Continuity of midwifery carer moderates the effects of prenatal maternal stress on postnatal maternal wellbeing: the Queensland flood study

Abstract

Poor postnatal mental health is a major public health issue, and risk factors include experiencing adverse life events during pregnancy. We assessed whether midwifery group practice, compared to standard hospital care, would protect women from the negative impact of a sudden-onset flood on postnatal depression and anxiety. Women either received midwifery group practice care in pregnancy, in which they were allocated a primary midwife who provided continuity of care, or they received standard hospital care provided by various on-call and rostered medical staff. Women were pregnant when a sudden-onset flood severely affected Queensland, Australia, in January 2011. Women completed questionnaires on their flood-related hardship (objective stress), emotional reactions (subjective stress), and cognitive appraisal of the impact of the flood. Self-report assessments of the women's depression and anxiety were obtained during pregnancy, at 6 weeks and 6 months postnatally. Controlling for all main effects, regression analyses at 6 weeks postpartum showed a significant interaction between maternity care type and objective flood-related hardship and subjective stress, such that depression scores increased with increasing objective and subjective stress with standard care, but not with midwifery group practice (continuity), indicating a buffering effect of continuity of midwifery carer. Similar results were found for anxiety scores at 6 weeks, but only with subjective stress. The benefits of midwifery continuity of carer in pregnancy extend beyond a more positive birth experience and better birthing and infant outcomes, to mitigating the effects of high levels of stress experienced by women in the context of a natural disaster on postnatal mental health.

Role of midwife‑supported psychotherapy on antenatal depression, anxiety and maternal health: A meta‑analysis and literature review

“…In the included studies, 12 were randomized controlled trials (32,51-61), whereas five were controlled clinical trials (35,(62)(63)(64)(65). Significant reduction (P<0.05) in depression and anxiety was reported in 13 of the included studies which received midwife-supported psychotherapy (19,32,51,52,(54)(55)(56)(57)(58)(60)(61)(62)64). Two studies reported an insignificant reduction (P>0.05) (53,59), and two studies reported no effect (63,65), of midwife-supported psychotherapy on depression, anxiety and maternal health-status outcome during the antenatal stage of pregnancy.…”

“…The average baseline, follow-up assessments for the included studies was performed at 19.8±2.3 and 35.7±2.3 weeks, respectively. However, from the included studies six did not report the initial baseline stage of assessment (19,54,55,60,63,64), whereas eleven did not report the stage at which the follow-up assessment was perfor med (19,32,51,(55)(56)(57)(58)60,(63)(64)(65).…”

“…Intervention. In the included studies, midwife-supported psychoeducation counselling was administered by 12 studies (19,32,52,(57)(58)(59)(60)(61)(63)(64)(65)(66). Four studies used midwife-supported cognitive behavioral therapy (51,(54)(55)(56), and one study used midwife-supported self-regulation therapy (53), for managing depression and anxiety during the antenatal stage of pregnancy.…”

Ecosystem approaches to the risk for schizophrenia

“…1). Research on prenatal exposure to the pandemic may consider how prenatal stress and maternal immune activation are affected by, among others; (1) the risks of maternal coronavirus infection, (2) the effect of social distancing on stress and its interaction with partner support (Brock et al, 2014), (3) the effect of social distancing on access to perinatal care (Kildea et al, 2018), and (4) the effects of urbanicity, notably in a context of potential decrease in air pollution and traffic noise (Cai et al, 2017).…”

Unheard, unseen and unprotected: DOHaD council’s call for action to protect the younger generation from the long-term effects of COVID-19

“…Evidence suggests that the negative effects of adversity in prenatal life can be mitigated if antenatal care is sustained. 12 During the Queensland floods of 2011, continuity of care to pregnant women not only protected them against adverse pregnancy outcomes, but also had positive effects on children's future neurodevelopment. 13 Whilst the pandemic persists, this is a critically important message to maternity care providers in all global settings.…”