Hannah Woolhouse

Physical health after childbirth and maternal depression in the first 12 months post partum: Results of an Australian nulliparous pregnancy cohort study

OBJECTIVE to investigate the relationship between maternal physical health problems and depressive symptoms in the first year after childbirth. DESIGN prospective pregnancy cohort study. SETTING Melbourne, Victoria, Australia. POPULATION 1507 nulliparous women. METHODS women were recruited from six public hospitals between six and 24 weeks gestation. Written questionnaires were completed at recruitment and at three, six and 12 months post partum. OUTCOME MEASURES Edinburgh Postnatal Depression Scale (EPDS); standardised measures of urinary and faecal incontinence, a checklist of symptoms for other physical health problems. RESULTS overall, 16.1% of women reported depressive symptoms during the first 12 months post partum, with point prevalence at three, six and 12 months post partum of 6.9%, 8.8% and 7.8% respectively. The most commonly reported physical health problems in the first three months were tiredness (67%), back pain (47%), breast problems (37%), painful perineum (30%), and urinary incontinence (29%). Compared with women reporting 0-2 health problems in the first three months post partum, women reporting 5 or more health problems had a six-fold increase in likelihood of reporting concurrent depressive symptoms at three months post partum (Adjusted OR=6.69, 95% CI=3.0-15.0) and a three-fold increase in likelihood of reporting subsequent depressive symptoms at 6-12 months post partum (Adjusted OR=3.43, 95% CI 2.1-5.5). CONCLUSIONS poor physical health in the early postnatal period is associated with poorer mental health throughout the first 12 months post partum. Early intervention to promote maternal mental health should incorporate assessment and intervention to address common postnatal physical health problems.

Depressive symptoms and intimate partner violence in the 12 months after childbirth: a prospective pregnancy cohort study

Please cite this paper as: Woolhouse H, Gartland D, Hegarty K, Donath S, Brown S. Depressive symptoms and intimate partner violence in the 12 months after childbirth: a prospective pregnancy cohort study. BJOG 2011;118:000–000. DOI: 10.1111/j.1471‐0528.2011.03219.x.

Maternal depression from early pregnancy to 4 years postpartum in a prospective pregnancy cohort study: implications for primary health care

To describe the prevalence of maternal depression from pregnancy to 4 years postpartum, and the risk factors for depressive symptoms at 4 years postpartum.

Antenatal mindfulness intervention to reduce depression, anxiety and stress: a pilot randomised controlled trial of the MindBabyBody program in an Australian tertiary maternity hospital

BackgroundMindfulness interventions to reduce psychological distress are well-suited to pregnancy, due to their brief and non-pharmacological nature, but there is a need for more robust evidence determining their usefulness. This pilot study was designed to explore the feasibility of a randomised controlled trial of a mindfulness intervention to reduce antenatal depression, anxiety and stress.MethodsThe study was designed in two parts 1) a non-randomised trial targeting women at risk of mental health problems (a selected population) and 2) a randomised controlled trial (RCT) of a universal population. Process evaluation focused on feasibility of recruitment pathways, participant retention, acceptability of study measures, and engagement with mindfulness practices. Measurement of psychological distress was taken pre and post intervention through the Centre for Epidemiologic Studies Depression Scale Revised, the Depression Anxiety and Stress Scale-21, the State-Trait Anxiety Inventory, and the Perceived Stress Scale.Results20 women were recruited to the non-randomised trial, and 32 to the RCT. Recruitment through a mailed study brochure at the time of booking-in to the hospital resulted in the largest number of participants in the RCT (16/32; 50%), and resulted in considerably earlier recruitment (50% in first trimester, 50% second trimester) compared to recruitment through the antenatal clinic waiting room (86% in second trimester, 14% third trimester). Over a third of women in the universal population scored above clinical cut-offs for depression and anxiety, indicating a sample with more symptomology than the general population. The most common reason for loss to follow-up was delivery of baby prior to follow-up (n = 9). In the non-randomised study, significant within group improvements to depression and anxiety were observed. In the intervention arm of the RCT there were significant within group improvements to anxiety and mindfulness. No between group differences for the intervention and `care as usual’ control group were observed.ConclusionsThis small pilot study provides evidence on the feasibility of an antenatal mindfulness intervention to reduce psychological distress. Major challenges include: finding ways to facilitate recruitment in early pregnancy and engaging younger women and other vulnerable populations.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12613000742774 (31/10/2012).

Adding Mindfulness to CBT Programs for Binge Eating: A Mixed-Methods Evaluation

The current study investigated the effectiveness of a combined mindfulness-CBT group therapy program for women with binge eating problems. Questionnaires were completed by group participants pre-program (n = 30), post-program (n = 30) and 3 month follow-up (n = 28). Significant reductions between pre- and post-program scores were found on standardised measures assessing binge eating, dieting, and body image dissatisfaction, with all reductions maintained at follow-up. Qualitative interviews with 16 women following completion of the program revealed the value of mindfulness in improving eating behaviour through increased self-awareness. This exploratory study supports the value of adding mindfulness to the more commonly utilised CBT-based programs for binge eating.

Physical Health and Recovery in the First 18 Months Postpartum: Does Cesarean Section Reduce Long‐Term Morbidity?

BACKGROUND Research examining long-term health outcomes for women after childbirth has been limited. The objective of this study was to investigate the natural history of common morbidities in the 18 months after the birth of a first child, and to explore the hypothesis that women who have a cesarean section for a first birth experience less overall morbidity in the postnatal period. METHODS A prospective nulliparous pregnancy cohort study was conducted of 1,507 women recruited in early pregnancy from six public hospitals in Melbourne, Australia (mean gestation 15 weeks). Follow-up questionnaires at 3, 6, 12, and 18 months postpartum included standardized measures of urinary and fecal incontinence, and a symptom checklist asking about common physical health problems. RESULTS At 6, 12, and 18 months postpartum, no statistically significant differences were found in the proportion of women reporting three or more health problems by method of birth. Compared with women who had a spontaneous vaginal birth, women who had a cesarean section were more likely to report extreme tiredness at 6 months postpartum (adjusted OR: 1.39; 95% CI: 1.07-1.82) and at 12 months postpartum (adjusted OR: 1.40; 95% CI: 1.05-1.85), and were more likely to report back pain at 6 months postpartum (adjusted OR: 1.37; 95% CI: 1.06-1.77) and at 12 months postpartum (adjusted OR: 1.41; 95% CI: 1.06-1.87). Women who had a cesarean section were less likely to report urinary incontinence at 3, 6, and 12 months postpartum, respectively (adjusted OR: 0.26; 95% CI: 0.19-0.36; adjusted OR: 0.36; 95% CI: 0.25-0.52; adjusted OR: 0.48; 95% CI: 0.33-0.68). For all other physical health problems the pattern of morbidity did not differ between cesarean section and spontaneous vaginal birth. CONCLUSIONS Physical health problems commonly persist or recur throughout the first 18 months postpartum, with potential long-term consequences for womens health. Cesarean section does not result in women experiencing less overall morbidity in the postpartum period compared with women who have a spontaneous vaginal birth.

Women's experiences of sex and intimacy after childbirth: making the adjustment to motherhood.

The aim of this study was to explore women’s experiences of changes to their sexual relationship, sexuality and intimacy, as a result of pregnancy, childbirth and parenting. A sub-sample of women was purposively selected from a larger prospective pregnancy cohort study of nulliparous women in Melbourne, Australia. Eighteen women (including a mixture of parity, birth methods and relationship status) were interviewed 2.5–3.5 years after a first birth. Interviews were transcribed verbatim and analyzed using interpretive phenomenological analysis. Women identified numerous factors affecting sexual and intimate relationships including extreme tiredness, changing lifestyles and body image issues, leading to changes in libido and intimacy in relationships. Of particular note were feelings of guilt and failure women experienced as a result of a lowered libido. Finding ways to stay connected – whether through sex, quality time together or working as a team – helped women and their partners navigate the transition to parenthood. This study demonstrates that pregnancy, childbirth and parenting can bring about significant changes to women’s experiences of sex and intimacy. Women who experience significant reductions in their libido may be vulnerable to feelings of guilt and failure, connected with high expectations that they should be able to “do it all”.

Maternal depression and physical health problems in early pregnancy: Findings of an Australian nulliparous pregnancy cohort study

OBJECTIVE to investigate the relationship between physical health problems and depressive symptoms in early pregnancy. DESIGN baseline questionnaire, prospective pregnancy cohort study. SETTING six metropolitan public maternity hospitals in Victoria, Australia. PARTICIPANTS 1507 nulliparous women recruited in early pregnancy. FINDINGS nine per cent of women (131/1500) scored ≥ 13 on the EPDS indicating probable clinical depression in early pregnancy (mean gestation=15 weeks). The five most commonly reported physical health problems were as follows: exhaustion (86.9%), morning sickness (64.3%), back pain (45.6%), constipation (43.5%) and severe headaches or migraines (29.5%). Women scoring ≥ 13 on the EPDS reported a mean of six physical health problems compared with a mean of 3.5 among women scoring <13 on the EPDS. Women reporting five or more physical health problems had a three-fold increase in likelihood of reporting depressive symptoms (Adj OR=3.13, 95% CI 2.14-4.58) after adjusting for socio-demographic factors, including maternal age. CONCLUSIONS the findings from this large multi-centre study show that women experiencing a greater number of physical health problems are at increased risk of reporting depressive symptoms in early pregnancy. IMPLICATIONS FOR PRACTICE early detection and support for women experiencing physical and psychological health problems in pregnancy is an important aspect of antenatal care. The extent of co-morbid physical and psychological health problems underlines the need for comprehensive primary health care as an integral component of antenatal care.

Frequency, severity and risk factors for urinary and faecal incontinence at 4 years postpartum: a prospective cohort

To investigate frequency, severity and risk factors for urinary incontinence and faecal incontinence 4 years after a first birth.

The case for early intervention to reduce the impact of intimate partner abuse on child outcomes: results of an Australian cohort of first-time mothers.

BACKGROUND Intimate partner abuse is a major contributor to death, disability, and illness in women of childbearing age, but little is known about population level impact on children. METHOD Prospective pregnancy cohort of 1,507 first-time mothers recruited from six public hospitals in Melbourne, Australia. Follow-up included validated measures of intimate partner abuse at 1 and 4 years (Composite Abuse Scale) and child emotional and behavioral difficulties at 4 years (Strengths and Difficulties Questionnaire). RESULTS Twenty-nine percent of mothers reported partner abuse in the first 4 years postpartum: 20 percent reported abuse in the first year and 21 percent at 4 years; 12 percent of mothers reported abuse at both time points. Children of mothers reporting abuse at both times were more likely to experience emotional and/or behavioral difficulties at age 4, compared to children of mothers not reporting abuse, after adjusting for maternal depressive symptoms, relationship transitions and other social characteristics (Adj. OR 2.6 [95% CI 1.2-5.5]). CONCLUSIONS Intimate partner abuse impacted the lives of one in four children. Children of mothers reporting abuse at both time points were at most risk of emotional/behavioral difficulties. The case for early intervention to reduce the impact of intimate partner abuse on womens and childrens lives is compelling.