Date: 17 Sep 2012
Strategies to Reduce Postnatal Psychological Morbidity
- Dr Debra Bick
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Psychological morbidity after childbirth is a major public health problem, with prevalence rates of depression ranging from 10–15%, depending on assessment times and diagnostic criteria. Depression can have long-lasting consequences for both the woman and her child, with increasing evidence of an association between maternal depression and effects on the child’s behavioral and cognitive development. A variety of interventions implemented during the antenatal, intrapartum and postnatal periods to reduce postnatal psychological morbidity have been evaluated. This paper summarizes the outcomes of studies that have evaluated interventions provided by midwives.
There is no evidence to suggest that changing routine antenatal visit schedules will benefit postnatal psychological health or to support the introduction of routine antenatal screening to identify women more vulnerable to postnatal depression. Evaluation of the role of the midwife in implementing recommendations for screening women to identify those at risk of recurrence of serious mental illness during and after pregnancy is necessary. Educational interventions, including those specifically tailored for women deemed more vulnerable to depression, have shown limited evidence of benefit, and further research in this area is warranted. There is currently little evidence to support postnatal debriefing by midwives, with some evidence to suggest this intervention may actually be harmful to psychological well-being. The widespread introduction of debriefing services to postnatal women, particularly in the UK, highlights the urgent need for further research into the definition and content of this aspect of midwifery care. Significant benefits to postnatal psychological well-being have been found following the implementation of new models of midwifery-led care. Such findings have important implications for the role of the midwifery services within the UK, as well as for maternity service provision in other healthcare systems. Further evidence is required to inform how midwifery care can best be provided to all women throughout the maternity episode to ensure the early detection and management of postnatal psychological morbidity. Preventative and management strategies of postnatal psychological morbidity should consider the direct and indirect costs to women, healthcare providers and funders.
Kumar R, Robson K. A prospective study of emotional disorders in child-bearing women. Br J Psychiatry 1984; 144: 34–47.CrossRef
Seeley S, Murray L, Cooper PJ. Postnatal depression: the outcome for mothers and babies of health visitor intervention. Health Visit 1996; 69: 135–8.
Hoffbrand S, Howard L, Crawley H. Antidepressant drug treatment for postnatal depression (protocol). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 2. Oxford. Update Software 2002.
Coghill SR, Caplan HL, Alexandra H, et al. Impact of maternal postnatal depression on cognitive development of young children. BMJ 1986; 292: 1165–7.CrossRef
MacArthur C, Lewis M, Knox EG. Health after childbirth. London: The Stationery Office, 1991.
Saurel Cubizolles MJ, Romito P, Lelong N, et al. Women’s health after childbirth: a longitudinal study in France and Italy. Br J Obstet Gynaecol 2000; 107: 1202–9.CrossRef
Reid M, Lang G, Murray G, et al. A two centre pragmatic randomised controlled trial of two interventions. Edinburgh: Scottish Office Chief Scientist Office, 1999.
Lavender T, Walkinshaw S. Can midwives reduce postpartum psychological morbidity? A randomised trial. Birth 1998: 25; 215–219.
Oakley A, Hickey D, Rajan L, et al. Social support in pregnancy: does it have long-term effects? J Reprod Infant Psychol 1996; 14: 7–22.CrossRef
Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1990; 150: 782–6.CrossRef
Green J, Murray D. The use of the Edinburgh Postnatal Depression Scale in research to explore the relationship between antenatal and postnatal dysphoria. In: Cox J, Holden J, editors. Perinatal psychiatry. London: Gaskell, 1994: 180–98.
Webster J, Linnane JW, Dibley LM, et al. Improving antenatal recognition of women at risk for postnatal depression. Aust N Z Journal Obstet Gynaecol 2000; 10: 409–12.CrossRef
Forman DN, Videbech P, Hedegaard M, et al. Postpartum depression: identification of women at risk. Br J Obstet Gynaecol 2000; 107: 1210–7.CrossRef
Lewis G, editor. The fifth report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. London: RCOG Press, 2001.
Shields N, Reid M, Cheyne H, et al. Impact of midwife-managed care in the postnatal period: an exploration of psychosocial outcomes. J Reprod Infant Psychol 1997; 15: 91–108.CrossRef
Rose S, Bisson J, Wessely S. Psychological debriefing for preventing post traumatic stress disorder (PTSD). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 4. Oxford: Update Software 2002.
Davidson LL, Garcia J, Parsons J. Psycho-social interventions in maternity care: the need for evaluation [letter]. BMJ 2000; 321: 1043–7.CrossRef
Bick D, MacArthur C, Knowles H, Winter H. Postnatal care: evidence and guidelines for management. Edinburgh: Churchill Livingstone, 2002.
Bick D, MacArthur C. The extent, severity and effect of health problems after childbirth. Br J Midwifery 1995; 3: 27–31.
Brown S, Lumley J. Physical health after childbirth and maternal depression at six to seven months postpartum. Br J Obstet Gynaecol 2000; 107: 194–2001.
Hodnett ED. Caregiver support for women during childbirth. Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 4. Oxford: Update Software, 2002.
- Strategies to Reduce Postnatal Psychological Morbidity
Disease Management & Health Outcomes
Volume 11, Issue 1 , pp 11-20
- Cover Date
- Print ISSN
- Springer International Publishing
- Additional Links
- Dr Debra Bick (1)
- Author Affiliations
- 1. RCN Institute, Radcliffe Infirmary, Woodstock Road, Oxford, OX2 6HE, UK