human
***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 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 ) in terms of clinical efficacy and women 's satisfaction . METHODS We carried out a r and omised controlled trial of 1299 pregnant women who had no adverse characteristics at booking ( consent rate 81.9 % ) . 648 women were assigned midwife-managed care and 651 shared care .  The research hypothesis was that compared with shared care , midwife-managed care would produce fewer interventions , similar ( or more favourable ) outcomes , similar complications , and greater satisfaction with care . Data were collected by retrospective review of case records and self-report question naires . Analysis was by intention to treat . FINDINGS Interventions were similar in the two groups or lower with midwife-managed care . For example , women in the midwife-managed group were less likely than women in shared care to have induction of labour ( 146 [ 23.9 % ] vs 199 [ 33.3 % ] ; 95 % CI for difference 4.4 - 14.5 ) . Women in the midwife-managed group were more likely to have an intact perineum and less likely to have had an episiotomy ( p = 0.02 ) , with no significant difference in perineal tears . Complication rates were similar . Overall , 32.8 % of women were permanently transferred from midwife-managed care ( 28.7 % for clinical reasons , 3.7 % for non- clinical reasons ) . Women in both groups reported satisfaction with their care but the midwife-managed group were significantly more satisfied with their antenatal ( difference in mean scores 0.48 [ 95 % CI 0.41 - 0.55 ] ) , intrapartum ( 0.28 [ 0.18 - 0.37 ] ) , hospital-based postnatal care ( 0.57 [ 0.45 - 0.70 ] ) , and home-based postnatal care ( 0.33 [ 0.25 - 0.42 ] ) . INTERPRETATION We conclude that midwife-managed care for healthy women , integrated within existing services , is clinical ly effective and enhances women 's satisfaction with maternity care Background there have been changes in maternity care policy over the last 20 years and women 's experience , continuity and satisfaction with care have become more prominent . However there has been no research examining changes over time in women 's reported experience . Methods this study used secondary analysis of data collected in four postal surveys of maternity care experiences in 1995 , 2006 , 2010 and 2014 . In each case women who had delivered in a specified time period in Engl and were r and omly sample d and sent a question naire three months after the birth . Women were excluded if they were aged less than 16 years or their infant had died . The majority of questions were comparable over the different surveys . Descriptive statistics and adjusted odds ratios are presented . Findings in the antenatal period , an increasing proportion of women had early first contact with a healthcare professional , screening for Down 's syndrome , both dating and anomaly scans and the total number of ultrasound scans increased over the period . The proportion of women given explanations about screening and choice regarding interventions during labour and birth both appear to have increased . In the postnatal period , length of hospital stay declined over time but the proportion of women who considered their length of stay too short remained constant . The number of postnatal home visits also declined and there was a substantial increase in the proportion of women who would have liked more visits . Overall satisfaction with care remained high especially for care during pregnancy , labour and birth . Conclusions despite fewer antenatal checks , shorter hospital stays and fewer postnatal home visits , women were generally very positive about their care in pregnancy , labour and birth , and the postnatal period . Maternity care has changed in many respects , with earlier contact with health professionals , more scans and more information . However , reduced continuity of care and a need for support in the early weeks with a new infant was expressed by many women and are issues that may be contributing to some of the dissatisfaction expressed OBJECTIVE To compare the outcomes of an adapted pilot Changing Childbirth initiative providing continuity of care by a group of known midwives with traditional maternity care .  DESIGN Between-groups trial to compare levels of satisfaction and clinical outcomes for two groups of women , cared for either under this Changing Childbirth scheme or the traditional model of care .  METHOD Of the 200 women who agreed to participate in the project , 100 were r and omly allocated to the pilot scheme and 100 to the traditional care package .  During the postpartum period , information was collected via a question naire about participants ' levels of satisfaction with a variety of aspects of care provided during the antenatal , delivery and postpartum periods . Data about clinical outcomes for the two groups were also obtained . RESULTS Women in the pilot group had significantly more continuity of care throughout each of the three periods , were generally more satisfied with their care , felt that they had more choice over a variety of aspects of care and experienced no compromise in clinical outcomes ( P = 0.05 or less in each case ) . IMPLICATION S FOR PRACTICE Many previous attempts to introduce the Changing Childbirth initiative have revealed significant problems , particularly with regard to the continuity of carer requirement . Taking account of local health care needs and existing provision , the present study adapted this concept to continuity of care . This did not apparently affect any of the guiding principles contained in the original document , and yet enhanced satisfaction . It would appear that the Changing Childbirth agenda can be adapted and integrated with local health care situations without sacrificing any of the overarching principles OBJECTIVE To compare women 's  satisfaction with midwife-managed care with ' shared care ' over three different time periods . DESIGN R and omised controlled trial . SETTING Glasgow Royal Maternity Hospital , Glasgow , UK . PARTICIPANTS 1299 women experiencing normal pregnancy ( consent rate : 82 % ) . Six hundred and forty-eight women were r and omised to midwife-managed care and 651 to ' shared care ' .  METHODS Three self-report question naires were sent to women 's homes . The question naires examined : satisfaction with antenatal care at 34 - 35 weeks ' gestation , and satisfaction with intrapartum , hospital- and home-based postnatal care at seven weeks postnatally . The third question naire review ed satisfaction with intrapartum care seven months after delivery . FINDINGS Women in both groups were satisfied . However , women in the midwife-managed group were more highly satisfied in relation to the dimensions examined : relationships with staff , information transfer , choices and decisions , and social support . The differences between the two groups were evident for all time periods ( i.e. antenatal , intrapartum and postnatal periods ) and were sustained at seven-month follow-up . This is illustrated in the mean scores for relationships with staff , as measured at 34 - 35 weeks ' gestation ( possible range -2 ; very negative attitudes to 2 ; very positive attitudes ) . Women in the midwife-managed group scored a mean of 1.22 compared to 0.74 for the ' shared care ' group ( mean diff : 0.48 ; 95 % CI : 0.42 to 0.55 ) . While women in both groups were more likely to make positive rather than negative comments in open-ended questions , the midwife-managed group were more likely to make positive comments whereas the ' shared care ' group were more likely to make negative comments . CONCLUSION Midwife-managed care for healthy pregnant women which is integrated into existing services improves satisfaction with antenatal , intrapartum and postnatal care BACKGROUND One-to-one midwifery was a demonstration project introduced into a London-based maternity service in 1993 to put into practice the new government policy for maternity services in Engl and . Evaluation was integral to the development of the project . METHODS The evaluation of women 's responses  was conducted between August 1994 and August 1995 based on a longitudinal , self-completion question naire , interviews , and focus groups . Women in the study group ( n = 728 ) received the new service and women in the control group ( n = 675 ) received conventional care . The study design integrated quantitative and qualitative methods and went beyond a simple estimation of satisfaction with care . RESULTS Satisfaction with antenatal and birth care was generally high , but study group women showed more positive responses overall . Both groups showed a preference for continuity of caregiver , but expectations were higher in the study group ( 72 % of the study group and 42 % of the control group preferred to see one caregiver ) . Both groups had less satisfied responses to hospital postnatal care ( 50 % study and 54 % control group were very satisfied ) . Study group women showed greater preparedness for birth than control group women ( 18 % vs 12 % " very well prepared " ) and for the time after the baby 's birth ( 26 % vs 15 % " very prepared " ) . CONCLUSIONS The study demonstrated that women were more satisfied with the one-to-one model of care . Taken together with the results of clinical and economic audit and professional responses , the evaluation suggests that this model should be developed and evaluated further to gain a greater underst and ing of women 's needs of the maternity service Objectives . Provision for ethnic minority groups has been acknowledged as integral to good maternity care in Engl and and ethnicity has been highlighted as an indicator of both poorer clinical outcomes and poorer experiences . Improving outcomes and services is dependent on underst and ing women 's interaction with both service delivery and provision . The aim of this study was to explore Black and minority ethnic ( BME ) women 's experiences of contemporary maternity care in Engl and . Design . A UK-wide survey which investigated core aspects of maternity care sought the views of BME women about their experiences . A r and om sample of women were selected by the Office for National Statistics from birth registration in Engl and and invited to complete a question naire three months after the birth . In a secondary analysis , text responses to open-ended questions about their maternity care were analysed using thematic analysis . Results . Sixty per cent of the 368 women who self-identified as BME responded with open text . Themes that emerged related to ‘ feeling cared for , ’ with subthemes of ‘ expectations of care ’ and ‘ policies , rules and organisational pressures ’ ; ‘ staff attitudes and communication ’ with sub-themes of ‘ please believe me , ’ ‘ hospital as a safe place , ’ ‘ choices denied ’ and ‘ being sensitive and supportive would help , ’ and ‘ ethnicity and culture ’ with sub-themes of ‘ stereotyping ’ and ‘ improving the quality of care . ’ Conclusion . The findings highlight issues affecting the quality of maternity care that BME women in Engl and receive . Many issues are not unique to BME women ; however , the findings reflect some seemingly enduring issues and coherence with other wider international findings , particularly in relation to post-natal care and staff attitudes . Actually being cared for and supported across their child-bearing experience are needs that women themselves identified as critical for care providers to recognise and respond to . The failures of care provision described should inform the development of services OBJECTIVE to investigate maternal  satisfaction with two pilot schemes based on the Changing Childbirth initiative ( DoH 1993 ) and to compare this with a traditional model of care . In addition , a limited number of clinical outcome measures were also assessed . DESIGN a retrospective between-group design was used . Question naire data were collected from three groups ( two pilot and one control ) about the antenatal , labour and postnatal periods to establish both satisfaction with key objectives of the Changing Childbirth initiative ( DoH 1993 ) , and basic clinical outcomes . SETTING a large Trust ( see definition in main article ) in Central Engl and , that covered a wide range of socio-economic strata . PARTICIPANTS the two pilot groups comprised 112 and 103 women respectively and were r and omly drawn from GP practice s within the Trust 's catchment area . The third group of 118 women ( Control ) was selected from the Trust 's obstetric unit . Women at high obstetric risk were excluded from this study . MEASUREMENT a five-part question naire was devised that covered : ( 1 ) preferences for type of care , health-care professional , venue etc ; ( 2 ) details of antenatal care provision and the participants ' satisfaction with this ; ( 3 ) labour , including clinical outcomes , labour and birth details and satisfaction with care ; ( 4 ) postnatal care information , including satisfaction scores ; and ( 5 ) information  and advice  given throughout the ante , delivery and postnatal periods and satisfaction with this . The question naires were administered six weeks postnatally . FINDINGS although the two pilot groups had been set up to follow a one-to-one midwifery care model , the second group naturally evolved into providing care from within a small group of midwives . This variation did not lead to any differences in any of the outcome measures . The women in the obstetrician-led group were not dissatisfied with the care , information and treatment they received , but they were significantly less satisfied than either of the two pilot groups . The pilot groups also rated more highly the information and choice that they had , and felt that the midwives acted as partners in the process . These findings applied to the antenatal , delivery and postnatal periods . No differences in clinical outcomes were observed between the groups . CONCLUSIONS midwifery-led care was much preferred to obstetrician-led care and did not lead to any deficits in clinical outcomes . The pilot scheme that adapted the initiative into small-group provision showed no reduction in satisfaction levels or other outcome measures . Since burn-out and stress have been identified as features of one-to-one midwifery provision , this model might have potential for off setting this problem , while still maintaining the spirit of the Changing Childbirth policy . From the perspective of maternal well-being , both physical and psychological , the initiative reported here appears to have been highly successful Breastfeeding was studied among women discharged early and late after normal delivery in a hospital . Early discharge was defined as leaving the hospital 24–48 h after delivery in combination with domiciliary visits , and late discharge as the regular hospital postpartum 
    Output:
    
agent
***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 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 ) in terms of clinical efficacy and women 's satisfaction . METHODS We carried out a r and omised controlled trial of 1299 pregnant women who had no adverse characteristics at booking ( consent rate 81.9 % ) . 648 women were assigned midwife-managed care and 651 shared care .  The research hypothesis was that compared with shared care , midwife-managed care would produce fewer interventions , similar ( or more favourable ) outcomes , similar complications , and greater satisfaction with care . Data were collected by retrospective review of case records and self-report question naires . Analysis was by intention to treat . FINDINGS Interventions were similar in the two groups or lower with midwife-managed care . For example , women in the midwife-managed group were less likely than women in shared care to have induction of labour ( 146 [ 23.9 % ] vs 199 [ 33.3 % ] ; 95 % CI for difference 4.4 - 14.5 ) . Women in the midwife-managed group were more likely to have an intact perineum and less likely to have had an episiotomy ( p = 0.02 ) , with no significant difference in perineal tears . Complication rates were similar . Overall , 32.8 % of women were permanently transferred from midwife-managed care ( 28.7 % for clinical reasons , 3.7 % for non- clinical reasons ) . Women in both groups reported satisfaction with their care but the midwife-managed group were significantly more satisfied with their antenatal ( difference in mean scores 0.48 [ 95 % CI 0.41 - 0.55 ] ) , intrapartum ( 0.28 [ 0.18 - 0.37 ] ) , hospital-based postnatal care ( 0.57 [ 0.45 - 0.70 ] ) , and home-based postnatal care ( 0.33 [ 0.25 - 0.42 ] ) . INTERPRETATION We conclude that midwife-managed care for healthy women , integrated within existing services , is clinical ly effective and enhances women 's satisfaction with maternity care Background there have been changes in maternity care policy over the last 20 years and women 's experience , continuity and satisfaction with care have become more prominent . However there has been no research examining changes over time in women 's reported experience . Methods this study used secondary analysis of data collected in four postal surveys of maternity care experiences in 1995 , 2006 , 2010 and 2014 . In each case women who had delivered in a specified time period in Engl and were r and omly sample d and sent a question naire three months after the birth . Women were excluded if they were aged less than 16 years or their infant had died . The majority of questions were comparable over the different surveys . Descriptive statistics and adjusted odds ratios are presented . Findings in the antenatal period , an increasing proportion of women had early first contact with a healthcare professional , screening for Down 's syndrome , both dating and anomaly scans and the total number of ultrasound scans increased over the period . The proportion of women given explanations about screening and choice regarding interventions during labour and birth both appear to have increased . In the postnatal period , length of hospital stay declined over time but the proportion of women who considered their length of stay too short remained constant . The number of postnatal home visits also declined and there was a substantial increase in the proportion of women who would have liked more visits . Overall satisfaction with care remained high especially for care during pregnancy , labour and birth . Conclusions despite fewer antenatal checks , shorter hospital stays and fewer postnatal home visits , women were generally very positive about their care in pregnancy , labour and birth , and the postnatal period . Maternity care has changed in many respects , with earlier contact with health professionals , more scans and more information . However , reduced continuity of care and a need for support in the early weeks with a new infant was expressed by many women and are issues that may be contributing to some of the dissatisfaction expressed OBJECTIVE To compare the outcomes of an adapted pilot Changing Childbirth initiative providing continuity of care by a group of known midwives with traditional maternity care .  DESIGN Between-groups trial to compare levels of satisfaction and clinical outcomes for two groups of women , cared for either under this Changing Childbirth scheme or the traditional model of care .  METHOD Of the 200 women who agreed to participate in the project , 100 were r and omly allocated to the pilot scheme and 100 to the traditional care package .  During the postpartum period , information was collected via a question naire about participants ' levels of satisfaction with a variety of aspects of care provided during the antenatal , delivery and postpartum periods . Data about clinical outcomes for the two groups were also obtained . RESULTS Women in the pilot group had significantly more continuity of care throughout each of the three periods , were generally more satisfied with their care , felt that they had more choice over a variety of aspects of care and experienced no compromise in clinical outcomes ( P = 0.05 or less in each case ) . IMPLICATION S FOR PRACTICE Many previous attempts to introduce the Changing Childbirth initiative have revealed significant problems , particularly with regard to the continuity of carer requirement . Taking account of local health care needs and existing provision , the present study adapted this concept to continuity of care . This did not apparently affect any of the guiding principles contained in the original document , and yet enhanced satisfaction . It would appear that the Changing Childbirth agenda can be adapted and integrated with local health care situations without sacrificing any of the overarching principles OBJECTIVE To compare women 's  satisfaction with midwife-managed care with ' shared care ' over three different time periods . DESIGN R and omised controlled trial . SETTING Glasgow Royal Maternity Hospital , Glasgow , UK . PARTICIPANTS 1299 women experiencing normal pregnancy ( consent rate : 82 % ) . Six hundred and forty-eight women were r and omised to midwife-managed care and 651 to ' shared care ' .  METHODS Three self-report question naires were sent to women 's homes . The question naires examined : satisfaction with antenatal care at 34 - 35 weeks ' gestation , and satisfaction with intrapartum , hospital- and home-based postnatal care at seven weeks postnatally . The third question naire review ed satisfaction with intrapartum care seven months after delivery . FINDINGS Women in both groups were satisfied . However , women in the midwife-managed group were more highly satisfied in relation to the dimensions examined : relationships with staff , information transfer , choices and decisions , and social support . The differences between the two groups were evident for all time periods ( i.e. antenatal , intrapartum and postnatal periods ) and were sustained at seven-month follow-up . This is illustrated in the mean scores for relationships with staff , as measured at 34 - 35 weeks ' gestation ( possible range -2 ; very negative attitudes to 2 ; very positive attitudes ) . Women in the midwife-managed group scored a mean of 1.22 compared to 0.74 for the ' shared care ' group ( mean diff : 0.48 ; 95 % CI : 0.42 to 0.55 ) . While women in both groups were more likely to make positive rather than negative comments in open-ended questions , the midwife-managed group were more likely to make positive comments whereas the ' shared care ' group were more likely to make negative comments . CONCLUSION Midwife-managed care for healthy pregnant women which is integrated into existing services improves satisfaction with antenatal , intrapartum and postnatal care BACKGROUND One-to-one midwifery was a demonstration project introduced into a London-based maternity service in 1993 to put into practice the new government policy for maternity services in Engl and . Evaluation was integral to the development of the project . METHODS The evaluation of women 's responses  was conducted between August 1994 and August 1995 based on a longitudinal , self-completion question naire , interviews , and focus groups . Women in the study group ( n = 728 ) received the new service and women in the control group ( n = 675 ) received conventional care . The study design integrated quantitative and qualitative methods and went beyond a simple estimation of satisfaction with care . RESULTS Satisfaction with antenatal and birth care was generally high , but study group women showed more positive responses overall . Both groups showed a preference for continuity of caregiver , but expectations were higher in the study group ( 72 % of the study group and 42 % of the control group preferred to see one caregiver ) . Both groups had less satisfied responses to hospital postnatal care ( 50 % study and 54 % control group were very satisfied ) . Study group women showed greater preparedness for birth than control group women ( 18 % vs 12 % " very well prepared " ) and for the time after the baby 's birth ( 26 % vs 15 % " very prepared " ) . CONCLUSIONS The study demonstrated that women were more satisfied with the one-to-one model of care . Taken together with the results of clinical and economic audit and professional responses , the evaluation suggests that this model should be developed and evaluated further to gain a greater underst and ing of women 's needs of the maternity service Objectives . Provision for ethnic minority groups has been acknowledged as integral to good maternity care in Engl and and ethnicity has been highlighted as an indicator of both poorer clinical outcomes and poorer experiences . Improving outcomes and services is dependent on underst and ing women 's interaction with both service delivery and provision . The aim of this study was to explore Black and minority ethnic ( BME ) women 's experiences of contemporary maternity care in Engl and . Design . A UK-wide survey which investigated core aspects of maternity care sought the views of BME women about their experiences . A r and om sample of women were selected by the Office for National Statistics from birth registration in Engl and and invited to complete a question naire three months after the birth . In a secondary analysis , text responses to open-ended questions about their maternity care were analysed using thematic analysis . Results . Sixty per cent of the 368 women who self-identified as BME responded with open text . Themes that emerged related to ‘ feeling cared for , ’ with subthemes of ‘ expectations of care ’ and ‘ policies , rules and organisational pressures ’ ; ‘ staff attitudes and communication ’ with sub-themes of ‘ please believe me , ’ ‘ hospital as a safe place , ’ ‘ choices denied ’ and ‘ being sensitive and supportive would help , ’ and ‘ ethnicity and culture ’ with sub-themes of ‘ stereotyping ’ and ‘ improving the quality of care . ’ Conclusion . The findings highlight issues affecting the quality of maternity care that BME women in Engl and receive . Many issues are not unique to BME women ; however , the findings reflect some seemingly enduring issues and coherence with other wider international findings , particularly in relation to post-natal care and staff attitudes . Actually being cared for and supported across their child-bearing experience are needs that women themselves identified as critical for care providers to recognise and respond to . The failures of care provision described should inform the development of services OBJECTIVE to investigate maternal  satisfaction with two pilot schemes based on the Changing Childbirth initiative ( DoH 1993 ) and to compare this with a traditional model of care . In addition , a limited number of clinical outcome measures were also assessed . DESIGN a retrospective between-group design was used . Question naire data were collected from three groups ( two pilot and one control ) about the antenatal , labour and postnatal periods to establish both satisfaction with key objectives of the Changing Childbirth initiative ( DoH 1993 ) , and basic clinical outcomes . SETTING a large Trust ( see definition in main article ) in Central Engl and , that covered a wide range of socio-economic strata . PARTICIPANTS the two pilot groups comprised 112 and 103 women respectively and were r and omly drawn from GP practice s within the Trust 's catchment area . The third group of 118 women ( Control ) was selected from the Trust 's obstetric unit . Women at high obstetric risk were excluded from this study . MEASUREMENT a five-part question naire was devised that covered : ( 1 ) preferences for type of care , health-care professional , venue etc ; ( 2 ) details of antenatal care provision and the participants ' satisfaction with this ; ( 3 ) labour , including clinical outcomes , labour and birth details and satisfaction with care ; ( 4 ) postnatal care information , including satisfaction scores ; and ( 5 ) information  and advice  given throughout the ante , delivery and postnatal periods and satisfaction with this . The question naires were administered six weeks postnatally . FINDINGS although the two pilot groups had been set up to follow a one-to-one midwifery care model , the second group naturally evolved into providing care from within a small group of midwives . This variation did not lead to any differences in any of the outcome measures . The women in the obstetrician-led group were not dissatisfied with the care , information and treatment they received , but they were significantly less satisfied than either of the two pilot groups . The pilot groups also rated more highly the information and choice that they had , and felt that the midwives acted as partners in the process . These findings applied to the antenatal , delivery and postnatal periods . No differences in clinical outcomes were observed between the groups . CONCLUSIONS midwifery-led care was much preferred to obstetrician-led care and did not lead to any deficits in clinical outcomes . The pilot scheme that adapted the initiative into small-group provision showed no reduction in satisfaction levels or other outcome measures . Since burn-out and stress have been identified as features of one-to-one midwifery provision , this model might have potential for off setting this problem , while still maintaining the spirit of the Changing Childbirth policy . From the perspective of maternal well-being , both physical and psychological , the initiative reported here appears to have been highly successful Breastfeeding was studied among women discharged early and late after normal delivery in a hospital . Early discharge was defined as leaving the hospital 24–48 h after delivery in combination with domiciliary visits , and late discharge as the regular hospital postpartum 
    Output:
    