Judith Lumley

Maternal health after childbirth: results of an Australian population based survey

Objective To describe the prevalence of maternal physical and emotional health problems six to seven months after birth.

Physical health problems after childbirth and maternal depression at six to seven months postpartum

Objective To investigate the relationship between maternal physical and emotional health problems six to nine months after childbirth.

Factors associated with breastfeeding at six months postpartum in a group of Australian women

BackgroundDespite high levels of breastfeeding initiation in Australia, only 47 percent of women are breastfeeding (exclusively or partially) six months later, with marked differences between social groups. It is important to identify women who are at increased risk of early cessation of breastfeeding.MethodsData from the three arms of a randomised controlled trial were pooled and analysed as a cohort using logistic regression to identify which factors predicted women continuing to feed any breast milk at six months postpartum. The original trial included 981 primiparous women attending a public, tertiary, womens hospital in Melbourne, Australia in 1999–2001. The trial evaluated the effect of two mid-pregnancy educational interventions on breastfeeding initiation and duration. In the 889 women with six month outcomes available, neither intervention increased breastfeeding initiation nor duration compared to standard care. Independent variables were included in the predictive model based on the literature and discussion with peers and were each tested individually against the dependent variable (any breastfeeding at six months).ResultsThirty-three independent variables of interest were identified, of which 25 qualified for inclusion in the preliminary regression model; 764 observations had complete data available. Factors remaining in the final model that were positively associated with breastfeeding any breast milk at six months were: a very strong desire to breastfeed; having been breastfed oneself as a baby; being born in an Asian country; and older maternal age. There was an increasing association with increasing age. Factors negatively associated with feeding any breast milk at six months were: a woman having no intention to breastfeed six months or more; smoking 20 or more cigarettes per day pre-pregnancy; not attending childbirth education; maternal obesity; having self-reported depression in the six months after birth; and the baby receiving infant formula while in hospital.ConclusionIn addition to the factors commonly reported as being associated with breastfeeding in previous work, this study found a negative association between breastfeeding outcomes and giving babies infant formula in hospital, a high maternal body mass index, and self-reported maternal depression or anxiety in the six months after the baby was born. Interventions that seek to increase breastfeeding should consider focusing on women who wish to breastfeed but are at high risk of early discontinuation.

Antenatal screening for postnatal depression: a systematic review

Objective: To describe the screening properties of the antenatal tools which have been developed to predict depression after birth and to summarize the implications of the findings for antenatal screening.

Defining the problem: the epidemiology of preterm birth

Preterm birth is the major clinical problem associated with perinatal mortality, serious neonatal morbidity and moderate to severe childhood disability in prosperous countries. Its prevalence is affected by the way in which gestational age is assessed, by national differences in the registration of births, associated practices, such as burial costs, or maternity benefits, which encourage or discourage registration, and by the perceived viability of extremely preterm infants. Despite these uncertainties, there is reliable evidence that preterm births are increasing, especially births before 28 weeks gestation. Contributing factors include births following assisted reproductive therapy and ovulation induction, especially multiple births, and the increasing proportion of births among women >34 years. On the other hand, improvements in neonatal care have substantially increased the survival of preterm infants during the last 15 years. There is wider acceptance of the importance of infection as a factor in preterm birth, and increasing recognition that processes leading to preterm birth may be initiated in very early pregnancy (the initiation of pre‐eclampsia, major birth defects, premature placental separation), or even prior to pregnancy (prior pregnancy losses). It is unclear whether the familiar clinical presentations of preterm labour and birth reflect different pathophysiological processes. The pathways which link those processes to the consistent pattern of social differences in the probability of preterm birth have prompted new research approaches but in 2002 ‘the stubborn challenge of preterm birth’ remains just that.

Randomised controlled trial of midwife led debriefing to reduce maternal depression after operative childbirth

Abstract Objective: To assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal depression at six months postpartum among women giving birth by caesarean section, forceps, or vacuum extraction. Design: Randomised controlled trial. Setting: Large maternity teaching hospital in Melbourne, Australia. Participants: 1041 women who had given birth by caesarean section (n= 624) or with the use of forceps (n= 353) or vacuum extraction (n= 64). Main outcome measures: Maternal depression (score ≥13 on the Edinburgh postnatal depression scale) and overall health status (comparison of mean scores on SF-36 subscales) measured by postal questionnaire at six months postpartum. Results: 917 (88%) of the women recruited responded to the outcome questionnaire. More women allocated to debriefing scored as depressed six months after birth than women allocated to usual postpartum care (81 (17%) v 65 (14%)), although this difference was not significant (odds ratio=1.24, 95% confidence interval 0.87 to 1.77). They were also more likely to report that depression had been a problem for them since the birth, but the difference was not significant (123 (28%) v 94 (22%); odds ratio=1.37, 1.00 to 1.86). Women allocated to debriefing had poorer health status on seven of the eight SF-36 subscales, although the difference was significant only for role functioning (emotional): mean scores 73.32 v 78.98, t= −2.31, 95% confidence interval −10.48 to −0.84). Conclusions: Midwife led debriefing after operative birth is ineffective in reducing maternal morbidity at six months postpartum. The possibility that debriefing contributed to emotional health problems for some women cannot be excluded.

Changing childbirth: lessons from an Australian survey of 1336 women

Objective To investigate the views and experiences of care in labour and birth of a representative sample

Cross-cultural experiences of maternal depression: associations and contributing factors for Vietnamese, Turkish and Filipino immigrant women in Victoria, Australia

Objectives. To investigate in an Australian study of immigrant women conducted 6–9 months following childbirth (a) the associations of a range of demographic, obstetric, health and social context variables with maternal depression, and (b) womens views of contributing factors in their experiences of depression. Design. Three hundred and eighteen Vietnamese, Turkish and Filipino women participated in personal interviews conducted by three bicultural interviewers in the language of the womens choice. Utilising three approaches to the assessment of maternal depression, the consistency of associations on the different measures is examined. Womens views of contributing factors are compared with previous research with largely English-speaking Australian-born women. Results. Analysis of the associations of maternal depression revealed considerable consistency in associations among the three approaches to assessing depression. Significant associations with depression on at least two of the measures were seen for: mothers under 25 years, shorter residence in Australia, speaking little or no English, migrating for marriage, having no relatives in Melbourne, or no friends to confide in, physical health problems, or a baby with feeding problems. There were no consistent associations found with family income or maternal education, method of delivery and a range of other birth events, or womens views about maternity care. The issues most commonly identified by women in this study as contributing to depression are similar to those found previously for Australian-born women: isolation (in this study, including being homesick)—29%; lack of support and marital issues—25%; physical ill-health and exhaustion—23%; family problems—19%, and baby-related issues—17%. There were some differences in the importance of these among the three country-of-birth groups, but all except family issues were in the top four contributing factors mentioned by women in all groups. Conclusions. These findings support the evidence for quite marked cross-cultural similarity in the associations of maternal depression and in womens views about their experiences.

Missing voices: What women say and do about depression after childbirth

Abstract Women who had participated in a population based survey at 8–9 months after childbirth and who had scored as depressed at that time on a well-validated self report instrument, the Edinburgh Postnatal Depression Scale (EPDS), were followed up 12–18 months later when the babies were around 2 years of age. Home interviews were conducted with this case group (n = 45, EPDS score > 12) and with a randomly selected control group (comprising women who had not scored as depressed at the time of the survey, n = 45, EPDS score < 9). Although most women who had scored as depressed also perceived themselves as having been depressed, a third did not want to label this experience postnatal depression. Women who reported feeling depressed believed the contributing factors to be lack of support, isolation, fatigue and physical ill health. Only two in five women in the case group had sought any form of professional assistance. Half die women in the case group had sought help from non-professional sources, mainly f...

Precancerous changes in the cervix and risk of subsequent preterm birth

Objective  The aims of this study were (i) to examine whether women referred for assessment of precancerous changes in the cervix had higher rates of preterm birth compared with those in the general population and (ii) to compare preterm birth rates for treated and untreated women adjusting for possible confounding factors.