Hodnett 1989.
Methods | RCT, stratified by type of prenatal classes (Lamaze versus general) | |
Participants | 145 nulliparous women (72 to support group and 73 to control) in the last trimester of a healthy pregnancy, booked for delivery at a Toronto, Canada, hospital | |
Interventions | Support provided by a monitrice (community 'lay' midwife or midwifery apprentice) compared with usual hospital care, defined as the intermittent presence of a nurse. Support described as including physical comfort measures, continuous presence, information, emotional support, and advocacy. The monitrice met with the woman twice in the latter weeks of pregnancy, to discuss her birth plans. Comparable prenatal attention was provided to the controls. All but 1 woman also had husbands or partners present during labour. Support began in early labour at home or in hospital and continued through delivery |
|
Outcomes | Intrapartum interventions, perceived control, method of delivery | |
Notes | Epidural analgesia was available and EFM was used routinely Dates of study: recruitment and follow‐up complete by 1986 Funding: supported by a grant from the National Health Research and Development Program, Health and Welfare Canada. Project no. 6606‐2939‐43. Conflicts of interest: not reported. |
|
Risk of bias | ||
Bias | Authors' judgement | Support for judgement |
Random sequence generation (selection bias) | Low risk | Computer‐generated table of random numbers |
Allocation concealment (selection bias) | Low risk | Randomisation done over the phone by a third party who had no knowledge of the participant, but used the open table of random numbers |
Blinding of participants and personnel (performance bias) All outcomes | High risk | Participants and labour room staff were not blinded to group assignment |
Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Initial collection of medical record data were not blinded. "Duplicate abstraction was done by a second research assistant blind to the subject's study group assignment, on a random sample of 20 records. Interrater agreement of over 95% was obtained for all categories of intervention and physical outcomes." In‐home interview at 2 to 4 weeks postpartum was blinded |
Incomplete outcome data (attrition bias) All outcomes | Low risk | Method of delivery outcome available on 88.3% of sample. Other outcomes collected on only 71% of the sample and thus not used |
Selective reporting (reporting bias) | Low risk | All outcomes were reported |
Other bias | Low risk | No other sources of bias noted |