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Community Midwives Were Trained In Critical Incident Stress De Ing By A ...

Community midwives were trained in critical incident stress debriefing by a consultant clinical psychologist. The main outcome was fear of childbirth as measured by the (WDEQ) at ten days, ten weeks, and twenty weeks following the birth. The WDEQ scores were lower in the intervention group, although differences at each follow-up period were not statistically significant. Debatably, this might have been due to several factors; some midwives commenced debriefing before ten days and selection bias was apparent because midwives in some cases did not consider it appropriate to debrief teenage women. Arguably, it is also possible that some contamination of the control group existed, if these women received care from the same midwives.
A midwife led counseling intervention was implemented in three maternity hospitals in Brisbane, Australia, for women deemed to be at risk of developing psychological trauma (Gamble et al., 2005, p11). Four hundred women were recruited during the last trimester of their pregnancy, and asked to complete the EPDS, the Depression Anxiety and Stress Scale-21 (DASS-21) and Maternity Social Support Scale (MSSS). Three hundred and forty-eight of these women were screened within seventy-two hours of giving birth to ascertain if they were at risk of developing psychological distress, the remaining fifty-two could not be contacted. The women were asked if at any time during their labour or birth they had feared for their own or for their baby's life, feared serious injury or permanent damage. One hundred and three participants responded positively and met the inclusion criterion of DSM-IV. They were subsequently randomised into an intervention or control group.
At four and six weeks, the women completed the EPDS and the MSSS, and at three months, all three scales were completed again, together with the Mini-International Neuropsychiatric Interview-Post Traumatic Stress Disorder (MINI-PTSD) scale, a structured diagnostic interview for DSM-IV and ICD-10 psychiatric disorders. Fifty women received the counselling intervention, and fifty-three were allocated to the control group. The intervention group received face to face counselling within seventy-two hours of birth and again by telephone at four to six weeks postpartum. The counselling processes included elements of critical stress debriefing and issues pertinent to the childbirth context. A second research midwife blinded to group allocation conducted a three month follow-up interview.
The results showed that there were no statistically significant differences between the number of women who met criteria for a diagnosis of PTSD in the two groups at four to six weeks or three months, although, however a trend towards improvement was noted in the intervention group. Those in the intervention group were less likely to have EPDS scores >12 at three months, a significant difference (p = 0.

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