Access to Labor Support

Rationale for Compliance	Evidence Grade
No evidence of harm found for unrestricted access to continuous emotional and physical support from a skilled woman (Hodnett, 2003).	Quality:	A
	Quantity:	A
	Consistency:	A* and **
Compared with a similar population receiving comparable clinical care, continuous labor support by a skilled or experienced woman reduces the likelihood of having pain medication in labor, increases the likelihood of spontaneous birth (vaginal birth without the aid of vacuum extraction or forceps), increases satisfaction with the birth experience, and reduces the likelihood of severe postpartum pain (Hodnett, 2003; Schroeder, 2005; Simkin, 2002; Waldenström, 2004).	Quality:	A
	Quantity:	A
	Consistency:	A
Compared with a similar population receiving comparable clinical care, continuous labor support by a skilled or experienced woman results in fewer newborn admissions to a neonatal intensive care unit (Hodnett, 2003).	Quality:	A
	Quantity:	A
	Consistency:	A**
Compared with outcomes from studies of labor support provided by nurses (hospital employees), studies where support was provided by a nonmedical trained or experienced woman resulted in fewer cesareans, less need for oxytocin during labor, and less need for pain medication (Hodnett, 2003; Simkin, 2002; Simkin, 2004).	Quality:	A
	Quantity:	A
	Consistency:	A

A = good

Quality = aggregate of quality ratings for individual studies

Quantity = magnitude of effect, numbers of studies, and sample size or power

Consistency = the extent to which similar findings are reported using similar and different study designs

^*no study reported harm

^**multiple studies in SR