What Is Postpartum Depression, Midwife Care Can Help Cut Postpartum Depression

Q: In the UK, women typically get 6 to 7 home visits by a midwife in the 10 to 14 days after birth. Professor Christine MacArthur, from the University of Birmingham, and colleagues, report that redesigning such care could have a significant impact on postpartum depression, which strikes one in ten mothers in countries like the UK and US

A:

A:About half the women received the redesigned care. Midwives used new guidelines designed to assess mothers' health, compiling care plans for individual patients and using a recognised screening tool to check for depression at ten days and one month. Each woman received home visits up to 28 days after birth and had a follow up visit 10 or 12 weeks after the birth. The remaining women received conventional postnatal care, which involved regular visits by the midwife for the first two weeks, followed by health visitor checks and a doctor's appointment after six or eight weeks. The results showed women receiving the new model of care had significantly better psychological well being, with an overall 40% reduction in the risk of depression. There was no difference between the two groups in terms of physical health. Whether the success of the scheme was due to a particular element, or the combination of measures, isn't clear, MacArthur told Reuters Health. ``But it may be that women benefited from talking to midwives about their problems, rather than undergoing examinations they do not really need,'' she said. A financial analysis is underway to see if midwife care is cost-effective, but MacArthur said feedback from midwives suggested it was no more time-consuming than existing care. ``The findings should command the attention of clinicians and policymakers in the USA who function in a health-care system in which the limited content of postpartum care is seldom questioned,'' Leah Albers, of the University of New Mexico, Albuquerque, and Deanne Williams from the American College of Nurse-Midwives, Washington DC, write in a commentary. ``Reimbursement is typically limited to one visit; in fact, the standard of care for new mothers as described by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists is one office visit at 4-6 weeks,'' they write. ``As in the UK and in Australia, postpartum depression affects 10-15% of new mothers in the USA; yet even when a mother is so extremely depressed that she murders all five of her children, as recently happened in Texas, there is no call to re-examine the system.'' Postnatal, or postpartum, depression can be triggered by a number of factors, such as the hormonal changes that take place around the time of birth, a previous history of depression or having to take care of a sick baby. Lack of partner support, housing worries or money problems can also make things worse. The symptoms--loss of interest in normally pleasurable activities, frequent crying, loss of appetite, lack of motivation, difficulty sleeping--are the same as those of depression. Mothers with postpartum depression may be less able to bond with their child. In severe cases, a woman may consider harming herself or her child, and may act on this impulse.

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