Can we prevent postnatal depression? A randomized controlled trial to assess the effect of continuity of midwifery care on rates of postnatal depression in high-risk women.
OBJECTIVE
To evaluate the effectiveness of continuous midwifery care in reducing rates of postnatal depression in women with histories of depression.


METHODS
Fifty-one women from a sample of 98 pregnant women with histories of major depressive disorder were randomly allocated, at antenatal booking, to continuous midwifery care. The remaining 47 women received standard maternity care. A total of 87 women (44 treatment, 43 control) completed baseline assessments (after randomization) and outcome assessments (at 3 months postpartum).


RESULTS
Of the women allocated to continuous midwifery care, 88% complied in full with their allocated treatment protocol. Forty-nine percent of women had an episode of illness in pregnancy (DSM-III-R case of major or minor depression), 26% developed a new episode of illness after antenatal booking, and 23% were depressed in the first 3 months postpartum. There were no differences between treatment conditions in total rates, or rates within the context of social adversity, of antenatal depression, depressions which occurred post-booking, postnatal depression, and the duration of depressive episodes.


CONCLUSIONS
While continuous midwifery care had no impact on psychiatric outcome, it was highly successful at engaging women in treatment and therefore has an important contribution to make in the care of child-bearing women with mental health problems.
Marks
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Section of Perinatal Psychiatry, Division of Psychological Medicine, Institute of Psychiatry, King's College, Denmark Hill, London, UK.
Siddle
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Warwick
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D003266:Continuity of Patient Care; D019052:Depression, Postpartum / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D001523:Mental Disorders / Q000453:epidemiology; D008880:Midwifery; D010352:Patient Dropouts; D011247:Pregnancy; D012307:Risk Factors