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Effectiveness of a Counseling Intervention after a Traumatic Childbirth: A Randomized Controlled Trial

Authors

  • Jenny Gamble RN, RM, PhD,

    Corresponding author
    1. Jenny Gamble, Debra Creedy, Wendy Moyle, Margaret McAllister and Paul Dickson are in the Research Centre for Clinical Practice Innovation, Griffith University, Meadowbrook; and Joan Webster is Director of Nursing & Women's Health Research Centre at the Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
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  • Debra Creedy RN, PhD,

    1. Jenny Gamble, Debra Creedy, Wendy Moyle, Margaret McAllister and Paul Dickson are in the Research Centre for Clinical Practice Innovation, Griffith University, Meadowbrook; and Joan Webster is Director of Nursing & Women's Health Research Centre at the Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
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  • Wendy Moyle RN, PhD,

    1. Jenny Gamble, Debra Creedy, Wendy Moyle, Margaret McAllister and Paul Dickson are in the Research Centre for Clinical Practice Innovation, Griffith University, Meadowbrook; and Joan Webster is Director of Nursing & Women's Health Research Centre at the Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
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  • Joan Webster RN, RM, BA,

    1. Jenny Gamble, Debra Creedy, Wendy Moyle, Margaret McAllister and Paul Dickson are in the Research Centre for Clinical Practice Innovation, Griffith University, Meadowbrook; and Joan Webster is Director of Nursing & Women's Health Research Centre at the Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
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  • Margaret McAllister RN, EDD,

    1. Jenny Gamble, Debra Creedy, Wendy Moyle, Margaret McAllister and Paul Dickson are in the Research Centre for Clinical Practice Innovation, Griffith University, Meadowbrook; and Joan Webster is Director of Nursing & Women's Health Research Centre at the Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
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  • Paul Dickson BPsych(Hons)

    1. Jenny Gamble, Debra Creedy, Wendy Moyle, Margaret McAllister and Paul Dickson are in the Research Centre for Clinical Practice Innovation, Griffith University, Meadowbrook; and Joan Webster is Director of Nursing & Women's Health Research Centre at the Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
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  • This study was supported by a grant from the Queensland Nursing Council and a scholarship from the Faculty of Nursing & Health, Griffith University, Meadowbrook, Queensland, Australia.

* Dr Jenny Gamble, School of Nursing, Faculty of Nursing and Health, Griffith University, Logan Campus, University Drive, Meadowbrook. Queensland 4131 Australia.

Abstract

Abstract: Adverse childbirth experiences can evoke fear and overwhelming anxiety for some women and precipitate posttraumatic stress disorder. The objective of this study was to assess a midwife-led brief counseling intervention for postpartum women at risk of developing psychological trauma symptoms. Method: Of 348 women screened for trauma symptoms, 103 met inclusion criteria and were randomized into an intervention (n = 50) or a control (n = 53) group. The intervention group received face-to-face counseling within 72 hours of birth and again via telephone at 4 to 6 weeks postpartum. Main outcome measures were posttraumatic stress symptoms, depression, self-blame, and confidence about a future pregnancy. Results: At 3-month follow-up, intervention group women reported decreased trauma symptoms, low relative risk of depression, low relative risk of stress, and low feelings of self-blame. Confidence about a future pregnancy was higher for these women than for control group women. Three intervention group women compared with 9 control group women met the diagnostic criteria for posttraumatic stress disorder at 3 months postpartum, but this result was not statistically significant. Discussion: A high prevalence of postpartum depression and trauma symptoms occurred after childbirth. Although most women improved over time, the intervention markedly affected participants’ trajectory toward recovery compared with women who did not receive counseling. Conclusions: A brief, midwife-led counseling intervention for women who report a distressing birth experience was effective in reducing symptoms of trauma, depression, stress, and feelings of self-blame. The intervention is within the scope of midwifery practice, caused no harm to participants, was perceived as helpful, and enhanced women's confidence about a future pregnancy.

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