Strategies to reduce postnatal psychological morbidity - The role of midwifery services

Psychological morbidity after childbirth is a major public health problem, with prevalence rates of depression ranging from 10-15%, depending on assessment times and diagnostic criteria. Depression can have long-lasting consequences for both the woman and her child, with increasing evidence of an association between maternal depression and effects on the child's behavioral and cognitive development. A variety of interventions implemented during the antenatal, intrapartum and postnatal periods to reduce postnatal psychological morbidity have been evaluated. This paper summarizes the outcomes of studies that have evaluated interventions provided by midwives. There is no evidence to suggest that changing routine antenatal visit schedules will benefit postnatal psychological health or to support the introduction of routine antenatal screening to identify women more vulnerable to postnatal depression. Evaluation of the role of the midwife in implementing recommendations for screening women to identify those at risk of recurrence of serious mental illness during and after pregnancy is necessary. Educational interventions, including those specifically tailored for women deemed more vulnerable to depression, have shown limited evidence of benefit, and further research in this area is warranted. There is currently little evidence to support postnatal debriefing by midwives, with some evidence to suggest this intervention may actually be harmful to psychological well-being. The widespread introduction of debriefing services to postnatal women, particularly in the UK, highlights the urgent need for further research into the definition and content of this aspect of midwifery care. Significant benefits to postnatal psychological well-being have been found following the implementation of new models of midwifery-led care. Such findings have important implications for the role of the midwifery services within the UK, as well as for maternity service provision in other healthcare systems. Further evidence is required to inform how midwifery care can best be provided to all women throughout the maternity episode to ensure the early detection and management of postnatal psychological morbidity. Preventative and management strategies of postnatal psychological morbidity should consider the direct and indirect costs to women, healthcare providers and funders.