Continuity of midwifery carer moderates the effects of prenatal maternal stress on postnatal maternal wellbeing: the Queensland flood study
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Poor postnatal mental health is a major public health issue, and risk factors include experiencing adverse life events during pregnancy. We assessed whether midwifery group practice, compared to standard hospital care, would protect women from the negative impact of a sudden-onset flood on postnatal depression and anxiety. Women either received midwifery group practice care in pregnancy, in which they were allocated a primary midwife who provided continuity of care, or they received standard hospital care provided by various on-call and rostered medical staff. Women were pregnant when a sudden-onset flood severely affected Queensland, Australia, in January 2011. Women completed questionnaires on their flood-related hardship (objective stress), emotional reactions (subjective stress), and cognitive appraisal of the impact of the flood. Self-report assessments of the women’s depression and anxiety were obtained during pregnancy, at 6 weeks and 6 months postnatally. Controlling for all main effects, regression analyses at 6 weeks postpartum showed a significant interaction between maternity care type and objective flood-related hardship and subjective stress, such that depression scores increased with increasing objective and subjective stress with standard care, but not with midwifery group practice (continuity), indicating a buffering effect of continuity of midwifery carer. Similar results were found for anxiety scores at 6 weeks, but only with subjective stress. The benefits of midwifery continuity of carer in pregnancy extend beyond a more positive birth experience and better birthing and infant outcomes, to mitigating the effects of high levels of stress experienced by women in the context of a natural disaster on postnatal mental health.
KeywordsPrenatal maternal stress Postnatal depression Anxiety Midwifery group practice Natural disaster Continuity of carer
Funding was provided by a grant from the Canadian Institutes of Health Research (CHIR grant # MOP-1150067) and funds from Mater Research, Mater Health, and Mater Foundation.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval was obtained from the Human Research Ethics Committees at the study site hospital and affiliated university (reference numbers 1709M and 2013001236, respectively).
All participants provided written informed consent at recruitment into the study and when completing the 6-week and 6-month postnatal surveys.
- Australian Institute of Health Welfare (2012) Perinatal depression: data from the 2010 Australian National Infant Feeding Survey. Australian Institute of Health and Welfare, CanberraGoogle Scholar
- Forster DA, McLachlan HL, Davey M-A, Biro MA, Farrell T, Gold L et al (2016) Continuity of care by a primary midwife (caseload midwifery) increases women’s satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial. BMC Pregnancy Childbirth 16(1):1CrossRefGoogle Scholar
- Kildea S, Gao Y, Rolfe M, Josif CM, Bar-Zeev SJ, Steenkamp M et al (2016) Remote links: redesigning maternity care for Aboriginal women from remote communities in Northern Australia—a comparative cohort study. Midwifery 34:47–57. https://doi.org/10.1016/j.midw.2016.01.009 CrossRefPubMedGoogle Scholar
- Kildea S, Hickey S, Nelson C, Currie J, Carson A, Reynolds M et al (2017) Birthing on Country (in Our Community): a case study of engaging stakeholders and developing a best-practice Indigenous maternity service in an urban setting. Aust Health Rev. https://doi.org/10.1071/AH16218
- King S, Kildea S, Austin MP, Brunet A, Cobham VE, Dawson PA et al (2015) QF2011: a protocol to study the effects of the Queensland flood on pregnant women, their pregnancies, and their children's early development. BMC Pregnancy Childbirth 15(1):109. https://doi.org/10.1186/s12884-015-0539-7 CrossRefPubMedPubMedCentralGoogle Scholar
- Kleinhaus K, Harlap S, Perrin M, Manor O, Margalit-Calderon R, Opler M, Friedlander, Y, Malaspina D. 2013 Prenatal stress and affective disorders in a populatin birth cohort. BIPOLAR DISORDERS 15:92–99Google Scholar
- Leach LS, Poyser C, Fairweather-Schmidt K (2015) Maternal perinatal anxiety: a review of prevalence and correlates. Clin Psychol 21:4–19Google Scholar
- Marmar CR, Weiss DS, Metzler TJ (1997) The peritraumatic dissociative experiences questionnaire. In: Wilson JP, Keane TM (eds) Assessing Psychological Trauma and PTSD. Guilford Press, New York, pp 412–428Google Scholar
- McLachlan H, Forster D, Davey M-A, Farrell T, Gold L, Biro M et al (2012) Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: the COSMOS randomised controlled trial. BJOG Int J Obstet Gynaecol 119(12):1483–1492CrossRefGoogle Scholar
- Spielberger CD, Gorsuch RL, Lushene PR, Vagg PR, Jacobs AG (1983) Manual for the state-trait anxiety inventory (Form y). Consulting Psychologists Press, Inc., Palo AltoGoogle Scholar
- Ward TS, Kanu FA, Robb SW (2016) Prevalence of stressful life events during pregnancy and its association with postpartum depressive symptoms. Arch Women's Ment Health. https://doi.org/10.1007/s00737-016-0689-2
- Weiss DS, Marmar CR (1997) The impact of event scale: revised. Guilford, New YorkGoogle Scholar