The post-operative review as an opportunity to intervene for postnatal depression in mothers undergoing Caesarean section

• This open-label, two-arm, parallel, active-controlled, randomised superiority study seeks to determine whether a brief, standardised intervention, delivered by a Senior House Officer (SHO) at the post-Caesarean section review, can reduce the rates of undiagnosed and untreated PND in the early postnatal period for mothers undergoing Caesarean section • Mothers randomised to the intervention group will be educated about PND, and given the resources to conduct their own PND screening using the EPDS which is then linked to local support services with text message reminders over the first 6 weeks postpartum ___________ The education will be part of the one off SHO review. The review lasts anywhere from 10-30 minutes. The time spent discussing PND will be around 2 minutes. In addition to routine post-op advice the SHO will: Explain that PND is a common condition affecting up to 20% of mothers. Explain that early recognition is key and that there is good help available. Provide the information package to mother. Explain that the package contains links to information and advice for where to get help if needed. Encourage her to read the package and complete the relevant sections at the appropriate time. Inform her that if she has any questions about the package, she can ask to speak to the on-call SHO at any time while in hospital. ___________ The specific resource given is a 4 page document. Page One contains an introduction to the prevalence, and symptoms of PND, with an explanation of how to use the EPDS scores in the package to access local supports. There is also a recommendation to download the “Mind the Bump” phone app a free mindfulness mediation program for new parents ___________ Page 2-3: Contain two EPDS, one to be completed while in hosptial after the SHO review, the other at week 6. Each EPDS score channels into three streams of advice, as below. D1 Score 0-9: This is a low risk score for PND. We encourage you to be mindful of your mental health and wellbeing and remember to repeat this questionnaire in six weeks’ time. D1 Score 10-12: This predicts mild to moderate risk of significant anxiety and depression. Please discuss this result with your midwife or ask to speak to the on-call Senior House Officer. It may be useful to look at the online resources listed on Page 4. D1 Score 13 or more OR EPDS Q10 score 2-3: This predicts a high chance of significant anxiety and depression and requires follow up. Our strong advice is talk to a doctor (in hospital or your GP), as well as your midwife. The online resources listed on Page 4 may also be beneficial. W6 Score 0-9: This is a low risk score for PND. We encourage you to be mindful of your mental health and wellbeing over the coming months and wish you all the best. W6 Score 10-12: This predicts mild to moderate risk of significant anxiety and depression. It would be a good idea to mention this to your GP when you go for baby’s check-up; they can organise appropriate follow up which may consist of repeat this questionnaire in a few weeks’ time. It may be useful to look into the online resources listed on Page 4 if you have not done so already. W6 Score 13 or more OR EPDS Q10 score 2-3: This predicts a high chance of significant anxiety and depression and requires follow up. Please take this questionnaire to your doctor when you go for baby’s check-up. It may be useful to look into the online resources listed on Page 4 if you have not done so already. The Local services linked from these scores include WDHB mental health and crisis teams, PND/Depression/Mindfulness websites, phone numbers of e.g. Lifeline, contacts for WDHB cultural services (Maori, Asian, Pacific), contacts for WDHB social workers, drug and alcohol support groups, and family violence support. ___________ The frequency and content of the text messages are as follows: Day Two Postnatal: Intervention Group Hello. This is a friendly reminder from the WDHB Maternity Ward to “check in” with your mental health using our information pack. If you have not done so already, please complete the questionnaire on Page 2. You can find an online copy of the questionnaire by following this link: http://perinatology.com/calculators/Edinburgh%20Depression%20Scale.htm. To receive a copy of the information package electronically, email pnd.wdhb@gmail.com. We wish you all the best until we touch base again in a few weeks. Please do not reply to this text message; if you have any concerns please talk to your GP or midwife. If you are still in hospital, then you can also ask to see the on-call Senior House Officer. Week Three Postnatal: Intervention Group Hello from the WDHB Maternity team. It is now about 3 weeks since you gave birth. We hope that the process of adjusting to life at home with your new baby is going well. If you get a moment, we encourage you to look at the mobile app, “Mind the Bump”, which is available on the Google Play Store (Android), and the App Store (Apple). This is a free mindfulness mediation program for parents. If you have downloaded this already, then well done, and we encourage you to continue practicing the techniques and skills it covers. Take care, and we will be in touch again in another few weeks. Please do not reply to this text message; if you have any concerns please talk to your GP or midwife. Week Six Postnatal: Intervention Group Hello again from the WDHB Maternity Ward. It is now about 6 weeks since you gave birth. This is a reminder to please complete the questionnaire on Page 3 of the information pack. You can find an online copy of the questionnaire by following this link: http://perinatology.com/calculators/Edinburgh%20Depression%20Scale.htm. To receive an electronic copy of the information package you were given in hospital, email pnd.wdhb@gmail.com. You will soon be seeing your GP for baby’s 6 week examination. This is a great time to touch base with a doctor to discuss any concerns you may have about your mental health. If this marks the end of your contact with WDHB for this pregnancy, then once again, congratulations, and good luck for the months and years ahead. Please do not reply to this text message; if you have any concerns please talk to your GP or midwife. Week Eight Postnatal Follow Up: Control Group and Intervention Group Hello from the WDHB Maternity Ward. It is now 8 weeks since you gave birth. While in hospital you met with one of our doctors or midwifes, and kindly agreed to participate in a research project. This study looked at aspects of discharge planning and follow up for mothers whose babies were born by Caesarean section. The key focus of the study was the issue of Postnatal Depression (PND). One of the study authors will call you this evening around 8 pm and ask you some questions that will not take more than 5 minutes. We ask that you please follow this link prior to 8pm, tick the box for each question that is most accurate for you, and remember your total score: http://perinatology.com/calculators/Edinburgh%20Depression%20Scale.htm. If 8pm is not good for you, please reply to this text with a more convenient time. We thank you again for agreeing to participate in this research project aimed at improving health care for mothers in the Waitemata DHB __________ Adherence and value of the intervention pack will be assessed at the week 8 follow up phone call for those in the intervention group. The questions are listed below. The strategy impolyed to maintain fidelity is the text message reminders discussed above. 1. Did you read through the information package provided when you were at NSH? Please rate its value from 1 (not at all) to 5 (very). 2. Did you receive text messages from us after giving birth? Please rate their value in helping you focus on your mental health and wellbeing from 1 (not at all) to 5 (very). 3. Did you download and use the “Mind the Bump App”? Please rate its value from 1 (not at all) to 5 (very). 4. Did you complete one or both EPDS questionnaires as recommended in the package? If so, can you provide the results 5. Do you have any feedback to improve the information package?