Developing an evidence-based midwifery model of postpartum debriefing

Abstract

Objective: Experiences associated with labour and delivery may be overwhelming and result in debilitating trauma responses. Very little attention has been given to preventing or reducing this distress in childbearing women. Method: Focus groups were conducted with postpartum women (n = 10) and midwives (n = 7) to inform the development of a midwifery model of debriefing which was then piloted with women who were recruited during the antenatal period as part of a larger, ongoing study. After birth participants completed the Edinburgh Postnatal Depression Scale (EPDS), the Depression, Anxiety and Stress Scale-21 item scale (DASS-21) and the Maternal Social Support Scale (MSSS) and the Mini-International Neuropsychiatric Interview (M.I.N.I.). Thirty-six women reported acute trauma symptoms in the postpartum period and accepted counselling within 72 hrs of birth up to 4 weeks postpartum. Findings: The pilot study found a reduction in measures of depression, anxiety and trauma symptoms at 4 and 12 weeks postpartum. The women reported a need to: talk about their birth sometimes repetitively; have events explained; explore alternative courses of action and receive emotional support. Midwives endorsed these needs, and also placed specific emphasis on addressing feelings of guilt or a sense of failure. Implications: Debriefing in the early postpartum period aims to assist the woman to gain a meaningful understanding of events, regain a sense of control and achieve completion of the birthing processes. The development of a well researched intervention will enhance practice and client outcomes.