***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: Abstract Background : Previous studies on the treatment of women with fear of childbirth have focused on the delivery mode . Women with fear of childbirth often suffer from anxiety and /or depression , and treatment therefore also needs to target postnatal psychological well-being and the early mother – infant relationship . Methods : Three hundred and seventy-one nulliparous women out of 4575 scored ≥100 in prospect i ve screening ( Wijma Delivery Expectancy Question naire , W-DEQ-A ) , indicating severe fear of childbirth . These women were r and omised to psychoeducative group intervention with relaxation ( n = 131 ; six sessions during pregnancy , one postnatal ) or to conventional care ( n = 240 ) by community nurses ( referral if necessary ) . Psycho-emotional and psychosocial evaluations [ Edinburgh Postnatal Depression Scale ( EPDS ) , social support , Maternal Adjustment and Attitudes ( MAMA ) , Traumatic Events Scale ( TES ) and the Wijma Delivery Experience Question naire ( W-DEQ-B ) ] were completed twice during pregnancy and /or 3 months postpartum . Results : Postnatal maternal adjustment ( MAMA mean score 38.1 ± 4.3 versus 35.7 ± 5.0 , p = 0.001 ) and childbirth experience ( mean W-DEQ-B sum score 63.0 ± 29 versus 73.7 ± 32 , p = 0.008 ) were better in the intervention group compared with controls . In hierarchical regression , social support , participating in intervention , and less fearful childbirth experience predicted better maternal adjustment . The level of postnatal depressive symptoms was significantly lower in the intervention group ( mean sum score 6.4 ± 5.4 versus 8.0 ± 5.9 p = 0.04 ) . There were no differences in the frequency of post-traumatic stress symptoms between the groups . Conclusions : In nulliparous women with severe fear of childbirth , participation in a targeted psychoeducative group result ed in better maternal adjustment , a less fearful childbirth experience and fewer postnatal depressive symptoms , compared with conventional care Background Childbirth fear is associated with increased obstetric interventions and poor emotional and psychological health for women . The purpose of this study is to test an antenatal psycho-education intervention by midwives in reducing women 's childbirth fear . Methods Women ( n = 1,410 ) attending three hospitals in South East Queensl and , Australia , were recruited into the BELIEF trial . Participants reporting high fear were r and omly allocated to intervention ( n = 170 ) or control ( n = 169 ) groups . All women received a decision-aid booklet on childbirth choices . The telephone counseling intervention was offered at 24 and 34 weeks of pregnancy . The control group received usual care offered by public maternity services . Primary outcome was reduction in childbirth fear ( WDEQ-A ) from second trimester to 36 weeks ’ gestation . Secondary outcomes were improved childbirth self-efficacy , and reduced decisional conflict and depressive symptoms . Demographic , obstetric & psychometric measures were administered at recruitment , and 36 weeks of pregnancy . Results There were significant differences between groups on postintervention scores for fear of birth ( p < 0.001 ) and childbirth self-efficacy ( p = 0.002 ) . Decisional conflict and depressive symptoms reduced but were not significant . Conclusion Psycho-education by trained midwives was effective in reducing high childbirth fear levels and increasing childbirth confidence in pregnant women . Improving antenatal emotional well-being may have wider positive social and maternity care implication s for optimal childbirth experiences AIM The aim of this study was to determine the effect of antenatal education on fear of childbirth , acceptance of pregnancy and identification with motherhood role . BACKGROUND There is insufficient evidence pertaining to the effect of antenatal education on fear of childbirth , acceptance of pregnancy and identification with motherhood role . INTRODUCTION The purpose of antenatal education is to help couples make the right decisions during delivery . Through antenatal education , couples prepare themselves for delivery . METHODS This is a quasi-experimental and prospect i ve study that employs a pre- and post-education model . In total , 192 pregnant women ( education group , n = 69 and control group , n = 123 ) participated in the study . Data were collected using the pregnancy identification form : the Prenatal Self-Evaluation Question naire and a version of the Wijma Delivery Expectancy/Experience Question naire . RESULTS Prior to participating in the study , the education group and control group had similar levels of acceptance of pregnancy and identification with motherhood role , whereas a significant difference was found in their fear of childbirth levels . When surveyed again after receiving education , the two groups ' levels of acceptance of pregnancy and fear of childbirth were found to be significantly different . However , they had similar levels of identification with the motherhood role . CONCLUSION Antenatal education appears to increase the acceptance of pregnancy , does not affect the identification with motherhood role and reduces the fear of childbirth . IMPLICATION S FOR NURSING AND HEALTH POLICY A systematic antenatal education programme , as part of routine antenatal care services , would help reduce the rate of interventional labour and facilitate pregnant women 's conscious participation in the act of labour by reducing their fear of childbirth BACKGROUND Forest plots are graphical displays of findings of systematic review s and meta-analyses . Little is known about the style and content of these plots and whether published plots maximize the graphic 's potential for information exchange . METHODS We examine the number , style and content of forest plots presented in a previously studied cross-sectional sample of 300 systematic review s. We studied all  forest plots in non-Cochrane review s and a sample of forest plots in Cochrane review s. RESULTS The data base contained 129 Cochrane review s and 171 non-Cochrane review s. All the Cochrane review s had forest plots ( 2197 in total ) , and a r and om sample of 500 of these plots were included . In total , 28 of the non-Cochrane review s had forest plots  ( 139 in total ) , all of which were included . Plots in Cochrane review s were st and ardized but often contained little data ( 80 % had three or fewer studies ; 10 % had no studies ) and always presented studies in alphabetical order . Non-Cochrane plots depicted a larger number of studies ( 60 % had four or more studies ) and 59 % ordered studies by a potentially meaningful characteristic , but important information was often missing . Of the 28 review s that had a forest plots with at least 10 studies , 3 ( 11 % ) had funnel plots . CONCLUSIONS Forest plots in Cochrane review s were highly st and ardized but some of the st and ards do not optimize information exchange , and many of the plots had too little data to be useful . Forest plots in non-Cochrane review s often omitted key elements but had more data and were often more thoughtfully constructed 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 BACKGROUND Childbirth is a dem and ing event in a woman 's life . The aim of this study was to explore whether a brief intervention in the form of an antenatal course in self-hypnosis to ease childbirth could improve the childbirth experience . METHOD In a r and omized , controlled , single-blinded trial , 1,222 healthy nulliparous women were allocated to one of three groups during pregnancy : A hypnosis group participating in three 1-hour sessions teaching self-hypnosis to ease childbirth , a relaxation group receiving three 1-hour lessons in various relaxation methods and Mindfulness , and a usual care group receiving ordinary antenatal care only .  Wijmas Delivery Expectancy/Experience Question naire ( W-DEQ ) was used to measure the childbirth experience 6 weeks postpartum . RESULTS The intention-to-treat analysis indicated that women in the hypnosis group experienced their childbirth as better compared with the other two groups ( mean W-DEQ score of 42.9 in the Hypnosis group , 47.2 in the Relaxation group , and 47.5 in the Care as usual group ( p = 0.01 ) ) . The tendency toward a better childbirth experience in the hypnosis group was also seen in subgroup analyses for mode of delivery and for levels of fear . CONCLUSION In this large r and omized controlled trial , a brief course in self-hypnosis improved the women 's childbirth experience Objective To examine whether depression and anxiety in early pregnancy are associated with  preeclampsia in an unselected nulliparous population . Methods In this prospect i ve population -based study during pregnancy at outpatient maternity clinics in the Helsinki metropolitan area , depression was assessed by a Finnish modification of the short form of the Beck Depression Inventory  and anxiety by one established question . Preeclampsia was defined as elevated blood pressure ( BP ) ( more than 140/100 mmHg ) and proteinuria ( 0.3 g during 24 hours or more ) . Age , smoking , alcohol consumption , marital status , socioeconomic status , and bacterial vaginosis were analyzed as potentially confounding factors in a multiple logistic regression analysis . Results Six hundred twenty-three consecutive nulliparous women with singleton pregnancies were studied at ten to 17 ( median 12 ) weeks ' gestation and at delivery . Of them , 28 ( 4.5 % ) women developed preeclampsia . Depression ( mean Beck score 4.5 , range 3–17 ) was observed in 185 ( 30 % ) , women and anxiety was observed in 99 ( 16 % ) in early pregnancy . In multivariate analysis , after adjustment for potentially confounding factors , depression was associated with increased risk ( odds ratio [ OR ] 2.5 ; 95 % confidence interval [ CI ] 1.1 , 5.4 ) for preeclampsia , as was anxiety ( OR 3.2 ; 95 % CI 1.4 , 7.4 ) . Either depression or anxiety , or both , were associated with increased risk ( OR 3.1 ; 95 % CI 1.4 , 6.9 ) for preeclampsia . Bacterial vaginosis together with depression was associated with increased risk ( OR 5.3 ; 95 % CI 1.8 , 15.0 ) for preeclampsia . Conclusion Depression and anxiety in early pregnancy are associated with risk for subsequent preeclampsia , a risk further increased by bacterial vaginosis Background : The number of women who select cesarean section due to fear of childbirth has increased . Role play education seems to be a helpful method to remove or reduce the fear of childbirth . Therefore , this study aim ed to investigate the effect of role play education on primiparous women 's fear of natural delivery and their decision on the mode of delivery . Material s and Methods : In this blind clinical trial , 67 primiparous women with natural pregnancy at 34–36 weeks of gestational age and with no indication of cesarean section were selected from the health care centers in Mashhad . They were r and omly assigned to two groups who underwent pre-test and post-test with the help of delivery attitude question naire to investigate their fear of childbirth and a research er-made pregnant women 's decision investigation question naire . Education through role play was conducted in the form of three scenarios during seven stages . The findings were analyzed by Fisher 's exact test and independent t-test through SPSS . Results : The two groups were significantly different concerning the fear of childbirth after the intervention ( P = 0.007 ) , and the fear score showed a higher reduction in the role play group compared to the lecture group . There was a significant difference between the two groups concerning the reduction of elective cesarean section and the decision on the mode of delivery at the time of admission in the labor room ( P = 0.000 ) . About 75 % in the lecture group and 100 % in the role play group selected natural delivery . Conclusions : In the present study , the effect of role play was more in making a decision on natural delivery , reducing the fear of childbirth , and reducing the rate of elective cesarean section . It is suggested to use role play method to educate pregnant women to reduce the rate of cesarean sections OBJECTIVE To compare intensive and conventional therapy for  severe fear of childbirth . METHODS In Finl and , 176 women who had fear of childbirth were r and omly assigned at the 26th gestational week to have either intensive therapy ( mean 3.8 ± 1.0 sessions with obstetrician and one with midwife ) or conventional therapy  ( mean 2.0 ± 0.6 sessions ) , with follow‐up 3 months postpartum . Pregnancy‐related anxiety and concerns , satisfaction with childbirth , and puerperal depression were assessed with specific question naires . Power analysis , based on previous studies , showed that 74 women per group were necessary to show a 50 % reduction in cesarean rates . 
    Output:
    
Both types of interventions were effective in reducing fear of childbirth ; however our pooled results revealed that educational interventions may reduce fear with double the effect of hypnosis .