Re: [ozmidwifery] emotional reactions to cs

[Marilyn Kleidon]

I totallly agree Jo with your response. I just feel there has to be other research out there. I was quite honestly disturbed to read the argument around supportive listening and debriefing. I haven't read the actual paper, so don't know first hand however the text I quoted reports that the debriefing was given by a midwife on the postnatal ward , so that seems like it happened in the first 4-5 days and the outcome measure the Hospital Anxiety Scale (HAD) was administered by postal questionare 3 weeks postpartum in one study (the British one) and at 6 months postpartum (Australian one). However this assessment tool (the HAD) had not been validated for use postpartum. Has anyone else read this little text? (Postnatal Care evidence and guidelines for management by Bick, MacArthur, Knowles and Winter). it is actually very good on the physical stuff.   marilyn ----- Original Message ----- From: Jo & Dean Bainbridge To: [EMAIL PROTECTED] Sent: Friday, March 21, 2003 11:26 PM Subject: Re: [ozmidwifery] emotional reactions to cs "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."   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   These two comments are linked I feel. From experience the immediate post natal period (the time in hospital and the first few months) are not really conducive to actually taking in what ever explanations are given to women.  You have to take into consideration the facts that a woman is most probably in shock (for any numbers of reasons :her well being, the safety and well being of the child....the impact of language can have a huge influence of the degree of shock...did someone mention the words baby dying/ distressed/ needing help out/ cant birth the baby normally?  etc.) and coupled with the amount of drugs that are given; the normal shock involved in becoming a mother (breast feeding caring for babe etc) the continuous sleep interruptions and all the other wonderful things that happen in hospital, all add up to either not fully taking the explanation in or simply saying "yes I understand" and not really exploring how she feels.   Another factor that would support the notion that debriefing doesn't help (don't think that I disagree with the need to explain the reasons whilst in hospital cause I feel it is hugely important) is that a woman will accept the explanation and think that it is true and factual and then find out further down the track that stalling at 8cm for 2 hours doesn't really mean failure to progress, some woman stall for many more and still go on to birth vaginally....THEN adverse psychological reactions kick in.  It would be interesting to read the study that the above mentioned statement came from to see at what period did they evaluate the woman's emotional state: the way in which information/ explanations were presented and their definition of 'depression'.   I agree wholeheartedly that more research has to be done and that its findings need to be published in Obs journals not the journals dealing with psychiatry or psychology cause obs don't read them!!!!!   Sorry this is so long...will hold back for now to continue the conversation in other emails ...not just the one email! Thanks for your comments Marilyn...love to talk more! - gee really? Jo Bainbridge founding member CARES SA www.cares-sa.org.au [EMAIL PROTECTED] phone: 08 8388 6918 birth with trust, faith & love... ----- Original Message ----- From: Marilyn Kleidon To: [EMAIL PROTECTED] Sent: Sunday, March 23, 2003 1:50 AM Subject: Re: [ozmidwifery] emotional reactions to cs 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   ----- Original Message ----- From: Rhonda To: [EMAIL PROTECTED] Sent: Friday, March 21, 2003 3:32 AM Subject: Re: [ozmidwifery] emotional reactions to cs   Not a study but from my own observations and experience -   There seems to be far less trauma after a c/s that is medically necessitated than one that is "just in case something goes wrong" or "for unreasonable obstetric reasons"   My first c/s at 27 weeks due to severe Pre Eclampsia was not an issue for me as I was so ill I was dying and as soon as the baby went into distress I was able to understand the reason, the medical necessity and cope with it.   I was severely traumatised by my second c/s as I was well, my baby was not in distress, I was not clear on why it was needed - if it was at all. I was told that the dr had better things to do than wait for me to deliver, conflicting advise from ob's and midwives and others.  Made it even more traumatic.   The other thing that increases trauma and feelings of failure are terms like   "she had an incompetant cervix." "she wasn't coping with labour" etc...   George got up - have to go.  Hope that helps a bit.    I guess if women were treated with a little more respect and had things explained a little more clearly thent hey would not be so traumatised.   Regards Rhonda.     -------Original Message-------   From: [EMAIL PROTECTED] Date: Friday, 21 March 2003 01:02:50 PM To: [EMAIL PROTECTED] Cc: c-aware list Subject: [ozmidwifery] emotional reactions to cs   Does anyone have any ideas on studies that have looked at methods to decrease chances of adverse psychological reactions to cs in the immediate post natal period? Jo Bainbridge founding member CARES SA www.cares-sa.org.au [EMAIL PROTECTED] phone: 08 8388 6918 birth with trust, faith & love...   ____________________________________________________   IncrediMail - Email has finally evolved - Click Here

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