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Chapter 3 Critical Review 3.1 Introduction To Critical Review This Chapter ...



CHAPTER 3
Critical Review
3.1 Introduction to Critical Review
This chapter will critically analyse eight studies on the effectiveness of debriefing following childbirth to reduce or alleviate symptoms of trauma or postpartum depression. Similarly the seven studies that offered anecdotal or descriptive data from evaluations of interventions offered in the United Kingdom maternity services that were referred to as debriefing, or reported the availability of such services are also reviewed in this chapter for the reasons already mentioned in the introduction.
3.2 Evidence of Effectiveness of Postnatal Debriefing
As previously mentioned eight RCTs were identified from four countries that had evaluated the impact of midwife-led postnatal interventions or other health care professionals on a range of maternal mental health outcomes, including anxiety, depression, and PTSD.
When critically reviewed it was found that only two studies included women of all parities and all modes of delivery (Priest et al., 2003, p542, Selkirk et al., 2006, p133), all the other studies imposed exclusion/inclusion criteria, including only primiparous women (Lavender & Walkinshaw, 1998, pp215), or women who had operative delivery including forceps and caesarean section (Small et al., 2000, p1043, Ryding et al., 2004, p247, Kershaw et al., 2005, p1504) or women screened after birth (Tam et al., 2003, p853, Gamble, et al., 2005, p 11). Some studies used a structured debriefing intervention, which involved adhering to a specific interview schedule, whilst others allowed women to determine the content of the intervention. Five studies offered one session, and three offered two. Psychological health was assessed at different times in each of the studies.
Lavender & Walkinshaw (1998, p215) allocated one hundred and twenty primiparous women who had a normal vaginal birth at a maternity unit in the Northwest of England to a debriefing intervention or routine care. The intervention comprised one session with a research midwife before hospital discharge, which lasted between thirty and one hundred and twenty minutes and included discussion about the woman's labour and her feelings about that. At three weeks, women were sent a postal questionnaire, which included the Hospital Anxiety Depression (HAD) scale. The intervention group had lower anxiety and depression scores as measured using the HAD scale, and reported that the intervention was helpful. A high proportion of women in the control group (fifty-five percent) had depression as defined by the HAD scale, however the definition of a high score in the analysis differed from that used to calculate the sample size, and the scale has not been validated for use after birth. Results may also have been based on an atypical population, because over half of the recruited women were single.
Small et al.

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