***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: Matched groups of primigravid women received one of three antenatal training programmes : normal antenatal classes , normal classes plus electromyography biofeedback relaxation training , or normal classes plus skin-conductance biofeedback relaxation training . Myographic training was found to be effective within conventional antenatal constraints , whereas skin-conductance training was not . The women reported use of biofeedback training and related skills to be of some benefit during early labour . However , no difference between effectively trained electromyographic , ineffectively trained skin-conductance and control groups was found on labour and delivery performance measures BACKGROUND Neonatal deaths in developing countries make the largest contribution to global mortality in children younger than 5 years . 90 % of deliveries in the poorest quintile of households happen at home . We postulated that a community-based participatory intervention could significantly reduce neonatal mortality rates . METHODS We pair-matched 42 geopolitical clusters in Makwanpur district , Nepal , selected 12 pairs r and omly , and r and omly assigned one of each pair to intervention or control . In each intervention cluster ( average population 7000 ) , a female facilitator convened nine women 's group meetings every month . The facilitator supported groups through an action-learning cycle in which they identified local perinatal problems and formulated strategies to address them . We monitored birth outcomes in a cohort of 28?931 women , of whom 8 % joined the groups . The primary outcome was neonatal mortality rate . Other outcomes included stillbirths and maternal deaths , uptake of antenatal and delivery services , home care practice s , infant morbidity , and health-care seeking . Analysis was by intention to treat . The study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N31137309 . FINDINGS From 2001 to 2003 , the neonatal mortality rate was 26.2 per 1000 ( 76 deaths per 2899 livebirths ) in intervention clusters compared with 36.9 per 1000 ( 119 deaths per 3226 livebirths ) in controls ( adjusted odds ratio 0.70 [ 95 % CI 0.53 - 0.94 ] ) . Stillbirth rates were similar in both groups . The maternal mortality ratio was 69 per 100000 ( two deaths per 2899 livebirths ) in intervention clusters compared with 341 per 100000 ( 11 deaths per 3226 livebirths ) in control clusters ( 0.22 [ 0.05 - 0.90 ] ) . Women in intervention clusters were more likely to have antenatal care , institutional delivery , trained birth attendance , and hygienic care than were controls . INTERPRETATION Birth outcomes in a poor rural population improved greatly through a low cost , potentially sustainable and scalable , participatory intervention with women 's groups Background ' Sitting month ' is the Chinese tradition for postpartum customs . Available studies indicate that some of the traditional postpartum practice s are potentially harmful for women 's health . However , no intervention study aim ing at postpartum practice s has been performed . In this paper we evaluated the effect of a health and nutrition education intervention , which focused on improving postpartum dietary quality and optimal health behaviors . Methods The study design was a r and omized controlled trial conducted in both urban and rural area of Hubei between August 2003 and June 2004 . A total of 302 women who attended the antenatal clinic during the third trimester with an uncomplicated pregnancy were recruited . Women r and omized to the education intervention group in both urban and rural area received two two-hour prenatal education sessions and four postpartum counseling visits . Control group women received usual health care during pregnancy and postpartum period . Women were followed up until 42 days postpartum . Outcome measures were nutrition and health knowledge , dietary behavior , health behavior and health problems during the postpartum period . Results Women in the intervention groups exhibited significantly greater improvement in overall dietary behaviors such as consumption of fruits , vegetables , soybean and soybean products as well as nutrition and health knowledge than those in the control groups . Significantly more women in the intervention groups give up the traditional behavior taboos . The incidence of constipation , leg cramp or joint pain and prolonged lochia rubra was significantly lower in the intervention groups as compared with the control groups . Conclusion The study shows that health and nutrition education intervention enable the women take away some of the unhealthy traditional postpartum practice s and decrease the prevalence of postpartum health problems . The intervention has potential for adaptation and development to large-scale implementation . Trial registration OBJECTIVE : To determine whether group prenatal care improves pregnancy outcomes , psychosocial function , and patient satisfaction and to examine potential cost differences . METHODS : A multisite r and omized controlled trial was conducted at two university-affiliated hospital prenatal clinics . Pregnant women aged 14–25 years ( n=1,047 ) were r and omly assigned to either st and ard or group care . Women with medical conditions requiring individualized care were excluded from r and omization . Group participants received care in a group setting with women having the same expected delivery month . Timing and content of visits followed obstetric guidelines from week 18 through delivery . Each 2-hour prenatal care session included physical assessment , education and skills building , and support through facilitated group discussion . Structured interviews were conducted at study entry , during the third trimester , and postpartum . RESULTS : Mean age of participants was 20.4 years ; 80 % were African American . Using intent-to-treat analyses , women assigned to group care were significantly less likely to have preterm births compared with those in st and ard care : 9.8 % compared with 13.8 % , with no differences in age , parity , education , or income between study conditions . This is equivalent to a risk reduction of 33 % ( odds ratio 0.67 , 95 % confidence interval 0.44–0.99 , P=.045 ) , or 40 per 1,000 births . Effects were strengthened for African-American women : 10.0 % compared with 15.8 % ( odds ratio 0.59 , 95 % confidence interval 0.38–0.92 , P=.02 ) . Women in group sessions were less likely to have suboptimal prenatal care ( P<.01 ) , had significantly better prenatal knowledge ( P<.001 ) , felt more ready for labor and delivery ( P<.001 ) , and had greater satisfaction with care ( P<.001 ) . Breastfeeding initiation was higher in group care : 66.5 % compared with 54.6 % , P<.001 . There were no differences in birth weight nor in costs associated with prenatal care or delivery . CONCLUSION : Group prenatal care result ed in equal or improved perinatal outcomes at no added cost . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00271960 LEVEL OF EVIDENCE : This study was design ed to test the effectiveness of using a broad conceptualization of childbirth education that includes parenting preparation in pregnancy . The goal is to assist in breaking cycles of dysfunction in families . At the core of this exp and ed model of childbirth education is the concept of prevention . The intervention described in Part I in the Journal of Perinatal Education 7(4 ) , 26–33 provided parents with information and coping mechanisms by drawing parallels to traditionally learned coping skills for childbirth with techniques needed to cope in post-partum . This approach also encouraged prenatal parents to learn techniques for promoting attachment to their children before birth . The curriculum was tested by r and omizing 48 couples to the exp and ed or traditional model of childbirth education .  A pre- and post-Prenatal Parenting Scale was administered to both groups . Only the experimental group demonstrated improvement at the post-class administration Abstract In this article we present the results of three studies investigating methods for including men in antenatal education in Istanbul , Turkey . Participants were first-time expectant parents living in low and middle-income areas . After a formative study on the roles of various family members in health during the period surrounding a first birth , an antenatal-clinic-based education programme for women and for couples was carried out as a r and omised , controlled study . Based on the results , separate community-based antenatal education programmes for expectant mothers and expectant fathers were tested . There was dem and among many pregnant women and some of their husb and s for including expectant fathers in antenatal education . In the short term , these programmes seemed to have positive effects on women and men 's reproductive health knowledge , attitudes and behaviours . In the clinic-based programme the positive effects of including men were mainly in the area of post-partum family planning , while in the community-based programme positive effects among men were also seen in the areas of infant health , infant feeding and spousal communication and support .  Free an tenatal education should be made available to all expectant mothers and when possible , men should be included , either together with their wives or in a culture such as that of Turkey , in separate groups . Résumé Trois etudes ont analysé des méthodes pour associer les hommes á l'éducation prénatale . Les participants , issus de quartiers à revenus faibles et moyens d'Istanbul , Turquie , attendaient leur premier enfant . Après une étude initiale des rôles en matiere de santé des membres de la famille pendant la période entourant une première naissance , un programme d'éducation a donné des soins prénatals en dispensaire aux femmes et aux couples , dans le cadre d'une etude aléatorie et contrôlée . En fonction des résultats , des programmes communautaires d'education prénatale , séparés pour les futurs péres et les futures mères , ont été testes . Beaucoup de femmes enceintes et quelques maris souhaitaient associer les futurs pères à l'éducation prénatale . A court terme , ces programmes semblaient avoir des effets positifs sur les connaissances , les attitudes et les comportements des hommes et des femmes en matière de santé génésique . Darts le programme mené au dispensaire , l'ínclusion des hommes avait des avantages touchant à la planification familiale post-partum , alors que les effets positifs du programme communautaire concernaient la santé infantile , 1'alimentation des nourrissons , la communication et le soutien entre époux . Une éducation prénatale gratuite devrait être proposée à toutes les futures mères et , lorsque c'est possible , les hommes devraient y être associés , soit avec leurs épouses soit , dans une culture comme celle de la Turquie , dans des groupes séparés . Resumen Tres investigaciones analizaron los métodos para incluir a los hombres en la educación prenatal en Estambul , Turquia . Los participantes eran parejas que vivían en Areas de bajos y medianos ingresos , quienes esperaban su primer bebé . Después de un estudio formativo acerca de los roles de los distintos integrantes de la familia en relación a la salud durante el período previo y posterior a un primer nacimiento , se implementó un estudio aleatorio controlado en la forma de un programa educativo  para mujeres y para parejas en una clínica prenatal . En base a los result ados , se probaron programas educativos prenatales comunitarios para mujeres embarazadas y sus parejas . Hubo una dem and a entre muchas de las mujeres embarazadas y algunos de sus esposos para incluir a los futures padres en la educación prenatal . A couo plazo , estos programas parecían tener efectos positivos en las actitudes , comportamientos y conocimientos de la salud reproductiva de las mujeres y los hombres . En el programa de la clinica , los efectos positivos de incluir a los hombres se notaban principalmente en el ámbito de la planificación familiar postparto , mientras que en el programa comunitario , se notaban además los efectos positivos en los ámbitos de la salud y la alimentacion infantil , el apoyo de los hombres a sus esposas y la comunicacíon con ellas . Se recomienda ofrecer educacion prenatal gratuita a todas las mujeres embarazadas y cu and o sea posible a los hombres , en conjunto con sus esposas o , en una cultura como la de Turquía , en grupos separados An experimental study using a r and om sample of 40 staff patients in two inner-city maternity hospital clinics was conducted to determine the optimum time to teach postpartum content to maternity patients .  Instruction of special postpartum content , or the lack of it , to prenatal and postpartum patients yielded no statistical difference in the results . However , the methodology used in patient instruction and the measurement of its effectiveness warrants scrutiny Objectives This study describes sleep patterns for mothers and fathers after the birth of their first child and compares exclusive breast-feeding families with parents who used supplementation during the evening or night at 3 months postpartum . Methods As part of a r and omized clinical trial , the study utilized infant feeding and sleep data at 3 months postpartum from 133 new mothers and fathers . Infant feeding type ( breast milk or formula ) was determined from parent diaries .  Sleep was measured objective ly using wrist actigraphy and subjectively using diaries . Lee 's General Sleep Disturbance Scale was used to estimate perceived sleep disturbance . Results Parents of infants who were breastfed in the evening and /or at night slept an average of 40–45 minutes more than parents of infants given formula . Parents of infants  given formula at night also self-reported more sleep disturbance than parents of infants who were exclusively breast-fed at night . Conclusions Parents who supplement their infant feeding with formula  under the impression that they will get more sleep should be encouraged to continue breast-feeding because sleep loss of more than 30 minutes each night can begin to affect daytime functioning , particularly in those parents who return to work Eighty-two Asian women ( 
    Output:
    
The effects of general antenatal education for childbirth or parenthood , or both , remain largely unknown .
Individualized prenatal education directed toward avoidance of a repeat caesarean birth does not increase the rate of  vaginal birth  after caesarean section