***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 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 Object To evaluate the effects of psychosocial support during labour , delivery and the immediate postpartum period provided by a female companion ( doula ) 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 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 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 Fourteen r and omized trials have demonstrated that continuous caregiver support during childbirth can lead to shorter labors and decrease the need for intervention . In response , there has been a significant increase in the number and use of doulas as paraprofessionals who provide social and emotional support to women during labor/birth for a fee . We conducted a mailed survey of a nationally representative sample of certified and certification-in-process doulas in the United States ( n = 626 , 64.4 % response rate ) to gather some descriptive information on their sociodemographic background s , practice characteristics , and beliefs/attitudes on a number of salient issues . The survey results suggest that , in 2003 , doulas were primarily white , well-educated married women with children . The majority of certified doulas worked in solo practice and provided childbirth support services on average to nine clients per year . Very few doulas were earning more than 5,000 dollars per year from this work , and only 10 % of certified doulas reported receiving third-party reimbursement for their services . Thus , while almost all doulas found their work emotionally satisfying , only one in three saw their work as financially rewarding . Doulas also reported challenges in getting support/respect from clinicians and in balancing doula work and family life . In addition , one in four doulas reported that they were preparing for a career in midwifery . Doulas can play an important and unique role in the childbirth process and reap many personal rewards engaging in this type of work . However , a number of financial , personal , and professional challenges present significant obstacles to the growth of doulas as childbirth paraprofessionals in the United States 
    Output:
    
In general , the results of such support were favorable , highlighting a reduction in the cesarean rate , analgesia/ medication for pain relief , duration of labor , and utilization of oxytocin and an increase in maternal satisfaction with the experience .
The benefits were greater when the support provider was not a health professional .