***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 Abstract Background Most women delivering in South African State Maternity Hospitals do not have a childbirth companion ; in addition , the quality of care could be better , and at times women are treated inhumanely . We piloted a multi-faceted intervention to encourage uptake of childbirth companions in state hospitals , and hypothesised that lay carers would improve the behaviour of health professionals . Methods We conducted a pilot r and omised controlled trial of an intervention to promote childbirth companions in hospital deliveries . We promoted evidence -based information for maternity staff at 10 hospitals through access to the World Health Organization Reproductive Health Library ( RHL ) , computer hardware and training to all ten hospitals . We surveyed 200 women at each site , measuring companionship , and indicators of good obstetric practice and humanity of care . Five hospitals were then r and omly allocated to receive an educational intervention to promote childbirth companions , and we surveyed all hospitals again at eight months through a repeat survey of postnatal women . Changes in median values between intervention and control hospitals were examined . Results At baseline , the majority of hospitals did not allow a companion , or access to food or fluids . A third of women were given an episiotomy . Some women were shouted at  ( 17.7 % , N = 2085 ) , and a few reported being slapped or struck ( 4.3 % , N = 2080 ) . Despite an initial positive response from staff to the childbirth companion intervention , we detected no difference between intervention and control hospitals in relation to whether a companion was allowed by nursing staff , good obstetric practice or humanity of care . Conclusion The quality and humanity of care in these state hospitals needs to improve . Introducing childbirth companions was more difficult than we anticipated , particularly in under-re source d health care systems with frequent staff changes . We were unable to determine whether the presence of a lay carer impacted on the humanity of care provided by health professionals . Trial registration : Current Controlled Trials IS RCT 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 OBJECTIVES : Despite recent efforts to increase breastfeeding , young African American mothers continue to breastfeed at low rates , and commonly introduce complementary foods earlier than recommended . This study examines the effects of a community doula home visiting intervention on infant feeding practice s among young mothers . METHODS : Low-income , African American mothers ( n = 248 ) under age 22 years participated in a r and omized trial of a community doula intervention . Intervention-group mothers received services from paraprofessional doulas : specialized home visitors trained as childbirth educators and lactation counselors . Doulas provided home visits from pregnancy through 3 months postpartum , and support during childbirth . Control-group mothers received usual prenatal care . Data were obtained from medical records and maternal interviews at birth and 4 months postpartum . RESULTS : Intent-to-treat analyses showed that doula-group mothers attempted breastfeeding at a higher rate than control-group mothers ( 64 % vs 50 % ; P = .02 ) and were more likely to breastfeed longer than 6 weeks ( 29 % vs 17 % ; P = .04 ) , although few mothers still breastfed at 4 months . The intervention also impacted mothers ’ cereal/solid food introduction ( P = .008 ) : fewer doula-group mothers introduced complementary foods before 6 weeks of age ( 6 % vs 18 % ) , while more waited until at least 4 months ( 21 % vs 13 % ) compared with control-group mothers . CONCLUSIONS : Community doulas may be effective in helping young mothers meet breastfeeding and healthy feeding guidelines . The intervention ’s success may lie in the relationship that develops between doula and mother based on shared cultural background and months of prenatal home visiting , and the doula ’s presence at the birth , where she supports early breastfeeding experiences Background Initiation of breastfeeding can be difficult in a busy maternity centre with inadequate manpower and social support . This study aims to explore the role of psychosocial support offered by companions on breastfeeding initiation  among first-time mothers . Methods This is a secondary data analysis of a r and omised controlled trial conducted among women attending the antenatal clinic of the University College Hospital , Ibadan , Nigeria in 2007 . Those in the experimental group were asked to bring someone of their choice to the labour room to act as a companion ; the comparison group received st and ard care . The results of 209 HIV negative women who had vaginal births were analysed . The main outcome measure was time to initiation of breastfeeding after childbirth . Results Of the total , 94 had companions during labour while 115 did not have a companion . The median time to breastfeeding initiation was significantly shorter in those with companions compared to controls ( 16 vs. 54 minutes ; p < 0.01 ) . The cumulative survival analysis indicated that all in the treatment group had initiated breastfeeding by 26 minutes , while among the control group none had commenced at 30 minutes post-delivery with some as late as 12 hours . After Cox regression analysis was used to adjust for possible confounders , the outcome still showed a significant hazard ratio of 207.8 ( 95%CI 49.2 , 878.0 ; p < 0.01 ) among women who were supported by a companion . Conclusion Use of companions during labour is associated with earlier time to breastfeeding initiation among first-time mothers in Nigeria . Trial Registration Australian New Zeal and Clinical Trials Registry : ACTRN12609000994280 To establish the spontaneous miscarriage rate and compare it with the procedure related miscarriage rate for amniocentesis and chorionic villus sampling ( CVS ) by experienced operators OBJECTIVE To study the availability of humanized service and healthy birth and it 's effect on maternal and neonatal outcomes . METHODS A multicenteral prospect i ve r and omized control study was carried out in 9 maternity hospitals from Nov. 2000 to June 2001 . 6,758 laboring women were r and omly divided into study group and control group . In study group ( n = 3,437 ) , midwives accompany laboring women in whole course of birth until two hours after delivery . According WHO " Monitoring rules for normal birth " medical staff support the mothers in physiological , psychological and physical aspects . In control group ( n = 3,321 ) mothers receive traditional management . Midwives visit and check the mothers discoutinually . In two groups husb and s can company laboring women according women 's requirement . A question naire will be filled on the second day after birth . RESULTS In study group the spontaneous delivery rate was significant higher than that of control group ( 85.5 % vs 66.0 % , P < 0.01 ) . The cesarean section rate , postpartum hemorrhage rate , neonatal asphyxia rate and neonatal morbidity were marked lower in study group than those of control group ( P < 0.01 and P < 0.05 ) . CONCLUSIONS Appropriate mode of intrapartum care can decrease the cesarean section rate and promote the vaginal delivery , also it can improve the maternal and neonatal outcomes OBJECTIVE To compare labor outcomes in women accompanied by an additional support person ( doula group )  with outcomes in women who did not have this additional support person ( control group ) . DESIGN R and omized controlled trial . SETTING A women 's ambulatory care center at a tertiary perinatal care hospital in New Jersey . PATIENTS / PARTICIPANTS Six hundred nulliparous women carrying a singleton pregnancy who had a low-risk pregnancy at the time of enrollment and were able to identify a female friend or family member willing to act as their lay doula . INTERVENTIONS The doula group was taught traditional doula supportive techniques in two 2-hour sessions . MAIN OUTCOME MEASURES Length of labor , type of delivery , type and timing of analgesia/anesthesia , and Apgar scores . RESULTS Significantly shorter length of labor in the doula group , greater cervical dilation at the time of epidural anesthesia , and higher Apgar scores at both 1 and 5 minutes . Differences did not reach statistical significance in type of analgesia/anesthesia or cesarean delivery despite a trend toward lower cesarean delivery rates in the doula group . CONCLUSION Providing low-income pregnant women with the option to choose a female friend who has received lay doula training and will act as doula during labor , along with other family members , shortens the labor process We wanted to study the effect of extra emotional support in the form of a non-professional woman ( doula ) before and during delivery . About 200 primiparae were invited to participate in a prospect i ve study which intended to assess differences in delivery outcome between women with and without a doula . Fifty-four declined to participate , 55 had a delivery with doula and 46 were controls . Lower rate of emergency caesarean sections in the doula-group was noted . The parents as well as the staff , became to regard the doula as a valuable support during delivery Objective : Vasoconstriction during anxiety reduces fetal oxygenation and leads to hypoxia . Hypoxia in turn results in increase of the number of nucleated red blood cells ( NRBCs ) in the cord blood . The present study aim ed to assess the effect of decreasing maternal  anxiety on fetal oxygenation and NRBCs count in the cord blood . 
    Output:
    
There was no apparent impact on other intrapartum interventions , maternal or neonatal complications , such as admission to special care nursery ( average RR 0.97 , 95 % CI 0.76 to 1.25 ; 7 trials , 8897 women ; low- quality evidence ) , and exclusive or any breastfeeding at any time point ( average RR 1.05 , 95 % CI 0.96 to 1.16 ; 4 trials , 5584 women ; low- quality evidence ) .Subgroup analyses suggested that continuous support was most effective at reducing caesarean birth , when the provider was present in a doula role , and in setting s in which epidural analgesia was not routinely available .
Continuous labour support in setting s where women were not permitted to have companions of their choosing with them in labour , was associated with greater likelihood of spontaneous vaginal birth and lower likelihood of a caesarean birth .
Subgroup analysis of trials conducted in high-income compared with trials in middle-income countries suggests that continuous labour support offers similar benefits to women and babies for most outcomes , with the exception of caesarean birth , where studies from middle-income countries showed a larger reduction in caesarean birth .
No conclusions could be drawn about low-income setting s , electronic fetal monitoring , the timing of onset of continuous support or model of support .
Continuous support during labour may improve outcomes for women and infants , including increased spontaneous vaginal birth , shorter duration of labour , and decreased caesarean birth , instrumental vaginal birth , use of any analgesia , use of regional analgesia , low five-minute Apgar score and negative feelings about childbirth experiences .
We found no evidence of harms of continuous labour support .
Subgroup analyses should be interpreted with caution , and considered as exploratory and hypothesis-generating , but evidence suggests continuous support with certain provider characteristics , in setting s where epidural analgesia was not routinely available , in setting s where women were not permitted to have companions of their choosing in labour , and in middle-income country setting s , may have a favourable impact on outcomes such as caesarean birth .