***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: The purpose of this stratified r and omized trial was to determine the physical and psychological effects of continuous , one-to-one professional support on childbirth outcomes . Data were gathered during prenatal and postpartum interviews with , and from the medical records of , 103 low-risk women . All subjects had attended one of two types of prenatal education programs , were accompanied by husb and s or partners during labor , and had vaginal deliveries . Subjects in the experimental group were less likely to have medication for pain relief and less likely to have episiotomies . Three variables were found to predict perceived control during childbirth -- expectations of control , the presence of a continuous professional caregiver , and pain medication usage . The results demonstrate the importance of the traditional nursing support role during childbirth Object To evaluate the effects of psychosocial support during labour , delivery and the immediate postpartum period provided by a female companion ( doula ) Various policies of management of prolonged labour have been proposed to prevent its two main consequences -- caesarean section and fetal distress . Two r and omised controlled trials were organised ; the first to assess the value of amniotomy with oxytocin  compared to a more conservative approach . The second trial compared the effect of continuous professional support during labour with the intermittent presence of a member of staff . These were multicentre studies in several countries of Europe . Preliminary results of early amniotomy suggested no difference in the rate of operative delivery . Continuous professional support was associated with a significant reduction in operative deliveries Objective — To measure the effects of supportive companionship on labour and various aspects of adaptation to parenthood , and thus by inference the adverse effects of a clinical ly orientated labour environment on these processes OBJECTIVE The presence of a supportive companion to women in labour has been found to reduce the duration of labour and the incidence of oxytocin augmentation . The mechanism which produces this improvement is unknown but work in animals suggests that environmental disturbance produces changes in endogenous oxytocin secretion . This study was carried out to assess maternal oxytocin secretion in relation to the presence of a supportive companion in labour . STUDY DESIGN A r and omised controlled trial involving allocation of unsupported women in the first stage of labour to a period of 1 h with a supportive companion or 1 h without .  Sixteen women with uncomplicated singleton pregnancies who were in the active phase of the first stage of labour were studied .  Maternal oxytocin levels were assayed by radioimmunoassay for 16 min ( eight specimens ) before and after the support or control period . RESULTS There are no differences between maternal oxytocin levels in the two groups of patients . There was no difference in either of the two groups between the oxytocin levels pre and post the support/control period . CONCLUSIONS One hour of birth support in the first stage of labour did not improve maternal oxytocin levels when compared to a control group Because continuous social support during labour is a component of care in many societies but inconsistent in our own , the clinical effect of support during labour on maternal and neonatal morbidity were studied . Social support was provided by female companions .  Four hundred and sixty five healthy primigravidous women were enrolled using a r and omised design . Compared with 249 women undergoing labour alone 168 women who had supportive female companions throughout labour had significantly fewer perinatal complications ( p less than 0.001 ) , including caesarean sections ( 7 % v 17 % , p less than 0.01 ) and oxytocin augmentation ( 2 % v 13 % , p less than 0.001 ) , and fewer infants admitted to neonatal intensive care ( p less than 0.10 ) . Of the women who had an uncomplicated labour and delivery requiring no interventions , those with a companion had a significantly shorter duration of labour ( 7.7 hours v 15.5 hours , p less than 0.001 ) . This study suggests that constant human support may be of great benefit to women during labour BACKGROUND Health research ers and provider groups have recommended that women in labor should receive continuous professional support . The objective of our study was to compare the risks and benefits of one-to-one nurse labor support with usual intrapartum nursing care . METHODS A r and omized , controlled trial was conducted in a 637-bed university hospital in Montreal , Quebec , with 413 nulliparous women who were at more than 37 weeks ' gestation , carrying singletons , and in labor . Women with scheduled cesarean section , scheduled induction , breech presentation , presence of paid labor support , or cervical dilatation over 4 cm were excluded .  One-to-one care consisted of the presence of a nurse during labor and birth who provided emotional support , physical comfort , and instruction for relaxation and coping techniques . Usual care consisted of care for two or three laboring women with various types of supportive activities . RESULTS A beneficial trend due to one-to-one nurse support was found with a 17 percent reduction in risk of oxytocin stimulation ( relative risk of experimental vs control = 0.83 ; 95 % confidence interval = 0.67 , 1.04 ) . No significant differences were found in overall labor duration s and overall rates of total cesarean section , cesarean section for cephalopelvic disproportion , epidural analgesia , admission to the neonatal intensive care unit , instrumental vaginal delivery , and perineal trauma . CONCLUSIONS The beneficial trend attributed to one-to-one nursing in reduction of oxytocin stimulation suggests that implementation of recommendations for continuous professional support by intrapartum nursing staff may be appropriate in North America OBJECTIVE  Postpartum depression  is a common feature of childbearing and is the cause of considerable morbidity . We have explored the possibility that clinical ly oriented care during labor may contribute to its occurrence . STUDY DESIGN Of 189 nulliparous women laboring in a familiar community hospital , 92 were allocated by r and omized , sealed envelopes to receive additional companionship from one of three volunteer labor companions recruited from the community . RESULTS The group receiving support attained higher self-esteem scores and lower postpartum depression and anxiety ratings 6 weeks after delivery . CONCLUSION In the clinical labor environment companionship modifies factors that contribute to the development of postnatal depression . We emphasize the importance of paying attention to the psychosocial environment in which labor takes place , to facilitate adaptation to parenthood The continuous presence of a supportive companion ( doula ) during labor and delivery in two studies in Guatemala shortened labor and reduced the need for cesarean section and other interventions . In a US hospital with modern obstetric practice s , 412 healthy nulliparous women in labor were r and omly assigned to a supported group ( n = 212 ) that received the continuous support of a doula or an observed group ( n = 200 ) that was monitored by an inconspicuous observer . Two hundred four women were assigned to a control group after delivery . Continuous labor support significantly reduced the rate of cesarean section deliveries ( supported group , 8 % ; observed group , 13 % ; and control group , 18 % ) and forceps deliveries . Epidural anesthesia for spontaneous vaginal deliveries varied across the three groups ( supported group , 7.8 % ; observed group , 22.6 % ; and control group , 55.3 % ) .  Oxytocin use , duration of labor , prolonged infant hospitalization , and maternal fever followed a similar pattern . The beneficial effects of labor support underscore the need for a review of current obstetric practice OBJECTIVE To evaluate whether providing doulas  during hospital-based labor affects mode of delivery , epidural use , breast-feeding , and postpartum perceptions of the birth , self-esteem , and depression . METHODS This was a r and omized study of nullipara enrollees in a group-model health maintenance organization who delivered in one of three health maintenance organization-managed hospitals ; 149 had doulas , and 165 had usual care .  Study data were obtained from the mothers ' medical charts , study intake forms , and phone interviews conducted 4 - 6 weeks postpartum . RESULTS Women who had doulas had significantly less epidural use ( 54.4 % versus 66.1 % , P < .05 ) than women in the usual-care group . They also were significantly ( P < .05 ) more likely to rate the birth experience as good ( 82.5 % versus 67.4 % ) , to feel they coped very well with labor ( 46.8 % versus 28.3 % ) , and to feel labor had a very positive effect on their feelings as women ( 58.0 % versus 43.7 % ) and perception of their bodies ' strength and performance ( 58.0 % versus 41.0 % ) . The two groups did not differ significantly in rates of cesarean , vaginal , forceps , or vacuum delivery , oxytocin administration ; or breast-feeding , nor did they differ on the postpartum depression or self-esteem measures . CONCLUSION For this population and setting , labor support from doulas had a desirable effect on epidural use and women 's perceptions of birth , but did not alter need for operative deliveries BACKGROUND This study was a r and omized controlled trial of primigravidas in Botswana to determine the effectiveness of the presence of a female relative as a labor companion on labor outcomes . METHODS One hundred and nine primigravidas in uncomplicated spontaneous labor were r and omly distributed into a control group who labored without family members present  , and an experimental group who had a female relative with them during labor . RESULTS Significantly more mothers in the experimental group had a spontaneous vaginal delivery ( 91 % vs 71 % ) , less  intrapartum analgesia ( 53 % vs 73 % ) , less  oxytocin  ( 13 % vs 30 % ) , fewer  amniotomies to augment labor ( 30 % vs 54 % ) , fewer  vacuum extraction s ( 4 % vs 16 % ) , and fewer cesarean sections ( 6 % vs 13 % ) than in the control group . These differences were all significant at p < 0.05 . Epidural analgesia was not used in the hospital at the time of the study . The only analgesics used were intramuscular pethidine or hyoscine N-butylbromide ( Buscopan ) . CONCLUSIONS The presence in labor of a female relative was shown to be associated with fewer interventions and a higher frequency of normal delivery compared with the outcomes of those without family member support . The presence of a female relative as a labor companion is a low-cost , preventative intervention that is consistent with the traditional cultural practice s in Botswana . In the light of this and previous studies , all women giving birth in a hospital should be offered the choice of a female relative as a companion to give support during labor We studied the effects of a supportive lay woman ( " doula " ) on the length of labor and on mother-infant interaction after delivery in healthy Guatemalan primigravid women . Initial assignment of mothers to the experimental ( doula ) or control group was r and om , but controls showed a higher rate ( P less than 0.001 ) of subsequent perinatal problems ( e.g. cesarean section and meconium staining ) . It was necessary to admit 103 mothers to the control group and 33 to the experimental group to obtain 20 in each group with uncomplicated deliveries . In the final sample , the length of time from admission to delivery was shorter in the experimental group ( 8.8 vs. 19.3 hours , P less than 0.001 ) . Mothers who had a doula present during labor were awake more after delivery ( P less than 0.02 ) and stroked ( P less than 0.001 ) , smiled at ( P less than 0.009 ) , and talked to ( P less than 0.002 ) their babies more than the control mothers . These observations suggest that there may be major perinatal benefits of constant human support during labor The birth of a  child  and adaptation to motherhood is generally accepted to be a stressful life event . During this time women may experience significant physiological , phycological and emotional changes in their lives One hundred three women who were r and omized to receive either routine nursing care ( controls ) or routine care plus one-to-one support by an experienced monitrice ( experimental ) were compared as to obstetric outcomes and their memories of types of support they had from nurse , monitrice , and mate . Women assigned a monitrice arrived at the hospital significantly further along in labor , and nearly twice as many had no medication during labor and delivery . Significantly fewer of these women used stirrups during delivery , and more had intact perineums . There was no difference between groups in use of forceps or cesarean sections . Length of labor was confounded by use of medications . Mothers in the experimental group remembered receiving more physical comfort measures , emotional support , and advocacy from monitrices compared to control mothers who received intrapartum care from nurses 
    Output:
    
REVIEW ER 'S CONCLUSIONS Continuous support during labour from caregivers ( nurses , midwives or lay people ) appears to have a number of benefits for mothers and their babies and there do not appear to be any harmful effects