How am I, really? Perceptions of health and distress by women and their midwives

Midwifery Acupuncturists' Management of Antenatal Anxiety and Depression: Data from a Survey in Aotearoa (New Zealand)

Objective

The goal of this research was to explore how New Zealand midwifery acupuncturists manage mild-to-moderate antenatal anxiety and depression (AAD).

Materials and Methods

A survey (Surveymonkey®) on midwives' perceptions of acupuncture for treating AAD was distributed late in 2019 to midwives who completed a Certificate in Midwifery Acupuncture. Data were collected on referrals and on acupuncture and complementary and alternative medicine use for AAD and associated symptoms of concern (SoC), such as low-back and pelvic pain (LBPP), sleep issues, stress, other pain, and pregnancy issues. Descriptive analysis was used to report data.

Results

Of 119 midwives, 66 responded (55.5%). For AAD and SoC, midwives mostly referred patients to general practitioners and counselors, and administered acupuncture themselves. Acupuncture was most accessed for LBPP (n = 38; 70.4%), sleep (n = 31; 57.4%), anxiety (n = 27; 50.0%); stress (n = 26; 48.1%), and other pain (n = 20, 37.0%). Massage was second most-accessed for LBPP (n = 36; 66.7%), sleep (n = 25; 46.3%), and stress (n = 24; 44.4%). For depression, treatments were herbs (n = 16; 29.6%), homeopathy (n = 14; 25.9%), and acupuncture and massage (both n = 13; 24.1%). Acupuncture was most used for other pregnancy issues: birth preparation (n = 44, 88.0%); assisted labor induction (n = 43; 86.0%): nausea and vomiting (n = 43; 86.0%); breech (n = 37; 74.0%); and headaches/migraines (n = 29; 58.0%).

Conclusion

Acupuncture is commonly used by midwife acupuncturists in New Zealand to treat a range of pregnancy issues, including anxiety, SoC for AAD, and other pregnancy issues. Further research would be beneficial.

Prevalence of Depression or Anxiety During Antepartum Hospitalizations for Obstetric Complications: A Systematic Review and Meta-analysis

OBJECTIVE

To systematically review the prevalence of antenatal depression and anxiety in women hospitalized in an antepartum unit for obstetric complications.

DATA SOURCES

We searched PubMed, EMBASE, CINAHL, PsycINFO, and ClinicalTrials.gov for English-language articles published from database inception through March 2020.

METHODS OF STUDY SELECTION

We included cross-sectional, cohort, case-control, quasi-experimental, and randomized controlled studies from any country that reported the proportion of pregnant women with an elevated depression or anxiety screening scale or diagnostic interview during antepartum hospitalization of any duration and at any gestational age.

TABULATION, INTEGRATION, AND RESULTS

We identified 8,799 articles and reviewed 79, 39 of which were included in a systematic review and 18 in meta-analysis of the primary outcome. Two raters independently assessed quality of individual studies using a 14-question tool. A random effects meta-analysis model was used to estimate prevalence and 95% CI of depression or anxiety. Heterogeneity was examined with the I2 test, and funnel plots were used to assess publication bias. After meta-analysis, the estimated prevalence of depression was 34% (95% CI 27-41%) and of anxiety 29% (95% CI 16-43%). There was expected substantial clinical and methodologic heterogeneity between studies that persisted even after planned a priori subgroup analyses and meta-regression. Even so, the direction of effect was consistent across studies. No publication bias was found.

CONCLUSION

The current meta-analysis suggests that one in three women hospitalized during pregnancy for obstetric complications report clinical levels of depression or anxiety symptoms, twice the reported prevalence of antenatal depression or anxiety in the general obstetric population.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, CRD42020172111.

Midwives' experiences of caring for women's emotional and mental well-being during pregnancy

AIMS AND OBJECTIVES

To explore midwives' experiences of caring for women's emotional and mental well-being during pregnancy.

BACKGROUND

Transitioning to motherhood is a major life event for any woman and while it is a joyful experience for the majority, 15%-25% of women will experience a perinatal mental health problem. Providing psychological support to mothers by midwives is acknowledged internationally. The 2016 Irish National Maternity Strategy identifies midwives as being ideally placed to assess women's emotional needs. The research revealed a paucity of qualitative research from an Irish context in this area; therefore, this study addressed this gap in the literature.

DESIGN

Qualitative descriptive design.

METHODS

Semi-structured interviews were conducted with a purposive sample of 10 midwives recruited from the Irish midwifery e-group. Data were analysed using Burnard (Nurse Educ. Today, 11, 1991, 461) thematic content analysis. Transcripts were coded, and meanings were formulated to reflect significant statements, which were categorised. Categories were then evolved into subthemes, and eventually, three themes were emerged using the COREQ checklist.

RESULTS

Three salient themes emerged from the data are as follows: 'awareness of Perinatal Mental Health', 'discussing emotional well-being' and 'the woman has something to divulge'. The themes convey the midwife's awareness, recognition and perceptions of mental well-being during pregnancy. How midwives discuss and assess emotional well-being, the observational skills they use, and what they perceive as the barriers and facilitators to discussing mental well-being were all identified.

CONCLUSIONS

Midwives reported an awareness and acceptance that women's emotional health was as important as their physical health. Midwives used every antenatal opportunity to raise awareness about perinatal mental health, whilst also identifying key challenges in getting women to talk.

RELEVANCE TO CLINICAL PRACTICE

Care pathways for assessing and identifying Perinatal Mental Health issues should be available in all maternity services. More support for midwives is required to debrief, which would assist them in supporting women's emotional well-being.