***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 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 Please cite this paper as : McLachlan H , Forster D , Davey M , Farrell T , Gold L , Biro M , Albers L , Flood M , Oats J , Waldenström U. Effects of continuity of care by a primary midwife ( caseload midwifery ) on caesarean section rates in women of low obstetric risk : the COSMOS r and omised controlled trial . BJOG 2012;119:1483–1492 Background In Australia and internationally , there is concern about the growing proportion of women giving birth by caesarean section .  There is evidence of increased risk of placenta accreta and percreta in subsequent pregnancies as well as decreased fertility ; and significant re source implication s. R and omised controlled trials ( RCTs ) of continuity of midwifery care have reported reduced caesareans and other interventions in labour , as well as increased maternal satisfaction , with no statistically significant differences in perinatal morbidity or mortality . RCTs conducted in the UK and in Australia have largely measured the effect of teams of care providers ( commonly 6–12 midwives ) with very few testing caseload ( one-to-one ) midwifery care . This study aims to determine whether caseload ( one-to-one ) midwifery care for women at low risk of medical complications decreases the proportion of women delivering by caesarean section  compared with women receiving  ' st and ard '  care . This paper presents the trial protocol in detail . Methods / design A two-arm RCT design will be used . Women who are identified at low medical risk will be recruited from the antenatal booking clinics of a tertiary women 's hospital in Melbourne , Australia . Baseline data will be collected , then women r and omised to caseload midwifery or st and ard low risk care . Women allocated to the caseload intervention will receive antenatal , intrapartum and postpartum care from a design ated primary midwife with one or two antenatal visits conducted by a ' back-up ' midwife . The midwives will collaborate with obstetricians and other health professionals as necessary . If the woman has an extended labour , or if the primary midwife is unavailable , care will be provided by the back-up midwife . For women allocated to st and ard care , options include midwifery-led care with varying levels of continuity , junior obstetric care and community based general medical practitioner care . Data will be collected at recruitment ( self administered survey ) and at 2 and 6 months postpartum by postal survey . Medical/obstetric outcomes will be abstract ed from the medical record . The sample size of 2008 was calculated to identify a decrease in caesarean birth from 19 to 14 % and detect a range of other significant clinical differences . Comprehensive process and economic evaluations will be conducted . Trial registration Australian New Zeal and Clinical Trials Registry ACTRN012607000073404 Background Australia has an enviable record of safety for women in childbirth . There is nevertheless growing concern at the increasing level of intervention and consequent morbidity amongst childbearing women . Not only do interventions impact on the cost of services , they carry with them the potential for serious morbidities for mother and infant . Models of midwifery have proliferated in an attempt to offer women less fragmented hospital care . One of these models that is gaining widespread consumer , disciplinary and political support is caseload midwifery care .  Caseload midwives manage the care of approximately 35 - 40 a year within a small Midwifery Group Practice ( usually 4 - 6 midwives who plan their on call and leave within the Group Practice . ) We propose to compare the outcomes and costs of caseload midwifery care compared to st and ard or routine hospital care through a r and omised controlled trial . Methods / design A two-arm RCT design will be used . Women will be recruited from tertiary women 's hospitals in Sydney and Brisbane , Australia . Women allocated to the caseload intervention will receive care from a named caseload midwife within a Midwifery Group Practice . Control women will be allocated to st and ard or routine hospital care . Women allocated to st and ard care will receive their care from hospital rostered midwives , public hospital obstetric care and community based general medical practitioner care . All midwives will collaborate with obstetricians and other health professionals as necessary according to the woman 's needs . Discussion Data will be collected at recruitment , 36 weeks antenatally , six weeks and six months postpartum by web based or postal survey . With 750 women or more in each of the intervention and control arms the study is powered ( based on 80 % power ; alpha 0.05 ) to detect a difference in caesarean section rates of 29.4 to 22.9 % ; instrumental birth rates from 11.0 % to 6.8 % ; and rates of admission to neonatal intensive care of all neonates from 9.9 % to 5.8 % ( requires 721 in each arm ) . The study is not powered to detect infant or maternal mortality , however all deaths will be reported . Other significant findings will be reported , including a comprehensive process and economic evaluation . Trial registration Australian New Zeal and Clinical Trials Registry Objective : To examine the cost‐effectiveness of the West Los Angeles Preterm Birth Prevention Project . Methods : Maternal and neonatal care data were collected on all preterm deliveries ( 150 ) and a r and om sample of term deliveries ( 140 ) from high‐risk patients at both experimental and control clinic sites .  Costs were determined for prenatal care , inpatient preterm labor , delivery and postpartum care , and newborn care . Cost calculations , weighted by the actual proportions of term and preterm births , were confirmed with square‐root transformation and trimmed mean ( 2 % ) values . Results : When compared to control clinic high‐risk patients , experimental clinic high‐risk patients had an average cost savings of $ 2196 for newborn care ( P = .02 ) , result ing in a net savings of $ 1768 per high‐risk mother‐infant pair . Births before 32 weeks ' gestation accounted for the greatest mean cost . Conclusion : Programs of comprehensive prenatal care and patient education may be highly cost‐effective for prevention of prematurity . ( Obstet Gynecol 1994;83:506‐11 BACKGROUND Midwife-managed programmes of care are being widely implemented although there has been little investigation of their efficacy . We have compared midwife-managed care with shared care ( ie , care divided among midwives , hospital doctors , and general practitioners 
    Output:
    
Alternative models of antenatal care for all pregnant women are effective in reducing PTB compared with routine care , but no firm conclusions could be drawn regarding the relative benefits of the two models .