Improving access to perinatal mental health services: the value of on-site resources

A rapid evidence review of postnatal listening services for women following a traumatic or negative childbirth experience

PROBLEM

Currently there is a lack of clear guidance to underpin postnatal listening services for women who have had a traumatic or difficult birth.

BACKGROUND

Postnatal listening (or birth reflections) services are important to help women review their birth and ask questions about their care, but currently there is no clear guidance on how these services should be provided.

AIM

To synthesise existing evidence on postnatal listening services for women following a traumatic or negative childbirth experience.

METHODS

A rapid evidence review using four databases (PsycINFO, CINAHL, Medline, Web of Science), backward and forward chaining, and hand searches of previous systematic reviews. The Mixed Methods Appraisal tool was used to appraise the studies. Quantitative and qualitative data were synthesised into descriptive themes.

FINDINGS

Database searches (n = 9,459 hits), backward and forward chaining and hand searching identified 27 articles for inclusion. Nineteen different services are described, evaluated as part of controlled trials (n = 16) or using quantitative and/or qualitative data (n = 8); three studies are audits of UK services. Findings are reported in 5 themes, 'Who provides the service?', 'Types and quality of care', 'Targeting the support', 'Timing and location', and 'Training and experiences of maternity staff'.

DISCUSSION

The findings identify who, how, when, where and what should be provided within postnatal listening services. Services should be flexibly provided by trained maternity staff via active listening, empathy, and a non-judgmental approach.

CONCLUSION

Further work is needed to develop an optimum training programme, to identify key components of effectiveness, and to ensure these services are culturally relevant.

Reproductive psychiatry training: A critical component of access to perinatal mental health treatment

Perinatal Mental Health Disorders (PMHDs) pose significant challenges to the well-being of perinatal individuals, infants, and families. Despite their prevalence and impact, PMHDs often go undetected and untreated due to gaps in clinician education and training. This manuscript reviews the current state of perinatal mental health training, identifies emerging initiatives, and discusses innovative models of care aimed at enhancing the clinical preparedness of healthcare providers. Key findings highlight disparities in PMHD detection and treatment, the need for standardized education across disciplines, and the role of interdisciplinary collaboration in improving care outcomes. The manuscript emphasizes the urgency of prioritizing reproductive psychiatry education to mitigate the adverse effects of PMHDs on maternal and infant health. By standardizing education and fostering interdisciplinary collaboration, we can ensure that all perinatal individuals receive the care they need to thrive.

Models of care: Opportunities and challenges

Perinatal mental health models can broadly be described by scope and structure. Within these two broad domains lies an array of diverse methodologies that have attempted to increase access and coordination of care. These efforts have uncovered many opportunities that, if addressed, may improve our current parent and infant outcomes within our healthcare system and community. Furthermore, there are several opportunities that, if addressed, will result in more equitable, inclusive care. These include being attentive to the unique needs of vulnerable populations, emphasizing community efforts, and closing the current gaps in legislation.

Can Obstetrics and Gynecology Hospitalists Reduce Severe Maternal Morbidity?

Maternal mortality in the United States has risen steadily over the past 20 years. Several interventions including maternal mortality committees and safety bundles have been introduced to decrease the trend. Severe maternal morbidity is a more frequent occurrence related to maternal mortality and can be used to track interventions. Within safety bundles, the presence of well-trained on-site staff such as obstetrics and gynecology (OB/GYN) hospitalists is key to correct implementation. In this article, the authors review the role of OB/GYN hospitalists in specific diagnoses and the evidence present to date on OB/GYN hospitalists' role in decreasing severe maternal morbidity.

Clinicians Speak: We Need to Redesign Postpartum Care

Research indicates gaps in postpartum care that negatively impact maternal and infant health. Prior research exploring clinicians' perspectives on these gaps is limited to those of maternal providers. We explored the views and experiences of maternal and infant health-care providers on the care of mothers and infants in the postpartum period. Qualitative analysis revealed three themes: Gaps in Infant Care Education and Preparation for Parenting, Gaps in Maternal Pregnancy and Postpartum Care and Expectations and Knowledge, and Ideas for Integrating Care, Education, and Support in the postpartum period. Results suggest a need for care models that offer improved prenatal education and expectation setting, methods to help mothers prepare their social support networks, and integrated and convenient access to postpartum care.

Effects of Two Group Prenatal Care Interventions on Mental Health: An RCT

INTRODUCTION

Perinatal depression and anxiety cost the U.S. health system $102 million annually and result in adverse health outcomes. Research supports that cognitive behavioral therapy improves these conditions, but barriers to obtaining cognitive behavioral therapy have prevented its success in pregnant individuals. In this study, the impact of a cognitive behavioral therapy-based intervention on anxiety, depression, stress, healthy lifestyle beliefs, and behaviors in pregnant people was examined.

STUDY DESIGN

This study used a 2-arm RCT design, embedded in group prenatal care, with one arm receiving a cognitive behavioral therapy-based Creating Opportunities for Personal Empowerment program and the other receiving health promotion content.

SETTING/PARTICIPANTS

Black and Hispanic participants (n=299) receiving prenatal care from 2018 to 2022 in New York and Ohio who screened high on 1 of 3 mental health measures were eligible to participate.

INTERVENTION

Participants were randomized into the manualized Creating Opportunities for Personal Empowerment cognitive behavioral therapy-based program, with cognitive behavioral skill-building activities delivered by advanced practice nurses in the obstetrical setting.

MAIN OUTCOME MEASURES

Outcomes included anxiety, depression, and stress symptoms using valid and reliable tools (Generalized Anxiety Disorder scale, Edinburgh Postnatal Depression Scale, and Perceived Stress Scale). The Healthy Lifestyle Beliefs and Behaviors Scales examined beliefs about maintaining a healthy lifestyle and reported healthy behaviors.

RESULTS

There were no statistically significant differences between groups in anxiety, depression, stress, healthy beliefs, and behaviors. There were significant improvements in all measures over time. There were statistically significant decreases in anxiety, depression, and stress from baseline to intervention end, whereas healthy beliefs and behaviors significantly increased.

CONCLUSIONS

Both cognitive behavioral therapy and health promotion content embedded in group prenatal care with advanced practice nurse delivery improved mental health and healthy lifestyle beliefs and behaviors at a time when perinatal mood generally worsens.

TRIAL REGISTRATION

This study is registered with clinicaltrials.gov NCT03416010.

Challenges in Using Progestin to Prevent Singleton Preterm Births: Current Knowledge and Clinical Advice

Preterm birth is the leading cause of infant morbidity and mortality in children younger than 5 years old and accounts for approximately 35% of newborn deaths worldwide. The use of progestogen therapy for prevention of preterm birth has been one of the most controversial topics in modern obstetrics. Progestogens can be classified as natural or synthetic. Progesterone is a natural progestogen while progestins such as 17-alpha-hydroxyprogesterone caproate (17OHP-C) are synthetic steroid hormones. Evidence supporting the use of progestogens varies by formulation and populations studied. After more than a decade, the US Food and Drug Administration has withdrawn accelerated approval of 17OHP-C for the prevention of recurrent preterm birth in pregnant individuals with a singleton gestation. With this decision, there is no current FDA-approved treatment for prevention of spontaneous preterm birth. In this review, we provide a historical context behind the rise and fall of 17OHP-C clinical application, highlight the challenges behind the data supporting progestogen use, and offer suggestions on how to make an impact on preterm birth moving forward.

Addressing caregiver mental health in the neonatal ICU

PURPOSE OF REVIEW

The neonatal ICU (NICU) setting is a unique opportunity to not only detect major changes in caregiver mental health through universal perinatal mood and anxiety disorder (PMAD) screening but also intervene with specialized support. We review evidence for addressing caregiver mental health in the NICU, explore current guidelines and models for integrated behavioural health programmes, and describe challenges specific to NICUs, particularly in standalone paediatric hospitals.

RECENT FINDINGS

Parents of infants admitted to the NICU are at an increased risk for developing PMADs at rates well above the general postpartum community. Select NICUs within the United States and internationally have recognized the importance of having an embedded psychologist to address caregiver PMADs. However, organizational structures within paediatric healthcare systems are not equipped to manage the logistical, ethical, legal and practical needs of comprehensive caregiver mental health programmes.

SUMMARY

To properly address caregiver mental health in NICU settings, clinical and administrative teams must work together to ensure seamless service provision. Systems that facilitate the development of unique parent medical records at the onset of paediatric care are likely to significantly reduce potential liability risks and solve several challenges related to caregiver-focused mental health support in the NICU.

VIDEO ABSTRACT

http://links.lww.com/MOP/A70.