***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: OBJECTIVE The purpose of this pilot study was to test the effects of guided imagery on blood loss during the third stage of labor . DESIGN AND SETTING This was a three-group r and omized controlled trial . Recruitment was conducted from a university nurse-midwifery practice . SUBJECTS Sixty ( 60 ) women between pregnancy weeks 36 and 38 participated . INTERVENTIONS The women were r and omized into experimental , placebo , and control groups . OUTCOME MEASURES Intrauterine pressure catheters were used to measure uterine contraction frequency and intensity . Blood loss was measured . Analysis of variance was used to compare the three groups on continuous variables . RESULTS Complete data were collected on 41 subjects . No significant differences were found among the groups on demographic or potentially confounding variables . CONCLUSIONS Blood loss was nominally lower in the experimental group , but conclusions can not be drawn due to the sample size BACKGROUND Postnatal and antenatal depression are a focus of considerable clinical and research attention , but little is known about the patterns of anxiety across this period . METHODS  Self-reported anxiety and depression were assessed at 18 and 32 weeks gestation and 8 weeks and 8 months postnatally in a prospect i ve longitudinal study of a community sample of women in Engl and ( n=8323 ) . RESULTS The majority of cases of postnatal depression were preceded by antenatal depression ; similarly , postnatal anxiety was preceded by antenatal anxiety . Despite the stability of anxiety and depression across this period , there was a mean decrease in both anxiety and depression . Finally , antenatal anxiety predicted postnatal depression at 8 weeks and 8 months , even after controlling for antenatal depression ( OR=3.22 , p<0.001 ) . LIMITATIONS Data were based on self-report only and there was evidence of selective attrition . CONCLUSION The findings confirm that antenatal anxiety occurs frequently , overlaps with depression and increases the likelihood of postnatal depression Background Although medical interventions play an important role in preserving lives and maternal comfort they have become increasingly routine in normal childbirth . This may increase the risk of associated complications and a less satisfactory birth experience . Antenatal hypnosis is associated with a reduced need for pharmacological interventions during childbirth . This trial seeks to determine the efficacy or otherwise of antenatal group hypnosis preparation for childbirth in late pregnancy . Methods / design A single centre , r and omised controlled trial using a 3 arm parallel group design in the largest tertiary maternity unit in South Australia . Group 1 participants receive antenatal hypnosis training in preparation for childbirth administered by a qualified hypnotherapist with the use of an audio compact disc on hypnosis for re-enforcement ; Group 2 consists of antenatal hypnosis training in preparation for childbirth using an audio compact disc on hypnosis administered by a nurse with no training in hypnotherapy ; Group 3 participants  continue with their usual preparation for childbirth with no additional intervention . Women > 34 and < 39 weeks gestation , planning a vaginal birth , not in active labour , with a singleton , viable fetus of vertex presentation , are eligible to participate . Allocation concealment is achieved using telephone r and omisation . Participants assigned to hypnosis groups commence hypnosis training as near as possible to 37 weeks gestation . Treatment allocations are concealed from treating obstetricians , anaesthetists , midwives and those personnel collecting and analysing data . Our sample size of 135 women/group gives the study 80 % power to detect a clinical ly relevant fall of 20 % in the number of women requiring pharmacological analgesia – the primary endpoint . We estimate that approximately 5–10 % of women will deliver prior to receiving their allocated intervention . We plan to recruit 150 women/group and perform sequential interim analyses when 150 and 300 participants have been recruited . All participant data will be analysed , by a research er blinded to treatment allocation , according to the " Intention to treat " principle with comprehensive pre-planned cost- benefit and subgroup analyses . Discussion If effective , hypnosis would be a simple , inexpensive way to improve the childbirth experience , reduce complications associated with pharmacological interventions , yield cost savings in maternity care , and this trial will provide evidence to guide clinical practice In a study of the effectiveness of systematic relaxation training alone or combined with biofeedback in the treatment of  hypertension in pregnancy , 60 women were seen weekly for 6 weeks . 18 were given relaxation therapy alone ( group A ) , 18 relaxation plus biofeedback ( group B ) , and there were 24 controls . Whereas two-thirds of the control group had to be admitted to hospital during their pregnancies , less than a third of each experimental group had to be admitted . The experimental groups also had significantly lower systolic and diastolic blood pressure than the control group . There were no significant differences between groups A and B in hospital admission rates or blood-pressure measurements 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 Purpose : To explore the effect of music therapy on anxiety alleviation for antepartal women on bedrest in China . Design and Methods : One hundred and twenty patients recruited from one tertiary hospital in Changsha city , China were enrolled in a r and omized controlled trial . Women in the experimental group received music therapy for 30 minutes on 3 consecutive days . Usual care participants had a 30-minute rest on 3 consecutive days . Variables included anxiety ( State-Trait Anxiety Inventory ) , and physiological responses ( vital signs , fetal heart rate ) . Descriptive statistics , t tests , χ2 tests , Wilcoxon rank sum tests , and Pearson correlation analyses were used to analyze the data . Results : Anxiety levels decreased and physiological responses improved significantly in the intervention group , which was provided with music therapy while on bedrest . Clinical Implication s : Carefully selected music that incorporates a patient 's own preferences may offer an inexpensive and effective method to reduce anxiety for antepartal women with high risk pregnancies who are on bedrest This study examined the effects of a yoga program during pregnancy , on  maternal comfort , labor pain , and birth outcomes .  A r and omized trial was conducted using 74-primigravid Thai women who were equally divided into two groups ( experimental and control ) . The yoga program involved six , 1-h sessions at prescribed weeks of gestation . A variety of instruments were used to assess maternal comfort , labor pain and birth outcomes . The experimental group was found to have higher levels of maternal comfort during labor and 2h post-labor , and experienced less subject evaluated labor pain than the control group . In each group , pain increased and maternal comfort decreased as labor progressed . No differences were found , between the groups , regarding pethidine usage , labor augmentation or newborn Apgar scores at 1 and 5 min . The experimental group was found to have a shorter duration of the first stage of labor , as well as the total time of labor Summary Stress and negative mood during pregnancy increase risk for poor childbirth outcomes and postnatal mood problems and may interfere with mother – infant attachment and child development . However , relatively little research has focused on the efficacy of psychosocial interventions to reduce stress and negative mood during pregnancy . In this study , we developed and pilot tested an eight-week mindfulness-based intervention directed toward reducing stress and improving mood in pregnancy and early postpartum . We then conducted a small r and omized trial ( n = 31 ) comparing women who received the intervention during the last half of their pregnancy to a wait-list control group .  Measures of perceived stress , positive and negative affect , depressed and anxious mood , and affect regulation were collected prior to , immediately following , and three months after the intervention ( postpartum ) . Mothers who received the intervention showed significantly reduced anxiety ( effect size , 0.89 ; p < 0.05 ) and negative affect ( effect size , 0.83 ; p < 0.05 ) during the third trimester in comparison to those who did not receive the intervention . The brief and nonpharmaceutical nature of this intervention makes it a promising c and i date for use during pregnancy BACKGROUND Paroxetine hydrochloride is commonly used for maternal depression , panic disorder , and obsessive-compulsive disorder . The drug readily crosses the human placenta . Although it does not appear to increase teratogenic risk , there have been case reports of neonatal withdrawal . Symptoms were described soon after birth and lasted up to 1 month . OBJECTIVE To investigate whether there is a clinical ly important discontinuation syndrome in neonates exposed to paroxetine in utero . METHODS Prospect i ve , controlled cohort study . PATIENTS Fifty-five pregnant women counseled prospect ively by the Motherisk program in Toronto , Ontario , regarding third-trimester exposure to paroxetine and their infants were included in the study group . Pregnant women who discontinued paroxetine before the third trimester or those receiving other drugs known to cause withdrawal-type symptoms , such as opioids or benzodiazepines , were excluded . A comparison group of 27 women using paroxetine during the first or second trimester and 27 women using nonteratogenic drugs  were matched for maternal age , gravity , parity , social drug use , and nonteratogenic drug use . RESULTS Of the 55 neonates exposed to paroxetine in late gestation , 12 had complications necessitating intensive treatment and prolonged hospitalization . The most prevalent clinical picture was respiratory distress ( n = 9 ) , followed by hypoglycemia ( n = 2 ) , and jaundice ( n = 1 ) . The symptoms disappeared within 1 to 2 weeks . In the comparison group , only 3 infants experienced complications ( P = .03 ) . In logistic regression , only third-trimester exposure to paroxetine was associated with neonatal distress ( odds ratio , 9.53 ; 95 % confidence interval , 1.14 - 79.3 ) . CONCLUSION When used near term , paroxetine is associated with a high rate of neonatal complications , possibly caused by its common discontinuation syndrome Eighty-four depressed pregnant women were recruited during the second trimester of pregnancy and r and omly assigned to a massage therapy group , a progressive muscle relaxation group or a control group that received st and ard prenatal care alone . These groups were compared to each other and to a non-depressed group at the end of pregnancy . The massage therapy group participants received two 20 min therapy sessions by their significant others each week for 16 weeks of pregnancy , starting during the second trimester . The relaxation group provided themselves with progressive muscle relaxation sessions on the same time schedule . Immediately after the massage therapy sessions on the first and last days of the 16-week period the women reported lower levels of anxiety and depressed mood and less leg and back pain . By the end of the study the massage group had higher dopamine and serotonin levels and lower levels of cortisol and norepinephrine . These changes may have contributed to the reduced fetal activity and the better neonatal outcome for the massage group ( i.e. lesser incidence of prematurity and low birthweight ) , as well as their better performance on the Brazelton Neonatal Behavior Assessment . The data suggest that depressed pregnant women and their offspring can benefit from massage therapy 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 . RES 
    Output:
    
Autogenic training might be effective for decreasing  women 's anxiety before delivering .
Mind-body interventions might benefit women 's anxiety during pregnancy .
Based on individual studies , there is some but no strong evidence for the effectiveness of mind-body interventions for the management of anxiety during pregnancy .