Telephone-based peer support for postnatal depression
Postnatal depression is a major concern for both mother and baby. A new study published in the Journal of Advanced Nursing suggests that telephone-based peer support helps to reduce postnatal depression. The study was conducted in New Brunswick, Canada.
Telephone-based peer support for women with postpartum depression provided by peers who have recovered from depression was found to effectively improve outcomes. This small study included 64 women: the average age of mothers was 26 years, with 77% reporting depressive symptoms prior to pregnancy and 57% having pregnancy complications. Sixteen women (35%) were taking medication for depression after the birth of their baby. Peer volunteers who had experienced and recovered from postpartum depression were trained and provided support telephone calls to women. An average of nine (range 1–13) supportive calls were provided which lasted on average 38.1 minutes. Depression and social support outcomes were assessed at mid-point in the intervention and at the end. Increased support was significantly related with lower depression symptoms.
These findings offer promise that telephone-based peer support is effective for both early postpartum depression and maternal depression up to 2 years after birth.
Alcohol consumption in pregnancy
An international study revealed that women who smoke during pregnancy are significantly more likely to drink alcohol. The researchers compared the prevalence of alcohol use in three different cohorts; growing up in Ireland (GUI), screening for endpoints (SCOPE) and the pregnancy risk assessment monitoring system (PRAMS). The studies assessed alcohol consumption before, during, and after pregnancy and involved 17 244 women who delivered live babies in the UK, Ireland, Australia and New Zealand. The results revealed low adherence to guidelines, which advised complete abstinence of alcohol during pregnancy. Alcohol use during pregnancy ranged from 20–80% in Ireland, and from 40% in the UK, Australia and New Zealand. The study found that the number of units of alcohol consumed during the first and second trimester were the lowest. Black and minority ethnic (BME) women were less likely than White women to drink during pregnancy. Increased levels of education, having other children and being overweight or obese were also associated with lower levels of alcohol consumption. Smoking was the strongest predictor of alcohol use across all studies and countries. The authors of the study state that evidence from this cross-cohort and cross-country comparison shows that gestational alcohol exposure may occur in over 75% of pregnancies in the UK and Ireland, and that this is a significant public health concern.
The findings from this study are very relevant to clinical practice. At the antenatal booking appointment women are asked about smoking and support is offered. However, the same support is not provided for alcohol consumption. If it has been identified that women who smoke are more likely to drink alcohol, this group of women should be targeted during the antenatal period.
Induction of labour and shoulder dystocia
A randomised control trial conducted between October 2002 and January 2009 in 19 tertiary care centres in France, Switzerland and Belgium found that induction of labour for suspected large-for-date babies is associated with a reduced risk of shoulder dystocia and associated morbidity compared with expectant management. Induction of labour does not increase the risk of caesarean delivery and improves the likelihood of spontaneous vaginal birth. A total of 409 women were randomly assigned to have their labour induced between 37 and 38 weeks' gestation, or to expectant management. Mean birth weight was 3.831 g and 4.118 g in the management group. Induction of labour significantly reduced the risk of shoulder dystocia or associated morbidity (n=8) compared with expectant management (n=25). The likelihood of spontaneous vaginal birth was higher in the induction group than in the expectant management group. Caesarean delivery and neonatal morbidity did not differ significantly between the groups.