Randomised controlled trial of midwife led debriefing to reduce maternal depression after operative childbirth

Objective To assess die effectiveness of a midwife led debriefing session d uring the postpartum hospital stay in reducing the prevalence of maternal d epression at six months postpartum among women giving birth by caesarean se ction, forceps, or vacuum extraction. Design Randomised controlled trial. Setting Large maternity teaching hospital in Melbourne, Australia. Participants 1041 women who had given birth by caesarean section (n=624) or with the use of forceps (n=353) or vacuum extraction (n=64). Main outcome measures Maternal depression (score greater than or equal to 1 3 on the Edinburgh postnatal depression scale) and overall health status (c omparison of mean scores on SF-36 subscales) measured by postal questionnai re at six months postpartum. Results 917 (88%) of the women recruited responded to the outcome questionn aire. More women allocated to debriefing scored as depressed six months aft er birth than women allocated to usual postpartum care (81 (17%) v 65 (14%) ), although this difference was not significant (odds ratio = 1.24, 95% con fidence interval 0.87 to 1.77). They were also more likely to report that d epression had been a problem for them since the birth, but the difference w as not significant (123 (28%) v 94 (22%); odds ratio = 1.37, 1.00 to 1.86). Women allocated to debriefing had poorer health status on seven of the eig ht SF-36 subscales, although the difference was significant only for role f unctioning (emotional): mean scores 73.32 v 78.98, t= - 2.31, 95% confidenc e interval - 10.48 to - 0.84). Conclusions Midwife led debriefing after operative birth is ineffective in reducing maternal morbidity at six months postpartum. The possibility that debriefing contributed to emotional health problems for some women cannot b e excluded.