[Delivery by midwife in full autonomy. Literature review and analysis of 80 months of activity at the University Hospital Erasme]

INTRODUCTION

The last century focused all its attention on the care of the pathological pregnancies with remarkable results, at the price of fatal overmedicalisation in normal pregnancies. Efforts centered on the pregnant patients at low risk are being developped.

OBJECTIVES

To compare obstetric and neonatal outcomes obtained by independent midwives (IM) to a group control of pregnant women at low risk at Hospital Erasme.

MATERIAL AND METHODS

Retrospective constitution of a multivariated cohort case-witnesses 1:2 of patients at low risk including 128 followed in antenatal and delivered by the IM and 256 followed in antenatal and delivered by the group control Erasme (E) RESULTS: The rate of spontaneous vaginal delivery is significantly higher in the group IM (88,28 % versus 77,7 % in the group E). The rates of epidurals (66,79 % versus 37,50 %) and episiotomies (24,61 % versus 8,60 %) are significantly higher in the group E. Transfers to the neonatal unit are more frequent in the group E.

CONCLUSION

The obstetrics attitudes are less interventionist in the IM group. The reasons can be linked to bias selection or to different obstetrics practices in both groups. Positive effects in terms of maternal and neonatal outcomes are quite positive.

Guided self-help concreteness training as an intervention for major depression in primary care: a Phase II randomized controlled trial

BACKGROUND

The development of widely accessible, effective psychological interventions for depression is a priority. This randomized trial provides the first controlled data on an innovative cognitive bias modification (CBM) training guided self-help intervention for depression.

METHOD

One hundred and twenty-one consecutively recruited participants meeting criteria for current major depression were randomly allocated to treatment as usual (TAU) or to TAU plus concreteness training (CNT) guided self-help or to TAU plus relaxation training (RT) guided self-help. CNT involved repeated practice at mental exercises designed to switch patients from an unhelpful abstract thinking habit to a helpful concrete thinking habit, thereby targeting depressogenic cognitive processes (rumination, overgeneralization).

RESULTS

The addition of CNT to TAU significantly improved depressive symptoms at post-treatment [mean difference on the Hamilton Rating Scale for Depression (HAMD) 4.28, 95% confidence interval (CI) 1.29-7.26], 3- and 6-month follow-ups, and for rumination and overgeneralization post-treatment. There was no difference in the reduction of symptoms between CNT and RT (mean difference on the HAMD 1.98, 95% CI -1.14 to 5.11), although CNT significantly reduced rumination and overgeneralization relative to RT post-treatment, suggesting a specific benefit on these cognitive processes.

CONCLUSIONS

This study provides preliminary evidence that CNT guided self-help may be a useful addition to TAU in treating major depression in primary care, although the effect was not significantly different from an existing active treatment (RT) matched for structural and common factors. Because of its relative brevity and distinct format, it may have value as an additional innovative approach to increase the accessibility of treatment choices for depression.

[The role of midwife during pregnancy and childbirth]

The profession of midwife, although one of the most ancient professions, remains quite unknown by the Belgian Public. A midwife accompanies and looks after healthy women and their new-born babies in an autonomous and holistic way. She does this since conception, during and after birth and stimulates family integration. She is the guardian of eutocia and stimulates the physiological evolution of the pregnancy, birth and postpartum. She makes her diagnosis based on her professional knowledge, her sensorial competence, her analytic capacity and her experience. She knows the medico-technical requirements, anticipates and reacts in an appropriate way. In order to detect risky situations, she pays attention to complications and refers in time to the most appropriate health professional. The midwife should participate in the evolution of her profession by means of continuing education, and maintain a close collaboration with other health professionals. This profession is part of the healing profession, but the autonomous practice is restricted to physiological motherhood. In Belgium, the profession is regulated by different Royal Decrees. The most important are the Royal Decree no 78 which regulates the health care professions and the Royal Decree of February 1st, 1991 concerning the midwife profession.

[Secondary prevention of posttraumatic stress disorder: challenging psychological debriefings]

This paper examines the efficacy of secondary prevention procedures following a trauma (psychological debriefing). After examining psychological processes leading to the onset of PSTD, 3 prevention procedures are presented: the CISD of Mitchell, the debriefing procedure of Brom and Kleber, and a cognitive and behavioral debriefing procedure. Outcome studies of these procedures are reviewed. They suggest that CISD has no proven efficacy, while the cognitive and behavioral debriefing procedure significantly decreases the probability of onset of PTSD following a trauma. Guidelines are provided for designing optimal debriefing procedures.