***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 No midwifery-led units existed in Irel and before 2004 . The aim of this study was to compare midwife-led ( MLU ) versus consultant-led ( CLU ) care for healthy , pregnant women without risk factors for labour and delivery . Methods An unblinded , pragmatic r and omised trial was design ed , funded by the Health Service Executive ( Dublin North-East ) . Following ethical approval , all women booking prior to 24 weeks of pregnancy at two maternity hospitals with 1,300 - 3,200 births annually in Irel and were assessed for trial eligibility .1,653 consenting women were central ly r and omised on a 2:1 ratio to MLU or CLU care , ( 1101:552 ) . ' Intention-to-treat ' analysis was used to compare 9 key neonatal and maternal outcomes . Results No statistically significant difference was found between MLU and CLU in the seven key outcomes : caesarean birth ( 163 [ 14.8 % ] vs 84 [ 15.2 % ] ; relative risk ( RR ) 0.97 [ 95 % CI 0.76 to 1.24 ] ) , induction ( 248 [ 22.5 % ] vs 138 [ 25.0 % ] ; RR 0.90 [ 0.75 to 1.08 ] ) , episiotomy ( 126 [ 11.4 % ] vs 68 [ 12.3 % ] ; RR 0.93 [ 0.70 to 1.23 ] ) , instrumental birth ( 139 [ 12.6 % ] vs 79 [ 14.3 % ] ; RR 0.88 [ 0.68 to 1.14 ] ) , Apgar scores < 8 ( 10 [ 0.9 % ] vs 9 [ 1.6 % ] ; RR 0.56 [ 0.23 to 1.36 ] ) , postpartum haemorrhage ( 144 [ 13.1 % ] vs 75 [ 13.6 % ] ; RR 0.96 [ 0.74 to 1.25 ] ) ; breastfeeding initiation ( 616 [ 55.9 % ] vs 317 [ 57.4 % ] ; RR 0.97 [ 0.89 to 1.06 ] ) . MLU women were significantly less likely to have continuous electronic fetal monitoring ( 397 [ 36.1 % ] vs 313 [ 56.7 % ] ; RR 0.64 [ 0.57 to 0.71 ] ) , or augmentation of labour ( 436 [ 39.6 % ] vs 314 [ 56.9 % ] ; RR 0.50 [ 0.40 to 0.61 ] ) . Conclusions Midwife-led care , as practised in this study , is as safe as consultant-led care and is associated with less intervention during labour and delivery . Trial registration numberIS RCT N : IS RCT Abstract Objective : To compare routine antenatal care provided by general practitioners and midwives with obstetrician led shared care . Design : Multicentre r and omised controlled trial . Setting : 51 general practice s linked to nine Scottish maternity hospitals . Subjects : 1765 women at low risk of antenatal complications . Intervention : Routine antenatal care by general practitioners and midwives according to a care plan and protocol s for managing complications . Main outcome measures : Comparisons of health service use , indicators of quality of care , and women 's satisfaction . Results : Continuity of carer was improved for the general practitioner and midwife group as the number of carers was less ( median 5 carers v 7 for shared care group , P<0.0001 ) and the number of routine visits reduced ( 10.9 v 11.7 , P<0.0001 ) . Fewer women in the general practitioner and midwife group had antenatal admissions ( 27 % ( 222/834 ) v 32 % ( 266/840 ) , P<0.05 ) , non-attendances ( 7 % ( 57 ) v 11 % ( 89 ) , P<0.01 ) and daycare ( 12 % ( 102 ) v 7 % ( 139 ) , P<0.05 ) but more were referred ( 49 % ( 406 ) v 36 % ( 305 ) , P<0.0001 ) . Rates of antenatal diagnoses did not differ except that fewer women in the general practitioner and midwife group had hypertensive disorders ( pregnancy induced hypertension , 5 % ( 37 ) v 8 % ( 70 ) , P<0.01 ) and fewer had labour induced ( 18 % ( 149 ) v 24 % ( 201 ) , P<0.01 ) . Few failures to comply with the care protocol occurred , but more Rhesus negative women in the general practitioner and midwife group did not have an appropriate antibody check ( 2.5 % ( 20 ) v 0.4 % ( 3 ) , P<0.0001 ) . Both groups expressed high satisfaction with care ( 68 % ( 453/663 ) v 65 % ( 430/656 ) , P=0.5 ) and acceptability of allocated style of care ( 93 % ( 618 ) v 94 % ( 624 ) , P=0.6 ) . Access to hospital support before labour was similar ( 45 % ( 302 ) v 48 % ( 312 ) visited labour rooms before giving birth , P=0.6 ) . Conclusion : Routine specialist visits for women initially at low risk of pregnancy complications offer little or no clinical or consumer benefit . Key messages Key messages Care by general practitioners and midwives improved continuity of care : there were fewer carers , non-attendances , and hospital admissions , and marginally fewer routine visits than with specialist led shared care ; incidences of hypertension , proteinuria , pre-eclampsia , and induction of labour were also lower Overall there were few deviations from the care protocol , but a greater proportion of Rhesus negative women in the general practitioner and midwife group did not have an appropriate check for antibodies The women in both trial groups were equally highly satisfied with all aspects of their care ; only a small minority of women in the general practitioner and midwife group said they would have liked to have seen a hospital doctor but did not Although there was no net benefit from routine specialist antenatal visits , over half of women developed some complication during their pregnancy ; in the general practitioner and midwife model of care , low risk women see a specialist when required and not at predefined routine Abstract Objective To identify potential risk or mishap in the  system of intrapartum care , relating to the deployment of midwives . Design Prospect i ve semistructured observational study . Setting Labour wards of seven maternity units in the north west of Engl and . Participants All midwives working on the labour ward during the observation period in 2000 . Main outcome measure “ Latent failures ” within the system relating to midwifery staffing levels , deployment , and training or updating opportunities . Results Despite the exemplary dedication of midwives , potential risk of mishap due to their deployment occurred within the system of care . A shortfall of midwives existed in all seven maternity units and was most acute in the largest units . Six units relied on bank midwives to maintain minimum staffing levels . High risk practice s ( oxytocin administration and epidural blockades ) continued during midwifery shortfalls in all units . Some adverse events and “ near misses ” were attributable to midwifery shortages in all units , and near misses remained unreported in all units . Uptake of opportunities for training or updating in interpretation of cardiotocographs and obstetric emergency management remained low owing to midwifery shortages in all units . A poor skill mix of midwives occurred at times in all units . In six units midwives spent time away from clinical areas performing clerical duties . In three units team midwifery systems were reported to erode labour ward skills and confidence . Conclusion Midwives are fundamental components in the system of intrapartum care , and the system can not operate safely and effectively when the number of midwives is inadequate , midwives are poorly deployed , and they are unable to engage in opportunities for training and updating OBJECTIVE to study the effect of birth centre care on the duration of breast feeding , breast feeding complications , and women 's experiences of breast feeding .  DESIGN r and omised controlled trial . SETTING in-hospital birth centre at South Hospital , Stockholm , and st and ard obstetric care in the Greater Stockholm area . SUBJECTS 1230 women with expected date of birth between October 1989 and February 1992 , interested in participating in a birth centre trial , and meeting medical low-risk criteria . 617 women were allocated to the experimental group offered birth centre care ( EG ) , and 613 to the  control group offered  st and ard obstetric care ( CG ) . MAIN OUTCOME MEASURES duration of breast feeding , breast feeding complications such as sore nipples , engorgement , milk stasis , and mastitis , and women 's experiences of breast feeding . FINDINGS no difference was found between EG and CG in the duration of breast feeding . Ninety-three per cent in both groups were breast feeding exclusively two months post partum . The average number of months of breast feeding , exclusively or partly , when investigated one year after the birth was 8.6 in EG and 8.5 in CG . No difference was observed in women 's experiences of breast feeding , but rather more women in EG than in CG reported sore nipples , 36 % and 30 % respectively ( p = 0.03 ) , and milk stasis , 26 % and 19 % respectively ( p = 0.002 ) . CONCLUSIONS birth centre care had no effect on the duration of breast feeding , or on women 's experiences of breast feeding . Prenatal attitudes were probably more significant predictors of these outcomes than differences in the two modes of maternity care in this population of highly breast feeding-motivated women . The larger proportion of sore nipples and milk stasis in the EG might have been due to earlier discharge , or to midwives less skilled in assisting with breast feeding at the birth centre than in the postpartum wards Objectives To compare the outcome of two methods of  maternity care during the antenatal period and at delivery . One was to be midwife‐led for both antenatal care and delivery , the latter taking place in rooms similar to those in one 's own home to simulate home confinement . The other would be consultant‐led with the mothers labouring in the delivery suite rooms with resuscitation equipment for both mother and baby in evidence , monitors present and a delivery bed on which both anaesthetic and obstetric procedures could be easily and safely carried out OBJECTIVE to explore the relationship between the degree to which labour is established on admission to hospital and method of birth . BACKGROUND a recent r and omised controlled trial found fewer caesarean sections ( CS ) in women allocated to  caseload midwifery  ( 19.4 % ) compared with st and ard care ( 24.9 % ) . There is interest in exploring what specific aspects of the care might have result ed in this reduction . SETTING a large tertiary-level maternity service in Melbourne , Australia . PARTICIPANTS English-speaking women with no previous caesarean section at low risk of complications in pregnancy were recruited to a r and omised controlled trial . Trial participants whose management did not include a planned caesarean and who were admitted to hospital in spontaneous labour were included in this secondary analysis of trial data ( n=1532 ) . METHODS this secondary analysis included women admitted to hospital in spontaneous labour who were r and omised to caseload midwifery compared with those r and omised to st and ard care  with regard to timing of admission in labour , augmentation of labour and use of epidural analgesia . In a further analysis r and omised groups were pooled to examine predictors of caesarean section for first births only using multiple logistic regression . RESULTS nulliparous women r and omised to st and ard care were more likely to have labour augmented than those having caseload care ( 54.2 % and 45.5 % respectively , p=0.008 ) , but were no more likely to use epidural analgesia . They were admitted earlier in labour , spending 1.1 hours longer than those in the caseload arm in hospital before the birth ( p=0.003 ) . Parous women allocated to st and ard care were more likely than those in the caseload arm to use epidural analgesia ( 10.0 % and 5.3 % respectively , p=0.047 ) , but were no more likely to have labour augmented . They were also admitted earlier in labour , with a median cervical dilatation of 4 cm compared with 5 cm in the caseload arm ( p=0.012 ) . Pooling the two r and omised groups of nulliparous women , and after adjusting for r and omised group , maternal age and maternal body mass index , early admission to hospital was strongly associated with caesarean section . Admission before the cervix was 5 cm dilated increased the odds 2.4-fold ( 95%CI 1.4 , 4.0 ; p=0.001 ) . Augmentation of labour and use of epidural analgesia were each strongly associated with caesarean section ( adjusted odds ratios 3.10 ( 95%CI 2.1 , 4.5 ) and 5.77 ( 95%CI 4.0 , 8.4 ) respectively . CONCLUSION these findings that women allocated to caseload care were admitted to hospital later in labour , and that earlier admission was strongly associated with birth by 
    Output:
    
Similarly , there was a trend towards a cost-saving effect for midwife-led continuity care compared to other care models .
This review suggests that women who received midwife-led continuity models of care were less likely to experience intervention and more likely to be satisfied with their care with at least comparable adverse outcomes for women or their infants than women who received other models of care .
Further research is needed to explore findings of fewer preterm births and fewer fetal deaths less than 24 weeks , and all fetal loss/neonatal death associated with midwife-led continuity models of care