The impact of midwifery continuity of care on maternal mental health: A narrative systematic review

BACKGROUND

Systematic reviews have shown that midwifery continuity of care programs lead to improvements in birth outcomes for women and babies, but no reviews have focused specifically on the impact of midwifery continuity of care on maternal mental health outcomes.

OBJECTIVE

To systematically review the available evidence on the impact of midwifery continuity of care on maternal mental health during the perinatal period.

METHOD

A systematic search of published literature available through to March 2021 was conducted. A narrative approach was used to examine and synthesise the literature.

RESULTS

The search yielded eight articles that were grouped based on the mental health conditions they examined: fear of birth, anxiety, and depression. Findings indicate that midwifery continuity of care leads to improvements in maternal anxiety/worry and depression during the perinatal period.

CONCLUSION

There is preliminary evidence showing that midwifery continuity of care is beneficial in reducing anxiety/worry and depression in pregnant women during the antenatal period. As the evidence stands, midwifery continuity of care may be a preventative intervention to reduce maternal anxiety/worry and depression during the perinatal period.

Parenting Fears and Concerns during Pregnancy: A Qualitative Survey

Previous research on the fears and anxieties of expectant mothers has focused mostly on their fears about giving birth rather than parenting. This study aims to describe mothers' fears and concerns about parenthood during pregnancy and to examine the similarities and differences in the perspectives of primiparous and multiparous mothers. The qualitative research for this study was conducted in three postpartum units in Finland and focused on the responses to an open-ended question about parenting fears and concerns that was part of a questionnaire given to 250 mothers after they had given birth. The responses from the 128 mothers who answered this question were subject to inductive content analysis. Fears and concerns on parenthood included worries about coping with the future and everyday life with their new baby, the psychological burden of parenthood, their maternal resources and self-efficacy, meeting their baby's needs, their baby's health, concerns about their relationship with their partner and financial issues. Primiparous and multiparous mothers shared many of the same concerns, but some differences emerged. The findings contribute an interesting perspective to the social debate about declining birth rates and their psychosocial causes. Further studies are needed to examine the fears and concerns of younger adults, and even teens, about parenthood.

Pregnancy with gestational hypertension or preeclampsia: A qualitative exploration of women's experiences

BACKGROUND

Hypertension complicates 10% of pregnancies and involves specialised care of the woman and her baby, a longer stay in hospital, and an increased risk of physical and mental morbidity. There is limited research reporting the woman's perspective on her experience, how she coped with it psychologically, and whether the care she received influenced her experience.

AIM

To gain insight into women's experience of hypertension in pregnancy and to report on what mediating factors may help improve their experience.

METHODS

A qualitative descriptive study was undertaken. Data were collected through a semi-structured, face to face interview at 10-12 months postpartum. In total, 20 women who had experienced hypertension in their pregnancy were interviewed. Thematic analysis was used to analyse the data.

FINDINGS

Four main themes were identified. These were: Reacting to the diagnosis, Challenges of being a mother, Processing and accepting the situation, and Moving on from the experience. The mediating factors that improved the experience were Feeling safe and trusting the care providers, Having continuity of care and carer, and Valuing social support from partner, family and friends.

CONCLUSION

The diagnosis of hypertension in pregnancy has a significant impact on women. This affects their pregnancy and birth experience and their pathway to motherhood. The implications of the findings for midwifery practice include having access to multidisciplinary continuity models of care and facilitating the support for these women.

A psychometric systematic review of self-report instruments to identify anxiety in pregnancy

AIMS

To report a systematic review of the psychometric properties of self-report instruments to identify the symptoms of anxiety in pregnancy to help clinicians and researchers select the most suitable instrument.

BACKGROUND

Excessive anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregnancy, the optimal methods to identify anxiety in pregnancy have not been confirmed.

DESIGN

Psychometric systematic review.

DATA SOURCES

A systematic literature search of the multiple databases (1990-September 2014).

REVIEW METHODS

Identification of self-report instruments to measure anxiety in pregnancy using COSMIN guidelines to assess studies reporting a psychometric evaluation of validity and reliability.

RESULTS

Thirty-two studies were included. Studies took place in the UK, Australia, Belgium, Canada, Germany, Italy, Scandinavia, Spain and the Netherlands. Seventeen different instruments were identified. Measures of validity were reported in 19 papers and reliability in 16. The overall quality of the papers was rated as fair to excellent using the COSMIN checklist. Only one paper scored excellent in more than one category.

CONCLUSION

Many instruments have been adapted for use in different populations to those for which they were designed. The State Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale and the Hospital Anxiety and Depression Scale have been tested more frequently than other instruments, yet require further assessment to confirm their value for use in pregnancy.

'You've got it within you': the political act of keeping a wellness focus in the antenatal time

OBJECTIVE

by exploring midwives' communication techniques intended to promote a wellness focus in the antenatal period, this study identified strategies midwives use to amplify women's own resources and capacities, with the aim of reducing antenatal anxiety.

DESIGN

a qualitative design utilising focus groups as a means of generating data.

SETTING

two Australian cities: Canberra, ACT and Sydney NSW.

PARTICIPANTS

14 experienced, practising midwives across two states/territories, employed in multiple hospitals and community settings.

FINDINGS

three themes emerged from the analysis: calm unhurriedness, speaking in wellness and reassuring bodies. Midwives in these focus groups used strategies in antenatal care that could be co-ordinated into a planned process for wellness focussed care.

KEY CONCLUSIONS

individually midwives used a variety of strategies specifically intended to facilitate women's capabilities, to employ worry usefully and to reduce anxiety. Midwives in the study clearly viewed this kind of wellness focussed care as their responsibility and their right.

IMPLICATIONS FOR PRACTICE

the midwives' collective wisdom could be shared and developed further into an overall salutogenic antenatal strategy to be used for the good of pregnant women and their infants.

The future role for a diabetes specialist midwife

In the United Kingdom diabetes is now the most common, pre-existing medical disorder in pregnancy [Jincoe A. Diabetes: monitoring maternal and fetal wellbeing. Br J Midwifery 2006;14(2):91-4], and still continues to have associated risks for the mother, fetus and neonate [Confidential Enquiry into Maternal and Child Health. Diabetes in pregnancy: are we providing the best care? Findings of a national enquiry: England, Wales and Northern Ireland. London: CEMACH; 2007]. Worldwide diabetes is becoming more prevalent [Macfarlane A. Diabetes and pregnancy. Br Med J 2006;333(7560):157-8] and there is the added new phenomenon of the increase in Type 2 diabetes in the childbearing population. The midwifery role in such pregnancies has come under question as some units have Diabetes Specialist Midwives and some do not and midwifery care is presently varied [Miller A. Diabetes: lessons for midwives. Pract Midwife 2005;8(11):4-5]. This review will specifically seek to address the midwifery role in relation to this client group with complex needs. It will explore how a specialist midwifery post could have an impact on improving care, how the role is developing and future perspectives. Aspects on how midwifery care is delivered to women with diabetes in the United Kingdom will be discussed and a brief international insight relayed.

Fear of the unknown: ultrasound and anxiety about fetal health

Using a qualitative approach, this study sought to explore the role of ultrasound in fetal health anxiety. One semi-structured interview was conducted with 30 pregnant women. Data analysis was inductive, following the principles of the template and editing organizing styles of coding and analysis. Overall, 93 percent of the women reported anxiety over fetal health, with 96.5 percent of these women indicating that ultrasound played a role in their anxiety. The women reported heightened fetal health anxiety in anticipation of the ultrasound, as well as during the ultrasound due to the sonographer's behavior and an inability to see the monitor. Findings indicated that fetal health anxiety was relieved by the ultrasound, particularly when women had access to the visual image and received encouraging verbal feedback. The findings are discussed with regard to their implications for policy and obstetric practice.

Psychosocial correlates of depression symptoms during the third trimester of pregnancy

OBJECTIVE

To explore the psychosocial correlates of depression symptoms during the third trimester of pregnancy.

DESIGN

Cross-sectional design guided by Selye's theory of stress.

SETTING

Prenatal care provider offices or mutually agreeable locations in the Pacific Northwest.

PARTICIPANTS

One hundred thirty-nine women in their third trimester of pregnancy. The majority was Caucasian and married. Fifty-two of the participants (38%) had scores greater than or equal to 16 on the Centers for Epidemiologic Studies Depressed Mood Scale.

MAIN OUTCOME MEASURE

The Centers for Epidemiologic Studies Depressed Mood Scale.

RESULTS

Stepwise linear regression indicated that 46% of the variance of third-trimester depressive symptoms was due to brief and intermittent negative mood states that occurred primarily during the first trimester, a lack of marital satisfaction and social support, and gravida. Lifetime abuse did not contribute significantly to third-trimester depression symptoms.

CONCLUSIONS

One third of the sample reported subclinical levels of depression symptoms. Prenatal care providers may want to consider these minor and brief mood changes as predictive of depression symptoms later in pregnancy, particularly when experienced during the first trimester.

Randomised-controlled trial of two antenatal education programmes

OBJECTIVE

to determine whether a new antenatal education programme with increased parenting content could improve parenting outcomes for women compared with a regular antenatal education programme.

DESIGN

a randomised-controlled trial. Data were collected through self-report surveys.

SETTING

specialist referral maternity hospital in Sydney, Australia.

PARTICIPANTS

170 women birthing at the hospital. Ninety-one women attended the new programme and 79 the regular programme.

INTERVENTION

a new antenatal education programme ('Having a Baby' programme) developed from needs assessment data collected from expectant and new parents. One important feature of the programme was the recognition that pregnancy, labour, birth and early parenting were a microcosm of the childbearing experience, rather than separate topics.

MEASURES

the primary outcome measure was perceived maternal parenting self-efficacy. Worry about the baby, and perceived parenting knowledge, were secondary outcome measures. They were measured before the programme and after birth. Birth outcomes were also recorded.

FINDINGS

the postnatal perceived maternal parenting self-efficacy scores of women who attended the 'Having a Baby' programme were significantly higher than those who attended the regular programme. Perceived parenting knowledge scores of women who attended the 'Having a Baby' programme were also significantly higher than those who attended the regular programme. Worry scores were lower but they did not reach statistical significant. Birth outcomes were similar.

IMPLICATIONS FOR PRACTICE

the 'Having a Baby' programme improved maternal self-efficacy and parenting knowledge. Parenting programmes that continue in the early postnatal period may be beneficial.

Fetal anomaly screening: what do women want to know?

AIM

This paper reports a study exploring women's experiences of receiving an adverse diagnosis at a routine second trimester ultrasound examination, and the factors that influenced their preparedness for an adverse finding.

BACKGROUND

Ultrasound has become a routine part of prenatal care offered to pregnant women in most developed countries and technological advances are making it increasingly possible to detect more anomalies, and at earlier gestations. When fetal anomaly detection can be an outcome of the examination, provision of effective information to ensure informed consent for screening remains a challenge.

METHOD

A grounded theory study (n = 38) was carried out in 2004 and 2005 using an in-depth interview within 4 weeks of diagnosis and constant comparative analysis.

FINDINGS

The core category of balancing information emerged, whereby women balanced the expectation of a healthy baby and the non-threatening nature of the ultrasound examination with the shock of an adverse diagnosis. Assumed fetal health was contributed to by being in good health, experiencing normal symptoms of pregnancy and having other healthy children. The majority of women believed that provision of extensive and detailed lists regarding fetal anomaly detection would only cause unnecessary anxiety and worry, and suggested that a less detailed approach is required for a routine screening programme for low-risk pregnancy.

CONCLUSION

The drive to inform all women fully of ultrasound detection rates for specific anomalies may be counter-productive as it will enhance the worry pregnant women already feel in relation to the health of their unborn baby.

Aromatherapy and massage for antenatal anxiety: Its effect on the fetus

Antenatal anxiety has been linked to maternal hypothalamic-pituitary-adrenal axis changes which can affect fetal development and may have lasting effects on the child's psychological development. Treatments for anxiety have hitherto focused on psychotherapy techniques or antidepressant drugs but these do not always effect long term improvement. Aromatherapy and massage have successfully been used to produce significantly greater improvement in reduction of anxiety. Midwives may highlight anxiety in some of the mothers in their care and can incorporate the holistic approach of aromatherapy and massage into their practice. However, further research is required to establish the efficacy and cost-effectiveness of aromatherapy and massage in the antenatal period.

Factor structure, validity and reliability of the Cambridge Worry Scale in a pregnant population

This article presents the Cambridge Worry Scale (CWS), a content-based measure for assessing worries, and discusses its psychometric properties based on a longitudinal study of 1,207 pregnant women. Principal components analysis revealed a four-factor structure of women's concerns during pregnancy: socio-medical, own health, socio-economic and relational. The measure demonstrated good reliability and validity. Total CWS scores were strongly associated with state and trait anxiety (convergent validity) but also had significant and unique predictive value for mood outcomes (discriminant validity). The CWS discriminated better between women with different reproductive histories than measures of state and trait anxiety. We conclude that the CWS is a reliable and valid tool for assessing the extent and content of worries in specific situations.