Postnatal debriefing: Have we thrown the baby out with the bath water?

Abstract

Postnatal debriefing is offered by 78% of maternity services in the UK despite little evidence from randomised controlled trials (RCTs) that it is effective. RCTs in this area have applied debriefing as a prophylactic to all or high risk women, rather than as a treatment for women who request it. This pragmatic trial therefore evaluated existing postnatal debriefing services that provide debriefing as a treatment for women who request it. Forty-six women who met criterion A for posttraumatic stress disorder (PTSD) and requested debriefing 1.3-72.2 months (median 16 weeks) postpartum completed measures of depression, PTSD, support and negative appraisals of the birth before and one month after debriefing. Women were compared with others who gave birth in the same hospitals during the same time period (n 34), who met criterion A for PTSD but had not requested debriefing. Results showed PTSD symptoms reduced over time in both groups but greater decreases were observed in women who attended debriefing. Debriefing also led to reduction in negative appraisals but did not affect symptoms of depression. Therefore, results suggest providing debriefing as a treatment to women who request or are referred to it may help to reduce symptoms of PTSD.

The efficacy of ‘debriefing’ after childbirth: Is there a case for targeted intervention?

“…Two studies conducted universal interventions (Priest, Henderson, Evans, & Hagan, 2003;Selkirk et al, 2006), and six reported findings from studies (including one longitudinal follow-up), which targeted interventions either according to a perception of trauma (Gamble et al, 2005;Meades, Pond, Ayers, & Warren, 2011) or mode of birth (Kershaw, Jolly, Bhabra, & Ford, 2005;Ryding, Wirén, Johansson, Ceder, & Dahlström, 2004;Small, Lumley, Donohue, Potter, & Waldenström, 2000;Small, Lumley, & Toomey, 2006). One study (Lavender & Walkinshaw, 1998) did not provide a universal intervention, but did not target interventions for individuals potentially at higher risk for PTS or depression after childbirth (e.g., due to perception of trauma or instrumental delivery).…”

“…Of these, two targeted interventions for women who perceived childbirth as traumatic (Gamble et al, 2005;Meades et al, 2011) and one provided an intervention for women following normal vaginal birth (Lavender & Walkinshaw, 1998). Two of these studies provided the intervention shortly after birth (first point of contact within 72 h; Gamble et al, 2005;Lavender & Walkinshaw, 1998) and one provided the intervention at the mother's request (median 16 weeks after birth; Meades et al, 2011). Of the three studies reporting efficacious results, one used a structured CISD approach (Gamble et al, 2005), and two used an unstructured approach (Lavender & Walkinshaw, 1998;Meades et al, 2011).…”

“…Two of these studies provided the intervention shortly after birth (first point of contact within 72 h; Gamble et al, 2005;Lavender & Walkinshaw, 1998) and one provided the intervention at the mother's request (median 16 weeks after birth; Meades et al, 2011). Of the three studies reporting efficacious results, one used a structured CISD approach (Gamble et al, 2005), and two used an unstructured approach (Lavender & Walkinshaw, 1998;Meades et al, 2011). Therefore, the findings from this review indicate some utility in targeting interventions based on a perception of childbirth trauma, with an initial contact shortly after birth (or when requested).…”

“…Strengths of this study include blind allocation to control or intervention groups, and assessment of trauma perception using Criterion A of the DSM (American Psychological Association, 2000). Meades et al (2011) evaluated the efficacy of an existing postnatal debriefing service in a study with women (n = 80) where allocation to treatment group was based on perception of childbirth as traumatic and a request to receive debriefing. Interventions took place between 12 weeks and 6 years postnatally (median 16 weeks).…”

État de stress post-traumatique et périnatalité

“…Le débriefing par un tiers doit être formalisé [32] et peut constituer une aide (réduction du sentiment de dépréciation) mais ne semble pas réduire les symptômes de la dépression [33].…”