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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Allen J, Kildea S, Stapleton H (2016) How optimal caseload midwifery can modify predictors for preterm birth in young women: Integrated findings from a mixed methods study. Midwifery 41:30–38
Allen J, Kildea S, Hartz DL, Tracy M, Tracy S (2017) The motivation and capacity to go ‘above and beyond’: Qualitative analysis of free-text survey responses in the M@ NGO randomised controlled trial of caseload midwifery. Midwifery 50:148–156
Austin M-PV, Hadzi-Pavlovic D, Priest SR, Reilly N, Wilhem K, Saint K, Parker G (2010) Depressive and anxiety disorders in the postpartum period: how prevalent are they and can we improve their detection? Arch Women's Ment Health 13:395–401
Australian Institute of Health Welfare (2012) Perinatal depression: data from the 2010 Australian National Infant Feeding Survey. Australian Institute of Health and Welfare, Canberra
Beck CT (2001) Predictors of postpartum depression: an update. Nurs Res 50:275–285
Brock RL, O’Hara MW, Hart KJ, McCabe JE, Williamson JA, Laplante DP et al (2014) Partner support and maternal depression in the context of the Iowa floods. J Fam Psychol 28(6):832
Brock RL, O'Hara MW, Hart KJ, McCabe-Beane JE, Williamson JA, Brunet A et al (2015) Peritraumatic distress mediates the effect of severity of disaster exposure on perinatal depression: the Iowa Flood Study. J Trauma Stress 28(6):515–522
Brunet A, Weiss DS, Metzler TJ, Best SR, Neylan TC, Rogers C et al (2001) The peritraumatic distress inventory: a proposed measure of PTSD criterion A2. Am J Psychiatr 158(9):1480–1485
Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150:782–786
Dancause KN, Laplante D, Oremus C, Fraser S, Brunet A, King S (2011) Disaster-related prenatal maternal stress influences birth outcomes: Project Ice Storm. Early Hum Dev 87(12):813–820. https://doi.org/10.1016/j.earlhumdev.2011.06.007
Forster DA, McLachlan HL, Davey M-A, Biro MA, Farrell T, Gold L et al (2016) Continuity of care by a primary midwife (caseload midwifery) increases women’s satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial. BMC Pregnancy Childbirth 16(1):1
Giarratano G, Harville EW, de Mendoza VB, Savage J, Parent CM (2015) Healthy start: description of a safety net for perinatal support during disaster recovery. Matern Child Health J 19(4):819–827. https://doi.org/10.1007/s10995-014-1579-8
Glasheen C, Richardson GA, Fabio A (2010) A systematic review of the effects of postnatal maternal anxiety on children. Arch Women's Ment Health 13:61–74
Goodman SH, Gotlib IH (1999) Risk for psychopathology in the children of depressed mothers: a developmental model for understanding mechanisms of transmission. Psychol Rev 106:458–490
Grant K, McMahon CA, Austin MP (2008) Maternal anxiety during the transition to parenthood: a prospective study. J Affect Disord 108:101–111
Harville EW, Xiong X, Pridjian G, Elkind-Hirsch K, Buekens P (2009) Postpartum mental health after Hurricane Katrina: a cohort study. BMC Pregnancy Childbirth 9(1):1–8. https://doi.org/10.1186/1471-2393-9-21
Harville EW, Xiong X, Beuekens P (2010) Disasters and perinatal health: a systematic review. Obstet Gynecol Surv 65(11):713
Hilmert CJ, Kvasnicka-Gates L, Fiebiger S, Teoh AN, Bresin K (2016) Major flood related strains and pregnancy outcomes. Health Psychol 35(11):1189–1196
Homer CS, Henry K, Schmied V, Kemp L, Leap N, Briggs C (2009) ‘It looks good on paper’: Transitions of care between midwives and child and family health nurses in New South Wales. Women Birth 22(2):64–72
Howard LM, Molyneaux E, Dennis C-L, Rochat T, Stein A, Milgrom J (2014) Non-psychotic mental disorders in the perinatal period. Lancet 384(9956):1775–1788
Kildea S, Gao Y, Rolfe M, Josif CM, Bar-Zeev SJ, Steenkamp M et al (2016) Remote links: redesigning maternity care for Aboriginal women from remote communities in Northern Australia—a comparative cohort study. Midwifery 34:47–57. https://doi.org/10.1016/j.midw.2016.01.009
Kildea S, Hickey S, Nelson C, Currie J, Carson A, Reynolds M et al (2017) Birthing on Country (in Our Community): a case study of engaging stakeholders and developing a best-practice Indigenous maternity service in an urban setting. Aust Health Rev. https://doi.org/10.1071/AH16218
King S, Kildea S, Austin MP, Brunet A, Cobham VE, Dawson PA et al (2015) QF2011: a protocol to study the effects of the Queensland flood on pregnant women, their pregnancies, and their children's early development. BMC Pregnancy Childbirth 15(1):109. https://doi.org/10.1186/s12884-015-0539-7
Kleinhaus K, Harlap S, Perrin M, Manor O, Margalit-Calderon R, Opler M, Friedlander, Y, Malaspina D. 2013 Prenatal stress and affective disorders in a populatin birth cohort. BIPOLAR DISORDERS 15:92–99
Leach LS, Poyser C, Fairweather-Schmidt K (2015) Maternal perinatal anxiety: a review of prevalence and correlates. Clin Psychol 21:4–19
Lee AM, Lam SK, Mun Lau SMS, Chong CSY, Chui HW, Fong DYT (2007) Prevalence, course, and risk factors for antenatal anxiety and depression. Obstet Gynecol 110(5):1102–1112
Marmar CR, Weiss DS, Metzler TJ (1997) The peritraumatic dissociative experiences questionnaire. In: Wilson JP, Keane TM (eds) Assessing Psychological Trauma and PTSD. Guilford Press, New York, pp 412–428
McLachlan H, Forster D, Davey M-A, Farrell T, Gold L, Biro M et al (2012) Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: the COSMOS randomised controlled trial. BJOG Int J Obstet Gynaecol 119(12):1483–1492
McLachlan H, Forster D, Davey MA, Farrell T, Flood M, Shafiei T, Waldenström U (2016) The effect of primary midwife-led care on women’s experience of childbirth: results from the COSMOS randomised controlled trial. BJOG Int J Obstet Gynaecol 123(3):465–474
Milgrom J, Gemmill AW, Bilszta JL, Hayes B, Barnett B, Brooks J et al (2008) Antenatal risk factors for postnatal depression: a large prospective study. J Affect Disord 108(1):147–157. https://doi.org/10.1016/j.jad.2007.10.014
O’Hara MW, Swain AM (1996) Rates and risk of postpartum depression: a meta-analysis. Int Rev Psychiatry 8:37–54
O’Hara MW, Schlechte JA, Lewis DA, Varner MW (1991) A controlled prospective study of postpartum mood disorders: psychological, environmental, and hormonal variables. J Abnorm Psychol 100:63–73
O’Hara MW, McCabe JE (2013) Postpartum depression: current status and future directions. Annu Rev Clin Psychol 9:379–407
Olds D (2006) The nurse–family partnership: an evidence-based preventive intervention. Infant Ment Health J 27:5–25
Sandall J, Soltani H, Gates S, Shennan A, Devane D (2016) Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev 4:Cd004667. https://doi.org/10.1002/14651858.CD004667.pub5
Sarason IG, Sarason BR, Shearin EN, Pierce GR (1987) A brief measure of social support: practical and theoretical implications. J Soc Pers Relat 4(4):497–510. https://doi.org/10.1177/0265407587044007
Saulnier DD, Brolin K (2015) A systematic review of the health effects of prenatal exposure to disaster. Int J Public Health 60(7):781
Spielberger CD, Gorsuch RL, Lushene PR, Vagg PR, Jacobs AG (1983) Manual for the state-trait anxiety inventory (Form y). Consulting Psychologists Press, Inc., Palo Alto
Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M et al (2014) Effects of perinatal mental disorders on the fetus and child. Lancet 384(9956):1800–1819. https://doi.org/10.1016/S0140-6736(14)61277-0
Talge NM, Neal C, Glover V (2007) Antenatal maternal stress and long-term effects on child neurodevelopment: how and why? J Child Psychol Psychiatry 48(3–4):245–261
Tees MT, Harville EW, Xiong X, Buekens P, Pridjian G, Elkind-Hirsch K (2010) Hurricane Katrina-related maternal stress, maternal mental health, and early infant temperament. Matern Child Health J 14(4):511–518. https://doi.org/10.1007/s10995-009-0486-x
Tracy SK, Hartz D, Hall B, Allen J, Forti A, Lainchbury A et al (2011) A randomised controlled trial of caseload midwifery care: M@NGO (Midwives @ New Group practice Options). BMC Pregnancy Childbirth 11(1):82–82. https://doi.org/10.1186/1471-2393-11-82
Tracy SK, Hartz DL, Tracy MB, Allen J, Forti A, Hall B et al (2013) Caseload midwifery care versus standard maternity care for women of any risk: M@NGO, a randomised controlled trial. Lancet 382(9906):1723–1732. https://doi.org/10.1016/S0140-6736(13)61406-3
van den Honert RC, McAneney J (2011) The 2011 Brisbane floods: causes, impacts and implications. Water 3(4):1149–1173. https://doi.org/10.3390/w3041149
Walsh D, Devane D (2012) A metasynthesis of midwife-led care. Qual Health Res 22(7):897–910
Ward TS, Kanu FA, Robb SW (2016) Prevalence of stressful life events during pregnancy and its association with postpartum depressive symptoms. Arch Women's Ment Health. https://doi.org/10.1007/s00737-016-0689-2
Weiss DS, Marmar CR (1997) The impact of event scale: revised. Guilford, New York
Xiong X, Harville EW, Mattison DR, Elkind-Hirsch K, Pridjian G, Buekens P (2008) Exposure to Hurricane Katrina, post-traumatic stress disorder and birth outcomes. Am J Med Sci 336(2):111–115. https://doi.org/10.1097/MAJ.0b013e318180f21c
Yelland J, Sutherland G, Brown SJ (2010) Postpartum anxiety, depression and social health: findings from a population-based survey of Australian women. BMC Public Health 10:771
Funding
Funding was provided by a grant from the Canadian Institutes of Health Research (CHIR grant # MOP-1150067) and funds from Mater Research, Mater Health, and Mater Foundation.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
Ethical approval was obtained from the Human Research Ethics Committees at the study site hospital and affiliated university (reference numbers 1709M and 2013001236, respectively).
Informed consent
All participants provided written informed consent at recruitment into the study and when completing the 6-week and 6-month postnatal surveys.
Rights and permissions
About this article
Cite this article
Kildea, S., Simcock, G., Liu, A. et al. Continuity of midwifery carer moderates the effects of prenatal maternal stress on postnatal maternal wellbeing: the Queensland flood study. Arch Womens Ment Health 21, 203–214 (2018). https://doi.org/10.1007/s00737-017-0781-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-017-0781-2