Project

Perinatal Mental Health

We have conducted projects in this area since 2000.

Each project leads to the use of best available evidence to develop, implement and evaluate primary prevention and health promotion interventions or programs that improve the well-being of women and their families.

Our specific focus is on primary prevention of perinatal mental health problems (such as anxiety, postnatal depression (PND), fear of birth, and trauma symptoms).

Lead: Professor Debra Creedy
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Study 1 – Effectiveness of caseload midwifery care in promoting maternal mental health and positive mother-infant relationships (MoMent Study) (2017-2020)

Around 19% of women experience a perinatal mental health disorder, which has long-term consequences for themselves, their families, and society.

There is an urgent need for nation-wide, population level, research-informed information that will allow maternity service planners to implement models that address healthcare needs, are accepted by women and are cost-effective.

This mixed methods project aims to:

  • identify the effectiveness of public hospital continuity of midwifery care (COMC), public hospital standard care on perinatal mental health outcomes
  • explore women’s experiences of different models of care, and the impact of their birthing experience on their likely future decision-making
  • quantify the cost-effectiveness of different models of care from a public hospital perspective to identify the costs involved in delivering different models.

Funding: Gold Coast Health Research Grants Scheme.
Researchers: Fenwick J, Gamble J Ellwood D, Creedy DK & Brittain H.
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Study 2 – Translation to practice: Implementing a midwife psycho-education intervention to improve women’s perinatal mental health (2016-2018)

Getting clinicians to base their practice on best available evidence is challenging.

This study tested the implementation of a midwifery-led psycho-education intervention to promote women’s mental health into practice.

The study determined the extent to which characteristics of midwives, the model of service delivery, policies and procedures, and delineation of roles of multidisciplinary team members impacted on midwives implementing the intervention and outcomes of care delivered to childbearing women.

Across the life of the project, information was progressively collected and evaluated to inform strategies to remediate barriers to practice translation.

Funding: Nursing & Midwifery Board, Queensland Implementation Grant Round.
Researchers: Gamble, J, Creedy DK, Fenwick J & Toohill J.
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Study 3 – Reducing childbirth related fear and preference for caesarean section: A RCT of a midwifery led psycho-education intervention (BELIEF Study) (2012 – 2016)

For first-time mothers, fear is often linked to a perceived lack of control and disbelief in the body’s ability to give birth safely, whereas multiparous women may be fearful due to previous negative and/or traumatic birth experiences.

A brief psycho-education intervention was offered during pregnancy by trained midwives.  The BELIEF intervention (Birth Emotions – Looking to Improve Expectant Fear) reduced women’s childbirth fear; decisional conflict; and depressive symptoms; while improving childbirth self-efficacy; and health and obstetric outcomes.

In study 2 (above) we investigated how best to implement our positive findings into practice, and in the MoMent study (above) we extended the work to determine how effective relationship-based care is in supporting and promoting women’s mental health around the time of birth.

Funding: NHMRC
Researchers: Fenwick J, Gamble J, Creedy D, Buist A, Turska E. & Ryding E-L.
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Study 4 – Improving postpartum women’s mental health: A RCT of a midwife-led counselling intervention (PRIME)

We investigated the impact of pre-existing ill mental health on postpartum maternal outcomes. Women reporting childbirth trauma received counselling (Promoting Resilience in Mothers’ Emotions [PRIME]; n =137) or parenting support (n =125) at birth and 6 weeks.

At 12 months, it was found that PRIME had improved women’s quality of life, parenting confidence and emotional wellbeing.

Funding: NHMRC
Researchers: Gamble J, Creedy D, Fenwick J, Barclay L Buist A, Thalib L. & Ryding E. (2008 – 2011)
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Study 5 – A couple-based program for the transition to parenthood (Couple Care) (2005-2007)

Most couples have significant struggles adapting to the challenges of parenthood.

For about 60% of couples their relationship deteriorates significantly, the health of many individuals deteriorates, and their children’s development does not flourish as well as it could.

In this study, couples expecting their first child were randomly assigned to either Becoming a Parent (BAP), a maternal parenting education program; or Couple CARE for Parents (CCP), a couple relationship and parenting education program.

Couples were assessed pre-intervention (last trimester of pregnancy), post-intervention (5 months postpartum), and follow-up (12 months postpartum).

Relative to BAP, CCP reduced negative couple communication, and prevented erosion of relationship adjustment and self-regulation in women but not men.

Parenting stress reduced in both groups. Couple Care for Parents shows promise as a brief program that can enhance couple communication and women’s adjustment to parenthood.

Funding: NHMRC
Researchers: Halford, WK, Creedy, DK, & Gamble J.
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Study 6 – Childbirth and the development of acute trauma symptoms (2000)

Little is known about the relationship between women’s birthing experiences and the development of trauma symptoms.

Using a prospective, longitudinal survey design, 499 women in their last trimester of pregnancy were recruited from four public hospital antenatal clinics.

Telephone interviews at 4 to 6 weeks and 3 months postpartum explored the medical and midwifery management of the birth, perceptions of intrapartum care, and the presence of trauma symptoms.

One in three women (33%) identified a traumatic birthing event. Twenty-eight women (5.6%) met diagnostic criteria for acute posttraumatic stress disorder.

The level of obstetric intervention experienced during childbirth and the perception of inadequate intrapartum care during labour was also associated with trauma symptoms.

Women who experienced both a high level of obstetric intervention and dissatisfaction with their intrapartum care were more likely to develop trauma symptoms than other women.

These findings should prompt a serious review of intrusive obstetric intervention during labour and birth, and the care provided to birthing women.

Researchers: Creedy DK, Shochet I & Horsfall J.
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