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There is a relatively recent book (which I think is a text book) called
Postnatal Care Evidence and Management by Debra Bick BA MMedSci
RGN RM, Christine MacArthur PhD, Helen Knowles BSc MPhil RGN RM, and Heather
Winter MD FRCOG, MFPHM; published by Churchill Livingstone 2002. It has 2
sections which may be of some input regarding research: Guideline 3.
Caesarean section wound care and pain relief and Guideline 7. Depression
and other psychological morbidity. There are substantial references and the
end of each guideline. Much to my surprise it states that
the "evidence of the effects of 'supportive listening' such as debriefing
(women of their labour and birth experience) in preventing PND indicates
that it is likely to be of no benefit." (p. 137). The refence for this is
Wessely S, Rose S, Bisson J 2000 Brief Psychological Interventions
("debriefing") for immediate trauma related symptoms and the prevention of
post-traumatic stress disorder. Cochrane Review 3. The Cochrane Library
Oxford.
To me this indicates that more research is crying out to be done. As I
looked through the references it appeared that most of the papers had been
published 1989 -1995 there were just a few papers 1998 - 2000. Isn't
there a Perinatal Psychology Association? I'll look this up.
Coming from working with homebirths in the US where I felt pretty confident
that with only 5% of our women having cesarean births that 99% (pobably 100%
but...) really needed the cesarean and after the birth but particularly after
discharge from hospital these women received counselling from us and
referral to psychologists specialising in postnatal care if necessary. Now I
feel like I was working in a bubble... this sort of care is just not available
in the hospital environment generally). We are very focused on pain (physical
pain) management, and so we should be, but with staffing ratios etc.. and the
randomness of a previously unknown midwife conducting a debriefing session...
and with the ever increasing ceasarean birth rate a significant percentage of
Australian women will be suffering. Sadly most women seem to have absorbed the
ethos to tough it out, not make a fuss, do whatever has to be done and just get
over it. This seems to be what is expected of them too by most staff. And then
with the staff ratios it is what you hope women can do. Help, we need this
research.
regards
marilyn
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