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Clinical question
Does counseling after traumatic birth experience reduce the risk of
persistent trauma symptoms and postpartum depression at 3 months?
Bottom line
Women with trauma symptoms who receive face-to-face counseling during their
hospital stay and phone counseling at 4 to 6 weeks postpartum are less
likely to have persistent trauma symptoms or postpartum depression at 3
months.
Reference
Gamble J, Creedy D, Moyle W, Webster J, McAllister M, Dickson P.
Effectiveness of a counseling intervention after traumatic childbirth: A
randomized trial. Birth 2005; 32:11-19.
Study design: Randomized controlled trial
Setting: Inpatient (ward only)
Synopsis
Women were screened within 72 hours after giving birth for trauma symptoms
using criterion A of the DSM-IV for diagnosing posttraumatic stress
disorder. This criterion inquires about perceived exposure to a traumatic
event and the initial emotional response. Specifically, women were asked if
they had been fearful for their own or their baby’s life or feared serious
injury or permanent damage. The 103 women (30%) who screened positive were
randomized to receive either counseling intervention or standard care. The
counseling intervention consisted of a 40- to 60-minute session during the
hospital stay with a midwife who had no specialized training in
psychotherapy. The elements included therapeutic relationship, acceptance of
women’s perceptions, support for expression of feelings, filling-in missing
information, connecting event with emotions and behaviors, review of labor
management, enhancement of social support, reinforcement of positive
approaches to coping, and exploration of solutions. A follow-up session was
conducted by telephone at 4 to 6 weeks postpartum. An investigator blinded
to study group allocation assessed outcomes. Several validated instruments
were used to assess outcomes at 3 months postpartum. The counseled group had
significantly better scores for total posttraumatic symptoms, but the study
was too small to determine whether a 5% absolute risk reduction was accurate
for the diagnosis of posttraumatic stress disorder at 3 months postpartum.
Rates of postpartum depression were lower in the counseled group (8% vs 32%;
number needed to treat = 4; 95% CI, 3-12) |