Postpartum Depressive Symptomatology: Results from a Two‐Stage US National Survey

Introduction: Up to 19% of new mothers have major or minor depression sometime during the first 3 months after birth. This article reports on the prevalence of postpartum depressive symptoms and risk factors obtained from a 2‐stage US national survey conducted by Childbirth Connection: Listening to Mothers II (LTM II) and Listening to Mothers II Postpartum Survey. Methods: The weighted survey results are based on an initial sample of 1573 women (1373 online, 200 telephone interviews) who had given birth in the year prior to the survey and repeat interviews with 902 women (859 online, 44 telephone) 6 months later. Three main instruments were used to collect data: the Postpartum Depression Screening Scale (PDSS), the Patient Health Questionnaire‐2 (PHQ‐2), and the Posttraumatic Stress Disorder Symptom Scale‐Self Report (PSS‐SR). Results: Sixty‐three percent of the women in the LTM II sample screened positive for elevated postpartum depressive symptoms with the PDSS, and 6 months later 42% of the women in this sample screened positive for elevated postpartum depressive symptoms with the PHQ‐2. A stepwise, multiple regression revealed 2 variables that significantly explained 54% of the variance in postpartum depressive symptom scores: posttraumatic stress symptom scores on the PSS‐SR and health promoting behaviors of healthy diet, managing stress, rest, and exercise. Discussion: The high percentage of mothers who screened positive for elevated postpartum depressive symptoms in this 2‐stage national survey highlights the need for prevention and routine screening during the postpartum period and follow‐up treatment.     

Effect of maternal depression and anxiety on mother’s perception of child and the protective role of social support

Objective: The purpose of this study was to investigate the impact of postpartum depressive and anxiety symptoms on maternal perception of the infant and the protective role of social support.

Background: Adverse effects of perinatal depression on mother–child interaction are well documented; however, the role of maternal perception has not been examined.

Methods: We used the data of 431 women enrolled in a prospective study in a single maternity unit. Depressive and anxiety symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS), the State Trait Anxiety Inventory (STAI), and the mother’s perception of infant with the Mother’s Object Relation Scale (MORS). We used Multidimensional Scale of Perceived Social Support (MSPSS) in order to measure social support.

Results: Depressive and anxiety symptoms were positively associated to less positive emotions and a more dominant attitude of child as perceived by mothers. This association was even more significant in the case of trait anxiety. Perceived social support has been found to be a protective factor which was able to reduce this tendency.

Conclusion: The findings have potential implications for our understanding of the impact of maternal depressive and anxiety symptoms on the developing mother–infant relationship.     

Posttraumatic Stress Disorder in New Mothers: Results from a Two‐Stage U.S. National Survey

Abstract: Background: Prevalence rates of women in community samples who screened positive for meeting the DSM‐IV criteria for posttraumatic stress disorder after childbirth range from 1.7 to 9 percent. A positive screen indicates a high likelihood of this postpartum anxiety disorder. The objective of this analysis was to examine the results that focus on the posttraumatic stress disorder data obtained from a two‐stage United States national survey conducted by Childbirth Connection: Listening to Mothers II (LTM II) and Listening to Mothers II Postpartum Survey (LTM II/PP). Methods: In the LTM II study, 1,373 women completed the survey online, and 200 mothers were interviewed by telephone. The same mothers were recontacted and asked to complete a second questionnaire 6 months later and of those, 859 women completed the online survey and 44 a telephone interview. Data obtained from three instruments are reported in this article: Posttraumatic Stress Disorder Symptom Scale‐Self Report (PSS‐SR), Postpartum Depression Screening Scale (PDSS), and the Patient Health Questionnaire‐2 (PHQ‐2). Results: Nine percent of the sample screened positive for meeting the diagnostic criteria of posttraumatic stress disorder after childbirth as determined by responses on the PSS‐SR. A total of 18 percent of women scored above the cutoff score on the PSS‐SR, which indicated that they were experiencing elevated levels of posttraumatic stress symptoms. The following variables were significantly related to elevated posttraumatic stress symptoms levels: low partner support, elevated postpartum depressive symptoms, more physical problems since birth, and less health‐promoting behaviors. In addition, eight variables significantly differentiated women who had elevated posttraumatic stress symptom levels from those who did not: no private health insurance, unplanned pregnancy, pressure to have an induction and epidural analgesia, planned cesarean birth, not breastfeeding as long as wanted, not exclusively breastfeeding at 1 month, and consulting with a clinician about mental well‐being since birth. A stepwise multiple regression revealed that two predictor variables significantly explained 55 percent of the variance in posttraumatic stress symptom scores: depressive symptom scores on the PHQ‐2 and total number of physical symptoms women were experiencing at the time they completed the LTM II/PP survey. Conclusion: In this two‐stage national survey the high percentage of mothers who screened positive for meeting all the DSM‐IV criteria for a posttraumatic stress disorder diagnosis is a sobering statistic. (BIRTH 38:3 September 2011)     

The Origin of the World: Science and Fiction of the Vagina

This study examined the course of psychological problems in women from late pregnancy to six months postpartum, the rates of psychiatric, especially depressive and post-traumatic stress symptoms and possible related antecedent variables. During late pregnancy, one to three days postpartum, six weeks and six months postpartum, 47 of the 60 participating women completed a battery of questionnaires including the General Health Questionnaire, the State-Trait Anxiety Inventory, the Edinburgh Postnatal Depression Scale, and the PTSD Symptom Scale. In general, most women recovered from psychiatric and somatic problems over the period of investigation. However, depressive and post-traumatic stress symptoms in particular were not found to decline significantly. Six weeks postpartum, 22% of the women had depressive symptoms, with this figure remaining at 21.3% six months postpartum. In addition, 6% of the women studied reported clinically significant PTSD symptoms at six weeks postpartum with 14.9% reporting such symptoms at six months postpartum. The most important predictor for depressive and post-traumatic stress symptoms was the block variable “anxiety in late pregnancy”. Other predictors were the variables “psychiatric symptoms in late pregnancy”, “critical life events” and the “experience of delivery”. The results of our study show a high prevalence rate of psychiatric symptoms in women after childbirth and suggest, besides the experience of the delivery itself, a vulnerability or predisposing history that makes the development of psychiatric symptoms after childbirth more probable.     

Going back to work after childbirth: women’s lived experiences

Objective: The study aimed at understanding the experiences of first-time mothers who returned to work after paid maternity leave. It explored the challenges new mothers faced during the transition of having a baby, taking 14 weeks of paid maternity leave and then returning to work. Background: Traditionally women left paid employment and stayed at home while their children were still young, but recent times have seen a change in local women’s labour force participation and the actual lived experiences of Maltese women in the context of transition to parenthood had not been explored. Society still seems to expect that the idea of balancing work and family life is principally a women’s issue as traditional gender roles still appear to prevail. Methods: The qualitative paradigm was used to conduct the study by means of a semi-structured interview schedule at three different phases throughout the experience. Ten women were chosen to participate in this study by purposive sampling. The theoretical framework used to guide this thesis included phenomenology, transitional theory as described by van Gennep and feminism. Interpretative phenomenological analysis was used during the analysing phase. Results: The resulting three super-ordinate themes identified how after childbirth maternity leave is ‘a time of preparation and planning ahead’ followed by a period when ‘lightening strikes on rejoining the workforce’ and ‘weathering the storm’ via an attempt to balance work and family life. Conclusion: Findings showed that while society encourages mothers to return to work after the birth of their children, few attempts have actually been made to support them during this delicate transition. This study identified the need to improve local policy with regards to family-friendly measures and the importance of an increase in local maternity leave duration. Moreover, the midwife was identified as an important figure that can help empower mothers and prepare them for what is yet to come.     

A multisite audit to assess how women with complex social factors access and engage with maternity services

Objectiveto audit women with socially complex lives’ documented access to and engagement with antenatal care provided by three inner city, UK maternity services in relation to birth and neonatal outcomes, and referral processes.Backgroundwomen living socially complex lives, including young mothers, recently arrived immigrants, non-English speaking, and those experiencing domestic violence, poor mental health, drug and alcohol abuse, and poverty experience high rates of morbidity, mortality and poor birth outcomes. This is associated with late access to and poor engagement with antenatal care.Methoddata was collected from three separate NHS trusts data management systems for a total of 182 women living socially complex lives, between January and December 2015. Data was presented by individual trust and compared to standards derived from NICE guidelines, local trust policy and national statistic using Excel and SPSS Version 22. Tests of correlation were carried out to minimise risks of confounding factors in characteristic differences.Findingsnon-English speaking women were much less likely to have accessed care within the recommended timeframes, with over 70% of the sample not booked for maternity care by 12 weeks gestation. On average 89% primiparous women across all samples had less than the recommended number of antenatal appointments. No sample met the audit criteria in terms of number of antenatal appointments attended. Data held on the perinatal data management systems for a number of outcomes and processes was largely incomplete and appeared unreliable.Conclusionthis data forms a baseline against which to assess the impact of future service developments aimed at improving access and engagement with services for women living with complex social factors. The audit identified issues with the completeness and reliability of data on the perinatal data management system.