title: Predictors of early postpartum mental distress in mothers with midwifery home care--results from a nested case-control study.
abstract: BACKGROUND
  The prevalence of early postpartum mental health conditions is high. Midwives and other health professionals visiting women at home may identify mothers at risk. This seems crucial given decreasing trends of length of hospital stay after childbirth. This study aimed to identify predictors of maternal mental distress in a midwifery home care setting.
  
  
  METHODS
  Using the statistical database of independent midwives' services in Switzerland in 2007, we conducted a matched nested case-control study. Out of a source population of 34,295 mothers with midwifery home care in the first ten days after childbirth, 935 mothers with maternal distress and 3,645 controls, matched by midwife, were included. We analysed whether socio-demographic, maternal and neonatal factors predict maternal mental distress by multivariable conditional logistic regression analysis.
  
  
  RESULTS
  Infant crying problems and not living with a partner were the strongest predictors for maternal distress, whereas higher parity was the most protective factor. Significantly elevated risks were also found for older age, lower educational levels, breast/breastfeeding problems, infant weight gain concerns, neonatal pathologies and use of midwifery care during pregnancy. A lower likelihood for maternal distress was seen for non-Swiss nationality, full-time employment before birth, intention to return to work after birth and midwife-led birth.
  
  
  CONCLUSIONS
  The study informs on predictors of maternal mental distress identified in a home care setting in the early postpartum period. Midwives and other health care professionals should pay particular attention to mothers of excessively crying infants, single mothers and primipara, and assess the need for support of these mothers.
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, SWITZERLAND; katharina.staehelin@bluewin.ch.
authors.forename: Katharina
authors.initials: K
authors.lastname: Staehelin
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Kurth
authors.forename: Christian
authors.initials: C
authors.lastname: Schindler
authors.forename: Monika
authors.initials: M
authors.lastname: Schmid
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Zemp Stutz
mesh_terms: D000328:Adult; D000367:Age Factors; D001942:Breast Feeding / Q000706:statistics & numerical data; D016022:Case-Control Studies; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D019052:Depression, Postpartum / Q000453:epidemiology*; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data; D005191:Family Characteristics; D005260:Female; D006699:Home Care Services; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008880:Midwifery; D009035:Mothers / Q000523:psychology*; D016017:Odds Ratio; D010298:Parity; D011181:Postnatal Care; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D064186:Prenatal Education / Q000706:statistics & numerical data; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology*; D013557:Switzerland / Q000453:epidemiology