***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: BACKGROUND Data collected on more than 12,000 women in 15 r and omized controlled trials provide robust evidence of the beneficial effects of doula support on medical outcomes to childbirth . The objective of this paper was to examine the association between doula support and maternal perceptions of the infant , self , and support from others at 6 to 8 weeks postpartum . The doula was a minimally trained close female relative or friend . METHODS Six hundred low-risk , nulliparous women were enrolled in the original clinical trial and r and omized to doula support ( n = 300 ) or st and ard care ( n = 300 ) . The mother-to-be and her doula attended two 2-hour classes about providing nonmedical , continuous support to laboring women . For the secondary study , presented here , research participants ( N = 494 ) were interviewed by telephone using a 42-item question naire . RESULTS Overall , when doula-supported mothers ( n = 229 ) were compared with mothers who received st and ard care ( n = 265 ) , they were more likely to report positive prenatal expectations about childbirth and positive perceptions of their infants , support from others , and self-worth . Doula-supported mothers were also most likely to have breastfed and to have been very satisfied with the care they received at the hospital . CONCLUSIONS Labor support by a minimally trained female friend or relative , selected by the mother-to-be , enhances the postpartum well-being of nulliparous mothers and their infants , and is a low-cost alternative to professional doulas Background To evaluate the effectiveness and safety of the support given to women  by a companion of their choice during labor and delivery . Methods A total of 212 primiparous women were enrolled in a r and omized controlled clinical trial carried out between February 2004 and March 2005 . One hundred and five women were allocated to the group in which support was permitted and 107 to the group in which there was no support .  Variables regarding patient satisfaction and events related to obstetrical care , neonatal results and breastfeeding were evaluated . Student 's t-test or Wilcoxon 's test , chi-square or Fisher 's exact test , risk ratios , and their respective 95 % confidence intervals were used in the statistical analysis . Results Overall , the women in the support group were more satisfied with labor ( median 88.0 versus 76.0 , p < 0.0001 ) and delivery ( median 91.4 versus 77.1 , p < 0.0001 ) . During labor , patient satisfaction was associated with the presence of a companion ( RR 8.06 ; 95%CI : 4.84 – 13.43 ) , with care received ( RR 1.11 ; 95%CI : 1.01 – 1.22 ) and with medical guidance ( RR 1.14 95%CI : 1.01 – 1.28 ) . During delivery , satisfaction was associated with having a companion ( RR 5.57 , 95%CI : 3.70 – 8.38 ) , with care received ( RR 1.11 95%CI : 1.01 – 1.22 ) and with vaginal delivery ( RR 1.33 95%CI:1.02 – 1.74 ) . The only factor that was significantly lower in the support group was the occurrence of meconium-stained amniotic fluid ( RR 0.51 ; 95%CI : 0.28 – 0.94 ) . There was no statistically significant difference between the two groups with respect to any of the other variables . Conclusion The presence of a companion of the woman 's choice had a positive influence on her satisfaction with the birth process and did not interfere with other events and interventions , with neonatal outcome or breastfeeding BACKGROUND A woman 's childbirth experience has an influence on her future preferred mode of delivery . This study aim ed to identify determinants for women who changed from preferring a planned vaginal birth to an elective cesarean section after their first childbirth . METHODS This prospect i ve longitudinal observational study involved two units that provide obstetric care in Hong Kong . A  mail survey was sent to 259 women 6 months after their first childbirth . These women had participated in a longitudinal cohort study that examined their preference for elective cesarean section in the antenatal period of their first pregnancies . Univariate and multivariate analyses were performed to identify determinants for women who changed from preferring vaginal birth to elective cesarean section . RESULTS Twenty-four percent ( 23.8 % , 95 % CI 18.4 - 29.3 ) of women changed from preferring vaginal birth to elective cesarean section after their first childbirth . Determinants found to be positively associated with this change included actual delivery by elective cesarean section ( OR 106.3 , 95 % CI 14.7 - 767.4 ) intrauterine growth restriction ( OR 19.5 , 95 % CI 1.1 - 353.6 ) , actual delivery by emergency cesarean section ( OR 8.4 , 95 % CI 3.4 - 20.6 ) , higher family income ( OR 3.2 , 95 % CI 1.1 - 8.8 ) , use of epidural analgesia ( OR 2.6 , 95 % CI 1.0 - 6.8 ) , and higher trait anxiety score ( OR 1.1 , 95 % CI 1.0 - 1.3 ) . The most important reason for women who changed from preferring vaginal birth to elective cesarean section was fear of vaginal birth ( 24.4 % ) . CONCLUSIONS A significant proportion of women changed their preferred mode of delivery after their first childbirth . Apart from reducing the number of cesarean sections in nulliparous women , prompt provision of education to women who had complications and investigations into fear factors during vaginal birth might help in reducing women 's wish to change to elective cesarean section CONTEXT North American cesarean delivery rates have risen dramatically since the 1960s , without concomitant improvements in perinatal or maternal health . A Cochrane Review concluded that continuous caregiver support during labor has many benefits , including reduced likelihood of cesarean delivery . OBJECTIVE To evaluate the effectiveness of nurses as providers of labor support in North American hospitals . DESIGN R and omized controlled trial with prognostic stratification by center and parity . Women were enrolled during a 2-year period ( May 1999 to May 2001 ) and followed up until 6 to 8 postpartum weeks . SETTING Thirteen US and Canadian hospitals with annual cesarean delivery rates of at least 15 % . PARTICIPANTS A total of 6915 women who had a live singleton fetus or twins , were 34 weeks ' gestation or more , and were in established labor at r and omization . INTERVENTION Patients were r and omly assigned to receive usual care ( n = 3461 ) or continuous labor support by a specially trained nurse ( n = 3454 ) during labor . MAIN OUTCOME MEASURES The primary outcome measure was cesarean delivery rate . Other outcomes included intrapartum events and indicators of maternal and neonatal morbidity , both immediately after birth and in the first 6 to 8 postpartum weeks . RESULTS Data were received for all 6915 women and their infants ( n = 6949 ) . The rates of cesarean delivery were almost identical in the 2 groups ( 12.5 % in the continuous labor support group and 12.6 % in the usual care group ; P = .44 ) . There were no significant differences in other maternal or neonatal events during labor , delivery , or the hospital stay . There were no significant differences in women 's perceived control during childbirth or in depression , measured at 6 to 8 postpartum weeks . All comparisons of women 's likes and dislikes , and their future preference for amount of nursing support , favored the continuous labor support group . CONCLUSIONS In hospitals characterized by high rates of routine intrapartum interventions , continuous labor support by nurses does not affect the likelihood of cesarean delivery or other medical or psychosocial outcomes of labor and birth BACKGROUND Approximately 31 percent of cesarean deliveries in the United States and Canada are performed for dystocia . The aim of this study was to determine the effectiveness of early labor assessment to reduce cesarean birth rates for low-risk nulliparous women . METHODS Two hundred and nine low-risk nulliparous women were r and omly allocated to either the early labor assessment group or the direct admission to hospital group . Women in the early labor assessment group were evaluated and , if found to be in false or latent labor , were encouraged to go home or walk before admission to the labor unit . Those in the direct admission group were admitted to the labor unit without an assessment . Data were collected and analyzed about method of delivery , duration of labor , intrapartum interventions , and neonatal well-being . Women completed an evaluation of their experience in the early postpartum period . RESULTS Significant decreases occurred in duration of labor , use of epidural analgesia for pain , and use of oxytocin to augment labor in the early labor assessment group . These women evaluated their labor and birth experience more positively than women in the direct admission group . No significant differences were found in the frequency of cesarean section or instrumental vaginal delivery for the two groups . CONCLUSIONS Early labor assessment has the potential to reduce the number of women receiving oxytocin for augmentation , the rate of epidural analgesia for pain relief , and the duration of the active and second stages of labor , and to improve women 's evaluations of their labor and birth experiences BACKGROUND Childbirth is an important experience in a woman 's life , and unfavorable birth experiences have been shown to negatively impact postpartum maternal health . Aim of this study was to evaluate the effects of music therapy on postpartum pain , anxiety level , satisfaction and early pospartum depression rate . METHODS Totally 161 primiparous women were recruited and r and omized either music group ( n=80 ) or a control group ( n=81 ) . Women in the music group listened to self-selected music during labor .  Postpartum pain intensity , anxiety level and satisfaction rate were measured using the visual analog scale ( VAS ) , postpartum depression rate was assessed with Edinburg Postpartum Depression Scale ( EPDS ) at postpartum day one and day eight . RESULTS Mothers in the music therapy group had a lower level of postpartum pain and anxiety than the control group and it was statistically significant at all time intervals ( 1 , 4 , 8 , 16 and 24h , p<0.001 ) . A significant difference was observed between the two groups in terms of satisfaction rate ( p<0.001 ) and postpartum depression rate at postpartum day one and day eight ( p<0.05 ) . LIMITATIONS We only measured the effect of music therapy on early postpartum depression rate . Effect of music on late postpartum depression rate should be investigated in future . CONCLUSIONS Using music therapy during labor decreased postpartum anxiety and pain , increased the satisfaction with childbirth and reduced early postpartum depression rate .  Music therapy can be clinical ly recommended as an alternative , safe , easy and enjoyable nonpharmacological method for postpartum well-being Object To evaluate the effects of psychosocial support during labour , delivery and the immediate postpartum period provided by a female companion ( doula ) BACKGROUND Current forms of analgesia often have significant side effects for women in labor . Bathing in warm water during labor has been reported to increase a woman 's comfort level and cause a reduction in painful contractions . The objective of this trial was to compare immersion in warm water during labor with traditional pain management for a range of clinical and psychological outcomes . METHODS A prospect i ve r and omized controlled trial of 274 pregnant women , who were free from medical and obstetric complications and expecting a singleton pregnancy at term , was conducted at the Women 's and Children 's Hospital , a maternity tertiary referral center in Adelaide , South Australia . Women in labor were r and omized to an experimental group who received immersion in a bath or to a nonbath group who received routine care .  Pharmacological pain relief was the primary outcome that was measured , and secondary outcomes included maternal and neonatal clinical outcomes , factors relating to maternal and neonatal infectious morbidity , psychological outcomes , and satisfaction with care . RESULTS The use of pharmacological analgesia was similar for both the experimental and control groups ; 85 and 77 percent , respectively , used major analgesia . No statistical differences were observed in the proportion of women requiring induction and augmentation of labor or in rates of perineal trauma , length of labor , mode of delivery , or frequency of cardiotocographic trace abnormalities . Neonatal outcomes ( birthweight , Apgar score , nursery care , meconium-stained liquor , cord pH estimations ) revealed no statistically significant differences . Infants of bath group women required significantly more resuscitation than routine group women . Routine group women rated their overall experience of childbirth more positively than bath group women . Psychological outcomes , such as satisfaction with care or postnatal distress , were the same for both groups . CONCLUSION Bathing in labor confers no clear benefits for the laboring woman but may contribute to adverse effects in the neonate BACKGROUND Childbirth is a dem and ing event in a woman 's life . The aim of this study was to explore whether a brief intervention in the form of an antenatal course in self-hypnosis to ease childbirth could improve the childbirth experience . METHOD In a r and omized , controlled , single-blinded trial , 1,222 healthy nulliparous women were allocated to one of three groups during pregnancy : A hypnosis group participating in three 1-hour sessions teaching self-hypnosis to ease childbirth , a relaxation group receiving three 1-hour lessons in various relaxation 
    Output:
    
Conclusion The most effective strategies to create a positive birth experience are supporting women during birth , intrapartum care with minimal intervention and birth preparedness .