Stephanie Brown

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.

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

Screening and counselling in the primary care setting for women who have experienced intimate partner violence (WEAVE): a cluster randomised controlled trial

BACKGROUND Evidence for a benefit of interventions to help women who screen positive for intimate partner violence (IPV) in health-care settings is limited. We assessed whether brief counselling from family doctors trained to respond to women identified through IPV screening would increase womens quality of life, safety planning and behaviour, and mental health. METHODS In this cluster randomised controlled trial, we enrolled family doctors from clinics in Victoria, Australia, and their female patients (aged 16-50 years) who screened positive for fear of a partner in past 12 months in a health and lifestyle survey. The study intervention consisted of the following: training of doctors, notification to doctors of women screening positive for fear of a partner, and invitation to women for one-to-six sessions of counselling for relationship and emotional issues. We used a computer-generated randomisation sequence to allocate doctors to control (standard care) or intervention, stratified by location of each doctors practice (urban vs rural), with random permuted block sizes of two and four within each stratum. Data were collected by postal survey at baseline and at 6 months and 12 months post-invitation (2008-11). Researchers were masked to treatment allocation, but women and doctors enrolled into the trial were not. Primary outcomes were quality of life (WHO Quality of Life-BREF), safety planning and behaviour, mental health (SF-12) at 12 months. Secondary outcomes included depression and anxiety (Hospital Anxiety and Depression Scale; cut-off ≥8); womens report of an inquiry from their doctor about the safety of them and their children; and comfort to discuss fear with their doctor (five-point Likert scale). Analyses were by intention to treat, accounting for missing data, and estimates reported were adjusted for doctor location and outcome scores at baseline. This trial is registered with the Australian New Zealand Clinical Trial Registry, number ACTRN12608000032358. FINDINGS We randomly allocated 52 doctors (and 272 women who were eligible for inclusion and returned their baseline survey) to either intervention (25 doctors, 137 women) or control (27 doctors, 135 women). 96 (70%) of 137 women in the intervention group (seeing 23 doctors) and 100 (74%) of 135 women in the control group (seeing 26 doctors) completed 12 month follow-up. We detected no difference in quality of life, safety planning and behaviour, or mental health SF-12 at 12 months. For secondary outcomes, we detected no between-group difference in anxiety at 12 months or comfort to discuss fear at 6 months, but depressiveness caseness at 12 months was improved in the intervention group compared with the control group (odds ratio 0·3, 0·1-0·7; p=0·005), as was doctor enquiry at 6 months about womens safety (5·1, 1·9-14·0; p=0·002) and childrens safety (5·5, 1·6-19·0; p=0·008). We recorded no adverse events. INTERPRETATION Our findings can inform further research on brief counselling for women disclosing intimate partner violence in primary care settings, but do not lend support to the use of postal screening in the identification of those patients. However, we suggest that family doctors should be trained to ask about the safety of women and children, and to provide supportive counselling for women experiencing abuse, because our findings suggest that, although we detected no improvement in quality of life, counselling can reduce depressive symptoms. FUNDING Australian National Health and Medical Research Council.

Stillbirths: recall to action in high-income countries

Variation in stillbirth rates across high-income countries and large equity gaps within high-income countries persist. If all high-income countries achieved stillbirth rates equal to the best performing countries, 19,439 late gestation (28 weeks or more) stillbirths could have been avoided in 2015. The proportion of unexplained stillbirths is high and can be addressed through improvements in data collection, investigation, and classification, and with a better understanding of causal pathways. Substandard care contributes to 20-30% of all stillbirths and the contribution is even higher for late gestation intrapartum stillbirths. National perinatal mortality audit programmes need to be implemented in all high-income countries. The need to reduce stigma and fatalism related to stillbirth and to improve bereavement care are also clear, persisting priorities for action. In high-income countries, a woman living under adverse socioeconomic circumstances has twice the risk of having a stillborn child when compared to her more advantaged counterparts. Programmes at community and country level need to improve health in disadvantaged families to address these inequities.

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...

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.

Being a ‘good mother’

Abstract This paper draws on tape-recorded interviews with 90 women who gave birth in Victoria, Australia in 1989, followed-up when their infants were around 2 years. Half of the sample had been assessed as depressed 8–9 months post-partum using the Edinburgh Postnatal Depression Scale (case/depressed group), the other half had low scores indicating they were unlikely to have been depressed at the time of the original survey (control). Fifteen of the women in the case/depressed group and two women in the control group had scores of 13 or higher on the EPDS at the time of follow-up at 2 years. The interviews explored a broad range of topics related to the experience of motherhood in the first 2 years after giving birth. The paper focuses on a section of the interviews in which women were asked to describe their conception of a ‘good mother’. Women who had been depressed at 8–9 months post-partum compared with women not scoring as depressed at this time, and those depressed at follow-up compared with women ...

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.