Postnatal debriefing interventions to prevent maternal mental health problems after birth: exploring the gap between the evidence and UK policy and practice.
BACKGROUND
Postnatal mental health problems range from transient psychological problems to depression, anxiety, psychosis, and post-traumatic stress disorder (PTSD). Debriefing is a structured psychological intervention to prevent postnatal psychological problems, particularly PTSD and depression. Many UK maternity service providers have established postnatal debriefing services, in some cases supported by policy, despite a lack of robust evidence. In this article, current evidence of the effectiveness of postnatal debriefing and the availability and current provision of debriefing offered in UK maternity services is described.


METHODS
A structured literature review was undertaken.


RESULTS
Eight randomized controlled trials were conducted to evaluate debriefing or counseling interventions in childbirth settings, and seven studies were done to evaluate debriefing or counseling interventions provided within UK maternity services or describe the availability of such services. Results of six RCTs were that no differences in outcomes were found, one report indicated possible harm from debriefing, and two indicated a positive association related to a psychological intervention. Methodological issues might account for differing trial outcomes. No standard intervention was used in any RCTs or service interventions. Confusion apparently exists in use of the term "debriefing" in UK maternity service policy and practice. Although service evaluations showed that women valued opportunities to discuss their birth, evidence to support the content and timing of service provision and effectiveness of this was lacking.


CONCLUSIONS
It might be appropriate to consider offering women an opportunity to discuss their childbirth experience and to differentiate this discussion from the offer of a formal debriefing, which is unsupported by evidence. IMPLICATIONS FOR PRACTICE/CONCLUSION: Midwives and other health care professionals who provide opportunities for women to talk about childbirth should be clear about terms used to describe the intervention, as well as the purpose and content of this. Differentiating between women who perceive their experience of childbirth as traumatic and those who develop symptoms of PTSD (for whom specific treatment may be required) is important. All health care professionals should be aware of the signs and symptoms of mental health problems after birth, which may include depression, anxiety, or psychosis in addition to PTSD.
Rowan
Cathy
C
Centre for Research in Midwifery and Childbirth, Thames Valley University, London, UK. cathy.rowan@tvu.ac.uk
Bick
Debra
D
Bastos
Maria Helena da Silva
MH
D001294:Attitude to Health; D003376:Counseling / Q000458:organization & administration; D003419:Crisis Intervention / Q000458:organization & administration*; D019052:Depression, Postpartum / Q000517:prevention & control; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D005260:Female; D006291:Health Policy; D006302:Health Services Research / Q000458:organization & administration; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration*; D016389:Maternal-Child Nursing / Q000458:organization & administration; D001523:Mental Disorders / Q000175:diagnosis / Q000517:prevention & control*; D009035:Mothers / Q000523:psychology; D020380:Needs Assessment; D009721:Nurse Midwives / Q000458:organization & administration; D015403:Nursing Evaluation Research / Q000458:organization & administration; D011181:Postnatal Care / Q000458:organization & administration*; D015397:Program Evaluation; D011644:Puerperal Disorders / Q000175:diagnosis / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D013222:State Medicine / Q000458:organization & administration; D013313:Stress Disorders, Post-Traumatic / Q000517:prevention & control; D006113:United Kingdom