BLUES AND DEPRESSION DURING EARLY PUERPERIUM - HOME VERSUS HOSPITAL DELIVERIES

Objective To investigate whether women who give birth at home are less prone to mood disturbances during the early puerperium than those who give birth in hospital. Design A prospective study of 303 pregnant women who registered for antenatal care. Setting The antenatal clinic at St Joseph's Hospital, Veldhoven, The Netherlands, and five antenatal consultation programmes of local midwives working in the surrounding region. Subjects Three hundred and eighty-two consecutive caucasian women registering for antenatal care were approached. Of these, 303 consented to participate and 293 completed the study. Main outcome measure The predictor variable was the way in which the women gave birth: spontaneous vaginal parturition at home or in hospital as follows: spontaneously; vaginal parturition after stimulation with medication; vaginal parturition with forceps/vacuum extraction; or caesarean section. The outcome variables were blues and depression. The occurrence of blues was assessed at 4 weeks postpartum, using Pitt's criteria. The occurrence of depression was assessed at 4 weeks postpartum using the Research Diagnostic Criteria. The possible confounding effects of a set of obstetrical and psyche-social variables relating to the early puerperium were investigated using logistic regression analysis. Results Of the 293 women who completed the study, 52% gave birth at home. Significantly more nullipara gave birth in hospital. Parturition occurred where it had been planned in 77% of women; referral occurred later on in pregnancy in 11% and during labour in 12%. Nullipara had to be referred significantly more often than multipara. In general, there was no difference in the incidence of blues and depression between women who gave birth at home and those who gave birth in hospital. Obstetric factors were not related to the occurrence of blues or depression in the early puerperium. Conclusions Women who give birth in hospital are no more prone to postpartum mood disturbances, such as blues and depression, than women who give birth at home.