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).
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.
Pregnant women (n = 309) were recruited and completed online surveys at five different times: at their first hospital pregnancy appointment, at 36 weeks, the week of birth and at 6 weeks and 6 months following birth. Surveys asked about women’s physical, mental and social well-being. Following birth, we collected information regarding mother-infant relationships, breastfeeding and birth experience as well as electronic hospital data.
There were beneficial outcomes for women who received caseload care compared to non-caseload care. For example, women in caseload were less likely to birth a preterm baby, less likely to have their labours induced, less likely to have an epidural and less likely to birth their baby by caesarean section. They were also more likely to experience water immersion during labour and waterbirth. There were no differences in terms of mental health, physical health or social support. Our study made an important contribution to validating the tools included in the ICHOM core outcome set. Our study facilitates a standardised way to collect a comprehensive set of outcome data in clinical practice which will enable the transformation of health care systems within and across states, as well as countries. The results from our study addresses two national health priority areas – mental health and healthy start to life; and supports the next phase of the implementation of the National Maternity Services Plan
Publications and presentations:
Slavin V, Gamble J, Creedy DK, Fenwick J, & Pallant J. (2019). Measuring physical and mental health during pregnancy and postpartum in an Australian childbearing population. Validation of the PROMIS Global Short Form. BMC Pregnancy and Childbirth, 19,370. https://doi.org/10.1186/s12884-019-2546-6
Slavin, V., Gamble, J., Creedy, D. K., & Fenwick, J. (2018). “Coming of age”: Assessing the feasibility of using a core set of value-based health outcomes for pregnancy and childbirth. Women and Birth, 31, S29-S30. https://doi.org/10.1016/j.wombi.2018.08.092 Paper presented at the Australian College of Midwives National Conference, Perth, 16–18 October 2018.
Gamble, J., Slavin, V., Creedy, D. K., & Fenwick, J. (2018). Effectiveness of caseload midwifery care in promoting maternal physical, mental and social health during pregnancy and birth. 21st Congress of the Nordic Federation of Midwives, Reykjavik, May 2019
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.
Gamble, J., Toohill, J., Slavin, V., Creedy, D. K., & Fenwick, J. (2017). Identifying barriers and enablers as a first step in the implementation of a midwife-led psychoeducation counseling framework for women fearful of birth. International Journal of Childbirth, 7(3), 152-168. DOI:10.1891/2156-5218.104.22.168
Fenwick J, Toohill J, Slavin V, Creedy DK. & Gamble J. (2018) Improving psychoeducation for women fearful of childbirth: Evaluation of a research translation project. Women & Birth, 31(1):1-9. doi: 10.1016/j.wombi.2017.06.004
Toohill J, Fenwick J, Sidebotham M, Gamble J, & Creedy, DK. (2019) Trauma and fear in Australian midwives. Women & Birth 32(1): 64-71. doi.org/10.1016/j.wombi.2018.04.003
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.
Toohill J, Callander E, Fox H, Lindsay D, Gamble, J. Creedy DK. & Fenwick J. (2019) Socioeconomic differences in access to care for women fearful of birth in Australia. Australian Health Review, 43(6): 639-643. doi.org/10.1071/AH17271
Fenwick J, Toohill J, Slavin V, Creedy DK. & Gamble J. (2018) Improving psychoeducation for women fearful of childbirth: Evaluation of a research translation project. Women & Birth, 31(1):1-9. doi:10.1016/j.wombi.2017.06.004
Toohill J; Callander E, Gamble J, Creedy DK, & Fenwick J. (2017) A cost effectiveness analysis of midwife psycho-education for fearful pregnant women – a health system perspective for the antenatal period. BMC Pregnancy and Childbirth 17, 217. DOI 10.1186/s12884-017-1404-7
Fenwick J, Toohill J, Gamble J, Creedy DK, Buist A, Turkstra E, Sneddon A, Scuffham PA, & Ryding EL. (2015) Effects of a midwife psycho-education intervention to reduce childbirth fear on women’s birth outcomes and psychological well-being. BMC Pregnancy & Childbirth, 15, 284 DOI 10.1186/s12884-015-0721-y
Toohill J, Creedy DK, Gamble J, & Fenwick J. (2015) A cross-sectional study to determine utility of childbirth fear screening in maternity practice: an Australian perspective. Women & Birth, 28, 310-316. https://doi.org/10.1016/j.wombi.2015.05.002
Fenwick J, Toohill J, Creedy DK, Smith J & Gamble J. (2015). Sources, responses and moderators of childbirth fear in Australian women: a qualitative investigation. Midwifery, 31(1), 239-246. https://doi.org/10.1016/j.midw.2014.09.003
Fenwick J, Gamble J Creedy DK, Buist A, Turska E. Sneddon A, Scuffham P, Ryding E, Jarrett V. & Toohill J. (2013). Study protocol for reducing childbirth fear: A midwife-led psycho-education intervention. BMC Pregnancy & Childbirth 13,190. https://doi.org/10.1186/1471-2393-13-190
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.
Turkstra E, Creedy DK, Fenwick J, Buist A, Scuffham PA. & Gamble J. (2015). Health services utilization of women following a traumatic birth. Archives of Women’s Mental Health, 18(6), 829-832. https://doi.org/10.1007/s00737-014-0495-7
Reed M, Fenwick J, Hauck Y, Gamble J. Creedy DK. (2014). Australian midwives’ experience of delivering a counselling intervention for women reporting a traumatic birth. Midwifery, 30 (2), 269-275. https://doi.org/10.1016/j.midw.2013.07.009
Boorman R, Devilly G J, Gamble, J, Creedy DK, Fenwick J. (2014). Childbirth and criteria for traumatic events. Midwifery, 30(2), 255-261 http://dx.doi.org/10.1016/j. midw.2013.03.001
Turkstra E, Gamble J, Creedy DK, Fenwick J, Barclay L, Buist A, Ryding E. & Scuffham PA. (2014). PRIME: Impact of previous mental health problems on health-related quality of life in women with childbirth trauma. Archives of Women’s Mental Health, 16(6), 561-564. DOI 10.1007/s00737-013-0384-5
Fenwick J, Gamble J, Creedy D, Barclay L Buist A, & Ryding EL. (2012). Women’s perceptions of emotional support following childbirth: A qualitative investigation. Midwifery, 29(3), 217-224. https://doi.org/10.1016/j.midw.2011.12.008
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.
Halford KW, Petch J, & Creedy DK (2015). Clinical guide to helping new parents: The Couple CARE Program. Springer New York. (170 pages) doi:10.1007/978-1-4939-1613-9
Petch J, Halford W.K., Creedy DK, & Gamble J. (2012). A randomised controlled trial of a couple relationship and co-parenting program (Couple CARE for Parents) for high- and low-risk new parents. Journal of Consulting and Clinical Psychology, 80(4), 662-73. DOI: 10.1037/a0028781
Petch J, Halford W.K., Creedy DK, & Gamble J. (2012). Couple relationship education at the transition to parenthood: A window of opportunity to reach high risk couples. Family Process, 51,(4), 489-511. https://doi.org/10.1111/j.1545-5300.2012.01420.x
Halford W, Petch J, Creedy DK & Gamble J. (2011). Intimate partner violence in couples seeking relationship education for the transition to parenthood. Journal of Couple & Relationship Therapy, 10(2), 152-168. https://doi.org/10.1080/15332691.2011.562835
Halford, WK, Petch, J, Creedy, DK. (2010). Promoting a positive transition to parenthood: a randomized clinical trial of couple relationship education. Prevention Science, 11(1), 89-100. https://doi.org/10.1007/s11121-009-0152-y
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.
Creedy, D. Shochet, I. & Horsfall, J. (2000). Childbirth and the development of acute trauma symptoms. Birth, 27(2), 104-111. https://doi.org/10.1046/j.1523-536x.2000.00104.x Article reprinted in full MIDIRS Midwifery Digest, (2000). 10(4), 491-497.
Creedy, D. (2000). Postnatal depression and posttraumatic stress disorder: What are the links? Birth Issues, 8(4), 125-130.