***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 Two studies were conducted to examine the effects of music on analogued labor pain using volunteer nulliparous subjects who were r and omly assigned to treatment groups ( n = 10 per group ) . Assessment s of the treatments were made in a 1-hour session involving twenty 80-second exposures to a laboratory pain stimulus patterned to resemble labor contractions . In the first experiment , it was hypothesized that subjects listening to easy-listening music would report lower pain ratings and cardiovascular responses than subjects listening to rock music , self-selected music , or a dissertation ( placebo-attention ) and subjects in a no-treatment control group . No significant group effects were found ; significant time effects were found for heart rate , systolic and diastolic blood pressure . Subjects spontaneously reported using imagery as a pain reduction technique . In the second study a combination of music and imagery was examined by r and omly assigning subjects to one of five groups : self-generated imagery with music ( SIM ) , guided imagery with music ( GIM ) , self-generated imagery without music ( SI ) , guided imagery without music ( GI ) , or no-treatment control . Again , no significant group effects were obtained . Significant time effects were obtained for heart rate , systolic and diastolic blood pressure British physician , Dr. Grantly Dick-Read , was the first to suggest the “ fear-tension-pain ” cycle in his work Natural Childbirth ( 1933 ) . As a result of his underst and ing of how this cycle affected birthing , he recommended women prepare for childbirth . Research studies from around the world have shown that the use of hypnosis for childbirth results in : ∗ shorter labors ∗ reduced use of pain medication ∗ higher Apgar scores ∗ reduced cesarean and forceps A study of the effects of biofeedback on the pain of childbirth was conducted . Forty primigravidae were r and omly assigned to either an experimental group or a control group . The experimental group was given a series of training sessions in biofeedback and used biofeedback equipment during labor . All subjects were monitored during the labor and delivery period for their reports of pain using a visual analogue scale ( VAS ) and a verbal descriptor scale ( VDS ) . Results showed that women using biofeedback during childbirth reported significantly lower pain : from admission to labor and delivery ( p less than 0.05:VDS ; p less than 0.01:VAS ) , at delivery ( p less than 0.005:VDS ) , and 24-hr postpartum ( p less than 0.01:VDS ) . Also , women in the biofeedback group labored an average of 2 hr less and used 30 % fewer medications . The results of this study suggest that EMG biofeedback may be effective in reducing levels of acute pain experienced by childbearing women CONTEXT A prior national survey documented the high prevalence and costs of  alternative medicine use in the United States in 1990 . OBJECTIVE To document trends in alternative medicine use in the United States between 1990 and 1997 . DESIGN Nationally representative r and om household telephone surveys using comparable key questions were conducted in 1991 and 1997 measuring utilization in 1990 and 1997 , respectively . PARTICIPANTS A total of 1539 adults in 1991 and 2055 in 1997 . MAIN OUTCOMES MEASURES Prevalence , estimated costs , and disclosure of alternative therapies to physicians . RESULTS Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8 % in 1990 to 42.1 % in 1997 ( P < or = .001 ) . The therapies increasing the most included herbal medicine , massage , megavitamins , self-help groups , folk remedies , energy healing , and homeopathy . The probability of users visiting an alternative medicine practitioner increased from 36.3 % to 46.3 % ( P = .002 ) . In both surveys alternative therapies were used most frequently for chronic conditions , including back problems , anxiety , depression , and headaches . There was no significant change in disclosure rates between the 2 survey years ; 39.8 % of alternative therapies were disclosed to physicians in 1990 vs 38.5 % in 1997 . The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 ( 64.0 % ) and 1997 ( 58.3 % ) ( P=.36 ) . Extrapolations to the US population suggest a 47.3 % increase in total visits to alternative medicine practitioners , from 427 million in 1990 to 629 million in 1997 , thereby exceeding total visits to all US primary care physicians . An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and /or high-dose vitamins ( 18.4 % of all prescription users ) . Estimated expenditures for alternative medicine professional services increased 45.2 % between 1990 and 1997 and were conservatively estimated at $ 21.2 billion in 1997 , with at least $ 12.2 billion paid out-of-pocket . This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations . Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $ 27.0 billion , which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services . CONCLUSIONS  Alternative medicine use and expenditures increased substantially between 1990 and 1997 , attributable primarily to an increase in the proportion of the population seeking alternative therapies , rather than increased visits per patient Objective To investigate acupuncture treatment  during labour with regard to pain intensity , degree of relaxation and outcome of the delivery Objective To evaluate the effectiveness of acupuncture as an analgesic during labor . Design A r and omized , unblinded , controlled study . Setting A labor ward in a University Hospital . Patients Parturients at term . Interventions One group received acupuncture ( N = 106 ) ; another did not ( N = 92 ) . A second control group ( N = 92 ) , drawn from the labor ward protocol , consisted of patients who met the eligibility criteria for the study and were matched to the  “ no acupuncture ” group by parity , but who had not been offered the opportunity to take part . Outcome measure “ effectiveness of acupuncture ” was measured by the requirement for use of meperidine . Results Meperidine was given to 11 % of the acupuncture group , 37 % of the no acupuncture group ( P < 0.0001 ) , and 29 % of the control group . The use of other analgesics was also lower in the acupuncture group . Patient satisfaction was high : 89 of 103 patients asked said they would want acupuncture during another labor . Conclusions Acupuncture during labor reduced the requirement for other painkillers and has high patient satisfaction in this r and omized , unblinded , controlled study The benefits of hypnotic analgesia as an adjunct to childbirth education were studied in 60 nulliparous women . Subjects were divided into high and low hypnotic susceptibility groups before receiving 6 sessions of childbirth education and skill mastery using an ischemic pain task . Half of the Ss in each group received a hypnotic induction at the beginning of each session ; the remaining control Ss received relaxation and breathing exercises typically used in childbirth education . Both hypnotic Ss and highly susceptible Ss reported reduced pain . Hypnotically prepared births had shorter Stage 1 labors , less medication , higher Apgar scores , and more frequent spontaneous deliveries than control Ss ' births . Highly susceptible , hypnotically treated women had lower depression scores after birth than women in the other 3 groups . We propose that repeated skill mastery facilitated the effectiveness of hypnosis in our study OBJECTIVE To determine the effect of breathing techniques and nurse-administered massage on the pain perception of pregnant woman during labour . SETTING AND PARTICIPANTS The present study was conducted among pregnant women ( 75 % primiparous ) admitted to the SSK Bakirkoy Women and Children 's Hospital ( Istanbul , Turkey ) between January 1 , and September 1 , 2000 . The patients were in their 38th to 42nd week of pregnancy , not at high risk and expected to have normal vaginal delivery . They were selected from volunteers by nonr and om sampling . STUDY DESIGN The present study involved 40 cases , with 20 in the experimental group and 20 in the control group . Data were obtained through the visual analogue scale , inspection form , observation form and postnatal interview form . The study investigators provided information about labour , breathing techniques and massage to the pregnant women assigned to the experimental group at the beginning of labour ( latent phase ) . A study investigator also accompanied them during labour . These women received nurse-administered massage and were encouraged to breathe and perform self-administered massage . They were also instructed to change their positions and to relax . RESULTS AND CONCLUSION Study results demonstrated that nursing support and patient-directed education concerning labour and nonpharmacological pain control methods ( eg , breathing and cutaneous stimulation techniques ) were effective in reducing the perception of pain by pregnant women ( when provided in the latent labour phase before delivery ) , leading to a more satisfactory birth experience Acupuncture treatment and control group interventions in parallel-group r and omised trials of acupuncture are not always precisely reported . In an attempt to improve st and ards , an international group of experienced acupuncturists and research ers devised a set of recommendations , design ating them STRICTA : ST and ards for Reporting Interventions in Controlled Trials of Acupuncture . In a further consensus-building round , the editors of several journals helped redraft the recommendations . These follow the Consoli date d St and ards for Reporting Trials ( CONSORT ) format , acting as an extension of the CONSORT guidelines for the specific requirements of acupuncture studies . Participating journal editors are publishing the STRICTA recommendations and requesting prospect i ve authors to adhere to them when preparing reports for publication . Other journals are invited to adopt these recommendations . The intended outcome is that interventions in controlled trials of acupuncture  will be more adequately reported , thereby facilitating an improvement in critical appraisal , analysis and replication of trials Labor pain is often severe , and analgesic medication may not be indicated . In this r and omized controlled trial we examined the effects of music on sensation and distress of pain in Thai primiparous women during the active phase of labor . The gate control theory of pain was the theoretical framework for this study . R and omization with a computerized minimization program was used to assign women to a music group ( n = 55 ) or a control group ( n = 55 ) . Women in the intervention group listened to soft music without lyrics for 3 hours starting early in the active phase of labor . Dual visual analog scales were used to measure sensation and distress of pain before starting the study and at three hourly posttests . While controlling for pretest scores , one-way repeated measures analysis of covariance indicated that those in the music group had significantly less sensation and distress of pain than did the control group ( F ( 1 , 107 ) = 18.69 , p < .001 , effect size = .15 , and F ( 1 , 107 ) = 14.87 , p < .001 , effect size = .12 ) , respectively . Sensation and distress significantly increased across the 3 hours in both groups ( p < .001 ) , except for distress in the music group during the first hour . Distress was significantly lower than sensation in both groups ( p < .05 ) . In this controlled study , music -- a mild to moderate strength intervention -- consistently provided significant relief of severe pain across 3 hours of labor and delayed the increase of affective pain for 1 hour . Nurses can provide soft music to laboring women for greater pain relief during the active phase when contractions are strong and women suffer OBJECTIVE The purpose of this study was to evaluate the effects of SP6 acupressure on labor pain and delivery time in women in labor . DESIGN R and omized clinical trial . SETTING /LOCATION Delivery room in a university hospital . PARTICIPANTS Seventy-five ( 75 ) women in labor were r and omly assigned to either the SP6 acupressure ( n = 36 ) or SP6 touch control ( n = 39 ) group . The participants were matched according to parity , cervical dilation , labor stage , rupture of amniotic membrane , and husb and 's presence during labor . There were no additional oxytocin augmentation or administration of analgesics during the study period . INTERVENTION The 30-minute acupressure or touch on SP6 acupoint was performed . OUTCOME MEASURES Labor pain was measured four times using a structured question naire , a subjective labor pain scale ( visual-analogue scale [ VAS ] ) : before intervention , immediately after the intervention , and 30 and 60 minutes after the intervention . Length of delivery time was calculated in two stages : from 3 cm cervical dilation to full cervical dilatation , and full cervical dilatation to the delivery . RESULTS There were significant differences between the groups in subjective labor pain scores at all time points following the intervention : immediately 
    Output:
    
REVIEW ER 'S CONCLUSIONS Acupuncture and hypnosis may be beneficial for the management of pain during labour .