Randomised controlled trial of midwife led debriefing to reduce maternal depression after operative childbirth
Abstract Objective: To assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal depression at six months postpartum among women giving birth by caesarean section, forceps, or vacuum extraction. Design: Randomised controll...
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Published in | BMJ Vol. 321; no. 7268; pp. 1043 - 1047 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
London
British Medical Journal Publishing Group
28.10.2000
British Medical Association BMJ Publishing Group LTD BMJ Publishing Group BMJ |
Edition | International edition |
Subjects | |
Online Access | Get full text |
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Summary: | Abstract Objective: To assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal depression at six months postpartum among women giving birth by caesarean section, forceps, or vacuum extraction. Design: Randomised controlled trial. Setting: Large maternity teaching hospital in Melbourne, Australia. Participants: 1041 women who had given birth by caesarean section (n= 624) or with the use of forceps (n= 353) or vacuum extraction (n= 64). Main outcome measures: Maternal depression (score ≥13 on the Edinburgh postnatal depression scale) and overall health status (comparison of mean scores on SF-36 subscales) measured by postal questionnaire at six months postpartum. Results: 917 (88%) of the women recruited responded to the outcome questionnaire. More women allocated to debriefing scored as depressed six months after birth than women allocated to usual postpartum care (81 (17%) v 65 (14%)), although this difference was not significant (odds ratio=1.24, 95% confidence interval 0.87 to 1.77). They were also more likely to report that depression had been a problem for them since the birth, but the difference was not significant (123 (28%) v 94 (22%); odds ratio=1.37, 1.00 to 1.86). Women allocated to debriefing had poorer health status on seven of the eight SF-36 subscales, although the difference was significant only for role functioning (emotional): mean scores 73.32 v 78.98, t= −2.31, 95% confidence interval −10.48 to −0.84). Conclusions: Midwife led debriefing after operative birth is ineffective in reducing maternal morbidity at six months postpartum. The possibility that debriefing contributed to emotional health problems for some women cannot be excluded. |
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Bibliography: | PMID:11053173 istex:FDD997A291D701C6D63F8D254F92D8B73E05040D ArticleID:bmj.321.7268.1043 Correspondence to: R Small ark:/67375/NVC-C3290TG6-7 local:bmj;321/7268/1043 href:bmj-321-1043.pdf ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Undefined-3 Contributors: RS drafted the grant application for the study, participated jointly in protocol design and discussion of core ideas at research team meetings, was the principal investigator for the study in its final two years, conducted the data analysis, and drafted the paper. JL initiated the study, formulated the research questions, contributed to the grant application, participated jointly in protocol design and discussion of core ideas at research team meetings, and contributed to the writing of the paper. LD contributed to the grant application and protocol design, undertook recruitment and conducted the debriefing intervention, participated in data collection and discussion of core ideas at research team meetings, and contributed to the paper. AP contributed to protocol design, undertook recruitment and conducted the debriefing intervention, participated in data collection and discussion of core ideas at research team meetings, coded all the questionnaires, and contributed to the paper. UW participated jointly in protocol design and discussion of core ideas at research team meetings, was the principal investigator for the study in its first two years, and contributed to the paper. Correspondence to: R Small r.small@latrobe.edu.au |
ISSN: | 0959-8138 0959-8146 1468-5833 1756-1833 |
DOI: | 10.1136/bmj.321.7268.1043 |