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 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.

Preventing Postpartum Depression Part II: A Critical Review of Nonbiological Interventions

“…Conversely, in a larger and well-executed Australian trial involving 1041 women who had operative deliveries, inhospital midwife-led debriefing had a negative effect (25). In particular, more women allocated to the debriefing group exhibited depressive symptomatology (n = 81, 17%) at 24 weeks postpartum, compared with women allocated to usual postpartum care (n = 65, 14%), though the difference was not significant (odds ratio [OR] 1.24; 95%CI, 0.87 to 1.77).…”

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

“…First, studies consistently find that women like postnatal debriefing and evaluate it as helpful (Small et al, 2000). It fits well with a stepped-care treatment approach and offers the opportunity to identify women who need referral forfurther psychological treatment.…”

“…Six RCfs have evaluated postnatal debriefing using a range of eligibility criteria and outcomes. Four trials found debriefing had no effect on outcomes such as depression, PTSD, quality of life, parenting stress, or fear of childbirth ( Kershaw, jolly, Bhabra, & Ford, 2005;Priest, Henderson, Evans, & Hagan, 2003;Selkirk, McLaren, Ollerneshaw, McLachlan, & Moten, 2006;Small, Lumley, Donohue, Potter, & Waldenstrom, 2000;Small, Lumley & Toomey, 2006). In contrast, two trials found postnatal debriefing was effective (Gamble et al,2005;Lavender & Walkinshaw, 1998).…”

Trauma & the reproductive lifecycle in women

“…76 Following delivery, women were randomized to either receive a debriefing session (n = 520) to discuss their labour, birth and post-delivery events/experiences prior to discharge or standard care (n = 521), which consisted of a brief visit by the midwife to give the mother a pamphlet on sources of assistance. Maternal depression and overall health status (bodily pain, mental and general health, vitality, physical and social functioning, as well as both physical and emotional role functioning) were measured with the Edinburg Postnatal Depression Scale and the 36-item short-form health survey (SF-36), respectively, at 6 months postpartum.…”