural analgesia, 3) control.  Subjects will be
observed throughout labor and delivery, and obstetric outcome variables
will be recorded.  Within 24 hours after delivery, evaluation of the
mothers' interaction with their infants will be made, along with
assessment of the newborns' behaviors.  Five RCTs have demonstrated that
doula support resulted in a significant reduction in labor length,
cesarean delivery rate, perinatal problems, and the need for medication.
In contrast, epidural analgesia has been correlated with increased
cesarean and forceps delivery rates, maternal pyrexia, decreased neonatal
responsiveness, and other adverse effects.  In spite of the impressive
positive results of doula support, the trend in obstetric care in the
U.S. has been in the opposite direction -- toward the increased use of
interventions, analgesia, and technology.  This proposed RCT is necessary
to assess the positive and negative effects of both techniques to manage
the discomfort and anxiety of labor and delivery -- epidural analgesia
and continuous doula support.

## Key facts

- **NIH application ID:** 2197386
- **Project number:** 5R01HD016915-10
- **Recipient organization:** CASE WESTERN RESERVE UNIVERSITY
- **SAM.gov UEI:** HJMKEF7EJW69
- **Principal Investigator:** JOHN H KENNELL
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 1994
- **Award amount:** $406,372
- **Award type:** 5
- **Project period:** 1984-09-01 → 1997-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/2197386

## Citation

> US National Institutes of Health, RePORTER application 2197386, PERINATAL EFFECTS OF SUPPORT FOR COUPLES DURING LABOR (5R01HD016915-10). Retrieved via MORVS 2026-10-25 from https://api.morvs.ai/grant/nih/2197386. Licensed CC0.

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