Abstract
Aim: According to the NICE Guidelines for Antenatal and Postnatal Mental Health (NICE; 2007a), there is insufficient evidence upon which to base the provision of effective postnatal mental health services. However, most hospitals in the UK provide a midwife debriefing service for women who have had what they and/or healthcare professionals perceive to be a difficult or traumatic birth experience (Ayers et al., 2006). This research aims to explore the effect of midwife debriefing on the psychological wellbeing of such women after birth. Design: A prospective, naturalistic, mixed between and within subjects design was used to compare change in women who had debriefing with those who did not. Setting: Maternity departments of two hospitals in southeast England, which offer a midwife debriefing service. Participants: 23 debriefing group and 61 comparison group women completed demographic, pregnancy and childbirth questionnaires and ‘pre’ outcome measures; 18 debriefing group and 50 comparison group women also completed ‘post’ outcome measures. Main outcome measures: Edinburgh Postnatal Depression Scale, PTSD Symptom Scale - Self Report, Posttraumatic Cognitions Inventory and Significant Others Scale. Results: A profile of the women who attended debriefing was obtained. The debriefing group experienced a significantly greater improvement in symptoms of postnatal depression but not in those of postnatal PTSD compared to women in the comparison group. The groups did not differ in change to trauma related appraisals. Women in the debriefing group were significantly less satisfied with their emotional and practical social support than those in the comparison group. Conclusions: Recommendations for clinical practice include routine screening following childbirth to identify women with symptoms of postnatal PTSD and/or depression, who should be encouraged to access debriefing when they are ready to focus on their own needs, rather than those of their baby. Debriefing services should develop routes to refer such women on to specialist trauma services, counselling or postnatal depression groups as necessary.