***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE to study the effect of birth centre care on the duration of breast feeding , breast feeding complications , and women 's experiences of breast feeding .  DESIGN r and omised controlled trial . SETTING in-hospital birth centre at South Hospital , Stockholm , and st and ard obstetric care in the Greater Stockholm area . SUBJECTS 1230 women with expected date of birth between October 1989 and February 1992 , interested in participating in a birth centre trial , and meeting medical low-risk criteria . 617 women were allocated to the experimental group offered birth centre care ( EG ) , and 613 to the  control group offered  st and ard obstetric care ( CG ) . MAIN OUTCOME MEASURES duration of breast feeding , breast feeding complications such as sore nipples , engorgement , milk stasis , and mastitis , and women 's experiences of breast feeding . FINDINGS no difference was found between EG and CG in the duration of breast feeding . Ninety-three per cent in both groups were breast feeding exclusively two months post partum . The average number of months of breast feeding , exclusively or partly , when investigated one year after the birth was 8.6 in EG and 8.5 in CG . No difference was observed in women 's experiences of breast feeding , but rather more women in EG than in CG reported sore nipples , 36 % and 30 % respectively ( p = 0.03 ) , and milk stasis , 26 % and 19 % respectively ( p = 0.002 ) . CONCLUSIONS birth centre care had no effect on the duration of breast feeding , or on women 's experiences of breast feeding . Prenatal attitudes were probably more significant predictors of these outcomes than differences in the two modes of maternity care in this population of highly breast feeding-motivated women . The larger proportion of sore nipples and milk stasis in the EG might have been due to earlier discharge , or to midwives less skilled in assisting with breast feeding at the birth centre than in the postpartum wards Objectives To compare the outcome of two methods of  maternity care during the antenatal period and at delivery . One was to be midwife‐led for both antenatal care and delivery , the latter taking place in rooms similar to those in one 's own home to simulate home confinement . The other would be consultant‐led with the mothers labouring in the delivery suite rooms with resuscitation equipment for both mother and baby in evidence , monitors present and a delivery bed on which both anaesthetic and obstetric procedures could be easily and safely carried out Abstract Objective : To examine whether intrapartum care and delivery of low risk women in a midwife managed delivery unit differs from that in a consultant led labour ward . Design : Pragmatic r and omised controlled trial . Subjects were r and omised in a 2:1 ratio between the midwives unit and the labour ward . Setting : Aberdeen Maternity Hospital , Grampian . Subjects—2844 low risk women , as defined by existing booking criteria for general practitioner units in Grampian . 1900 women were r and omised to the midwives unit and 944 to the labour ward . Main outcome measures : Maternal and perinatal morbidity . Results : Of the women r and omised to the midwives unit , 647 ( 34 % ) were transferred to the labour ward antepartum , 303 ( 16 % ) were transferred intrapartum , and 80 ( 4 % ) were lost to follow up . 870 women ( 46 % ) were delivered in the midwives unit . Primigravid women ( 255/596 , 43 % ) were significantly more likely to be transferred intrapartum than multigravid women ( 48/577 , 8 % ) . Significant differences between the midwives unit and labour ward were found in monitoring , fetal distress , analgesia , mobility , and use of episiotomy . There were no significant differences in mode of delivery or fetal outcome . Conclusions : Midwife managed intrapartum care for low risk women results in more mobility and less intervention with no increase in neonatal morbidity . However , the high rate of transfer shows that antenatal criteria are unable to determine who will remain at low risk throughout pregnancy and labour Objective To compare perinatal outcomes , maternal outcomes , and interventions in labour by planned place of birth at the start of care in labour for women with low risk pregnancies . Design Prospect i ve cohort study . Setting Engl and : all NHS trusts providing intrapartum care at home , all freest and ing midwifery units , all alongside midwifery units ( midwife led units on a hospital site with an obstetric unit ) , and a stratified r and om sample of obstetric units . Participants 64 538 eligible women with a singleton , term ( ≥37 weeks gestation ) , and “ booked ” pregnancy who gave birth between April 2008 and April 2010 . Planned caesarean sections and caesarean sections before the onset of labour and unplanned home births were excluded . Main outcome measure A composite primary outcome of perinatal mortality and intrapartum related neonatal morbidities ( stillbirth after start of care in labour , early neonatal death , neonatal encephalopathy , meconium aspiration syndrome , brachial plexus injury , fractured humerus , or fractured clavicle ) was used to compare outcomes by planned place of birth at the start of care in labour ( at home , freest and ing midwifery units , alongside midwifery units , and obstetric units ) . Results There were 250 primary outcome events and an overall weighted incidence of 4.3 per 1000 births ( 95 % CI 3.3 to 5.5 ) . Overall , there were no significant differences in the adjusted odds of the primary outcome for any of the non-obstetric unit setting s compared with obstetric units . For nulliparous women , the odds of the primary outcome were higher for planned home births ( adjusted odds ratio 1.75 , 95 % CI 1.07 to 2.86 ) but not for either midwifery unit setting . For multiparous women , there were no significant differences in the incidence of the primary outcome by planned place of birth . Interventions during labour were substantially lower in all non-obstetric unit setting s. Transfers from non-obstetric unit setting s were more frequent for nulliparous women ( 36 % to 45 % ) than for multiparous women ( 9 % to 13 % ) . Conclusions The results support a policy of offering healthy women with low risk pregnancies a choice of birth setting . Women planning birth in a midwifery unit and multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outcomes . For nulliparous women , planned home births also have fewer interventions but have poorer perinatal outcomes Please cite this paper as : Bernitz S , Roll and R , Blix E , Jacobsen M , Sjøborg K , Øian P. Is the operative delivery rate in low‐risk women dependent on the level of birth care ? A r and omised controlled trial . BJOG 2011;118:1357–1364 This r and omized , controlled trial compared women 's satisfaction with care at an in-hospital birth center with st and ard obstetric care in Stockholm . Subjects were 1230 women with an expected date of birth between October 1989 and February 1992 , who expressed interest in birth center care , and who were medically low risk . The intervention was the r and om allocation of maternity care at the birth center or st and ard obstetric care . Birth center women expressed greater satisfaction with antenatal , intrapartum , and postpartum care , especially psychological aspects of care . Of these women , 63 percent thought that the antenatal care had raised their self-esteem , versus 18 percent of the control group . Eighty-nine percent of the experimental group would prefer birth center care for any future birth , and 46 percent of the control group would prefer st and ard care . Birth center care successfully meets the needs of women who are interested in natural childbirth and active involvement in their own care , and are concerned about the psychological aspects of birth Objective : The midwifery service at our hospital has been observed to have a 2 % cesarean birth rate consistently over a 10-year period . There are substantial differences in labor management style between the midwives and physicians . We sought to test the hypothesis that the low cesarean birth rate on the midwifery service was the result of patient selection bias . Methods : A r and omized blinded clinical trial was conducted in which 492 low-risk patients were assigned to either physician or midwifery management . The provider responsible for labor management was unable to determine group assignment . Patients in the midwifery group were managed by previously established protocol s , and outcome was attributed to the midwives even if the patients subsequently required transfer to physician management . Route of delivery was the primary outcome measurement . Continuous variables were analyzed using Student t test and discrete variables using x2 . Results : There were no demographic differences between the groups , and the admission pelvic examinations were the same . The patients assigned to the midwifery group had a 2.1 % cesarean birth rate , whereas those assigned to physician management had a 0.4 % rate . The higher rate of operative vaginal deliveries in the physician group was statistically significant . There were no differences in neonatal outcomes . The physician-managed group had significantly more episiotomies and third- and fourth-degree extensions . Conclusions : The 2 % cesarean birth rate observed on the midwifery service appeared to be the result of patient selection bias . A low cesarean birth rate can be achieved by either physician or midwifery management in a selected low-risk population OBJECTIVE to investigate whether there are differences between the cost of intrapartum care for women at low obstetric risk in a midwife-managed labour and delivery unit and that in a consultant-led labour and delivery ward . DESIGN cost analysis based on the findings of a r and omised controlled trial comparing two alternative types of intrapartum care . SETTING Aberdeen Maternity Hospital , Grampian . SUBJECTS the number of women ' booked ' for care in the Midwives ' Unit in a st and ard year and a comparable group of women cared for in the consultant-led labour ward  . PRIMARY OUTCOME MEASURE the cost ' outcome ' is the extra ( or reduced ) cost per woman result ing from the introduction of a midwife-managed delivery unit . FINDINGS the baseline extra cost of the introduction of the Midwives ' Unit was found to be 40.71 pounds per woman . Depending on the scenario used , this ranged from a cost saving of 9.74 pounds per woman to an additional cost of 44.23 pounds per woman . CONCLUSIONS this study has shown that , in terms of costs incurred during the intrapartum period , the marginal cost of caring for women at low obstetric risk alongside women at high obstetric risk in a st and ard labour ward is small . However , the impact of establishing a separate midwife-managed delivery unit , requiring an increase in midwifery staffing levels , can be significant BACKGROUND Nearly all hospitalized laboring women spend most of the time in bed . We made simple but radical modifications to a hospital labor room , which included the removal of the st and ard hospital bed and the addition of equipment to promote relaxation , mobility , and calm . We design ed a pilot study , the objectives of which were to test the feasibility of a r and omized trial and the acceptability of the modified labor room to women and their care providers . METHODS Women were assessed and invited to participate just before their admission to the labor and delivery suite . Sixty-two women at two Toronto teaching hospitals were r and omly allocated to either the st and ard labor room or the " ambient room . " Data about labor and birth events were abstract ed from the medical records . Participants and their nurses and physicians completed question naires to elicit their views of their experiences with the labor rooms . RESULTS Women 's and practitioners ' evaluations of the ambient room were generally very positive . Nineteen women ( 65.5 % ) in the ambient group , compared with 4 ( 13.3 % ) in the st and ard group , reported spending 50 percent or less of their hospital labor in the st and ard labor bed . Twelve women allocated to the ambient room had artificial oxytocin infusions , compared with 21 allocated to the st and ard room ( X ( 2 ) = 4.73 , p = 0.03 ) . CONCLUSION We conclude that the ambient labor room should be evaluated in an adequately powered r and omized controlled trial A controlled clinical trial was carried out to assess whether a birth room setting would influence the care of mothers and newborns .  Of the 163 low-risk women enrolled , 49 ( 30 % ) manifested some prenatal risk and were excluded . The remaining 114 were allocated by strict alternation to a birth room or a conventional setting . Of the 56 women allocated to the birth room , 63 % of the primiparas and 19 % of the multiparas were later transferred . The numbers in the two setting s who had oxytocin stimulation , epidural anesthesia , forceps delivery or cesarean section did not show statistically significant differences . The episiotomy rates were slightly lower in the birth room than in the conventional setting , and the rates of an intact perineum were higher in the birth room . Neither the Apgar scores nor the morbidity rates of the infants showed statistically significant differences related to the setting to which the mother had been allocated , although more infants from the conventional setting were admitted to a special care unit . Both " experimental " groups of women less often received routine perineal shaving , enemas or intravenous infusions than did an obstetrically similar nonexperimental comparison group . Despite the apparent inability in this setting for the birth room to influence the rate of major obstetric procedures ( except for episiotomy ) and outcomes , the authors believe that a birth room is desirable in tertiary care centres as well as in community hospitals Objective 1 . To explore whether there are differences in women 's satisfaction with care 
    Output:
    
There was no apparent effect on other adverse maternal or neonatal outcomes .
Care by the same or separate staff had no apparent effects .
Hospital birth centres are associated with lower rates of medical interventions during labour and birth and higher levels of satisfaction , without increasing risk to mothers or babies