***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 The importance of psychosocial counselling after a diagnosis of cancer has been acknowledged and many intervention studies have been carried out , with the aim to find out which types of intervention are most effective in enhancing quality of life in cancer patients . A factor which could be part of effective counselling could be the time of offering psychosocial counselling . The aim of this study was to research the effect of time of enrolment in a psychosocial group intervention on psychosocial adjustment . METHODS In the present study , 67 women with early stage breast cancer were r and omised in a psychosocial group intervention program starting within 4 months after surgery or in the same intervention program starting at least 3 months later . RESULTS The main conclusion of this study is that women who started with their intervention early were less distressed at 6 months follow-up than women who were in the delayed condition . Medical and demographic variables were predictive for some psychosocial adjustment indicators , but were not associated with time of enrolment . Regardless of time of enrolment , women improved in distress , body image and recreational activities , but showed a decrease in social interaction . CONCLUSION Though results are limited , based on these results we suggest that psychosocial counselling should be offered as soon after diagnosis or surgery for breast cancer . PRACTICE IMPLICATION S Women diagnosed with primary breast cancer should be able to start with psychological counselling soon after being diagnosed , to prevent them from becoming distressed at long term OBJECTIVE To compare childbirth outcomes of women prospect ively r and omized to receive early labour assessment and support either through a home visit or by telephone triage . METHODS Women in early labour , upon seeking prior telephone advice on whether or not they were ready to be admitted to BC Women 's Hospital ( as was st and ard hospital practice ) , were voluntarily r and omized to receive either a home visit by an obstetrical nurse or telephone triage . RESULTS One hundred seventeen women were r and omized to receive home care and 120 to receive telephone triage .  Significantly fewer women in the home care group arrived at hospital in the latent stage of labour , compared to women in the telephone triage group ( odds ratio [ OR ] , 0.37 ; 95 % confidence interval [ CI ] , 0.19 - 0.72 ) . Significantly fewer women in the home care group received  narcotics  ( OR , 0.55 ; 95 % CI , 0.32 - 0.96 ) . Differences observed in use of epidural analgesia ( OR , 0.64 ; 95 % CI , 0.36 - 1.16 ) were not statistically significant . Newborns in the home care group were significantly less likely to be admitted to a level II observation nursery ( OR , 0.13 ; 95 % CI , 0.03 - 0.60 ) . More women in the home care group would recommend this type of care to a friend ( P = 0.001 ) . CONCLUSION Our findings suggest an association of early labour assessment at home with both admission to hospital in the active phase of labour and reduction in use of analgesia during labour . Early labour support at home was associated with reduced rates of admission of neonates to a level II observation nursery , possibly secondary to reduced exposure to analgesics . Early labour care at home by hospital-based obstetrical nurses is safe and acceptable to women , and may offer advantages in terms of reduced interventions and more vigorous neonates Objective : To compare the effect of the physiologic and facilitated labor on the mother and neonate outcomes in the prim gravid women referring to Arash Hospital . Material s and methods : This clinical trial study was performed on 200 low risk pregnant women referring to Arash Women ’s Hospital in 2012 - 2013 . Mothers were divided into two groups of 100 patients using a simple r and om sampling method . The first group received the on-pregnancy and physiologic labor training and the second group was nominated for facilitated labor without training . The mother and neonate outcomes in these two delivery methods were then compared . Results : The rate of cesarean section in the physiologic group was significantly lower compared with the intervention group ( p = 0.001 ) . Also in the first stage of labor , VAS was measured to be noticeably lower in the physiologic group in comparison with the intervention group ( p = 0.001 ) , while the difference of VAS between the two studied groups was found not to be significant in the second stage of labor . In terms of duration of the labor and neonatal Apgar score two groups were not considerably different ( p > 0.05 ) . Moreover , the laceration rate in the physiologic group was determined to be noticeably higher as compared to the intervention group ( p = 0.001 ) . The groups were considerably different in terms of the vaginal bleeding and maternal satisfaction ( p = 0.001 ) . Conclusion : This study revealed the lower rate of cesarean section , abnormal vaginal bleeding and pain score in the physiologic group compared with the facilitated group . Moreover , mothers of the first group were more content with the labor process Background Childbirth fear is associated with increased obstetric interventions and poor emotional and psychological health for women . The purpose of this study is to test an antenatal psycho-education intervention by midwives in reducing women 's childbirth fear . Methods Women ( n = 1,410 ) attending three hospitals in South East Queensl and , Australia , were recruited into the BELIEF trial . Participants reporting high fear were r and omly allocated to intervention ( n = 170 ) or control ( n = 169 ) groups . All women received a decision-aid booklet on childbirth choices . The telephone counseling intervention was offered at 24 and 34 weeks of pregnancy . The control group received usual care offered by public maternity services . Primary outcome was reduction in childbirth fear ( WDEQ-A ) from second trimester to 36 weeks ’ gestation . Secondary outcomes were improved childbirth self-efficacy , and reduced decisional conflict and depressive symptoms . Demographic , obstetric & psychometric measures were administered at recruitment , and 36 weeks of pregnancy . Results There were significant differences between groups on postintervention scores for fear of birth ( p < 0.001 ) and childbirth self-efficacy ( p = 0.002 ) . Decisional conflict and depressive symptoms reduced but were not significant . Conclusion Psycho-education by trained midwives was effective in reducing high childbirth fear levels and increasing childbirth confidence in pregnant women . Improving antenatal emotional well-being may have wider positive social and maternity care implication s for optimal childbirth experiences R and omised controlled trials are the ' gold st and ard ' for evaluating the effectiveness of interventions in health-care setting s. However , in midwifery care , many interventions are ' complex ' , comprising a number of different elements which may have an effect on the impact of the intervention in health-care setting s. In this paper we reflect on our experience of design ing and evaluating a  complex intervention ( a decision tool to assist with the diagnosis of labour in midwifery care ) , examining some of the issues that our study raises for future research in complex interventions Objective To compare the effectiveness of an algorithm for diagnosis of active labour in primiparous women with st and ard care in terms of maternal and neonatal outcomes . Design Cluster r and omised trial . Setting Maternity units in Scotl and with at least 800 annual births . Participants 4503 women giving birth for the first time , in 14 maternity units . Seven experimental clusters collected data from a baseline sample of 1029 women and a post-implementation sample of 896 women . The seven control clusters had a baseline sample of 1291 women and a post-implementation sample of 1287 women . Intervention Use of an algorithm by midwives to assist their diagnosis of active labour , compared with st and ard care . Main outcomes Primary outcome : use of oxytocin for augmentation of labour . Secondary outcomes : medical interventions in labour , admission management , and birth outcome . Results No significant difference was found between groups in percentage use of oxytocin for augmentation of labour ( experimental minus control , difference=0.3 , 95 % confidence interval −9.2 to 9.8 ; P=0.9 ) or in the use of medical interventions in labour . Women in the algorithm group were more likely to be discharged from the labour suite after their first labour assessment ( difference=−19.2 , −29.9 to −8.6 ; P=0.002 ) and to have more pre-labour admissions ( 0.29 , 0.04 to 0.55 ; P=0.03 ) . Conclusions Use of an algorithm to assist midwives with the diagnosis of active labour in primiparous women did not result in a reduction in oxytocin use or in medical intervention in spontaneous labour . Significantly more women in the experimental group were discharged home after their first labour ward assessment . Trial registration Current Controlled Trials IS RCT N00522952 Background High levels of childbirth fear impact birth preparation , obstetric outcomes and emotional wellbeing for around one in five women living in developed countries . Higher rates of obstetric intervention and caesarean section ( CS ) are experienced in fearful women . The efficacy of interventions to reduce childbirth fear is unclear , with no previous r and omised controlled trials reporting birth outcomes or postnatal psychological wellbeing following a midwife led intervention . Method Between May 2012 and June 2013 women in their second trimester of pregnancy were recruited . Women with a fear score ≥ 66 on the Wijma Delivery Expectancy / Experience Question naire ( W-DEQ ) were r and omised to receive telephone psycho-education by a midwife , or usual maternity care . A two armed non-blinded parallel ( 1:1 ) multi-site r and omised controlled trial with participants allocated in blocks of ten and stratified by hospital site and parity using an electronic central ised computer service . The outcomes of the RCT on obstetric outcomes , maternal psychological well-being , parenting confidence , birth satisfaction , and future birth preference were analysed by intention to treat and reported here . Results 1410 women were screened for high childbirth fear ( W-DEQ ≥66 ) . Three hundred and thirty-nine ( n = 339 ) women were r and omised ( intervention n = 170 ; controls n = 169 ) . One hundred and eighty-four women ( 54 % ) returned data for final analysis at 6 weeks postpartum ( intervention n = 91 ; controls n = 93).Compared to controls the intervention group had a clinical ly meaningful but not statistically significant reduction in overall caesarean section ( 34 % vs 42 % , p = 0.27 ) and emergency CS rates ( 18 % vs 25 % , p = 0.23 ) . Fewer women in the intervention group preferred caesarean section for a future pregnancy ( 18 % vs 30 % , p = 0.04 ) . All other obstetric variables remained similar . There were no differences in postnatal depression symptoms scores , parenting confidence , or satisfaction with maternity care between groups , but a lower incidence of flashbacks about their birth in the intervention group compared to controls ( 14 % vs 26 % , p = 0.05 ) . Postnatally women who received psycho-education reported that the ‘ decision aid ’ helped reduce their fear ( 53 % vs 37 % , p = 0.02 ) . Conclusion Following a brief antenatal midwife-led psycho-education intervention for childbirth fear women were less likely to experience distressing flashbacks of birth and preferred a normal birth in a future pregnancy . A reduction in overall CS rates was also found . Psycho-education for fearful women has clinical benefits for the current birth and expectations of future pregnancies . Trial registration Australian New Zeal and Controlled Trials Registry ACTRN12612000526875 , 17th May 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 Most interventions to prevent  postpartum depression  ( PPD ) focus on the mother rather than the mother – infant dyad . As strong relationships between infant sleep and cry behavior and maternal postpartum mood have been demonstrated by previous research , interventions targeted at the dyad may reduce symptoms of PPD . The goal of the current study was to examine the effectiveness of Practical Re sources for Effective Postpartum Parenting ( PREPP ) . PREPP is a new PPD prevention protocol that aims to 
    Output:
    
Assessment and support in early labour does not have a clear impact on rate of caesarean section or instrumental vaginal birth , or whether the baby was born before arrival at hospital or in an unplanned home birth .
However , evidence suggested that interventions may have an impact on reducing the use of epidural anaesthesia , labour augmentation and on increasing maternal satisfaction with giving birth .