Continuity of care and enhanced support for women experiencing antenatal distress: A pilot randomised control trial and pragmatic program evaluation

This arm will see the same midwife, the research midwife (RM) at each antenatal visit, including birth, and their postpartum assessment(s). Baseline screening will occur when the participant is booking in the Antenatal Clinic. The women could be recruited up until 26 weeks gestation, and then will complete measures at Time 1: 36 weeks pregnant, Time 2: 8 weeks postpartum, and Time 3: 6 months postpartum. The RM would also check in with women about every two weeks from the baseline point. The communication between the midwife and participant will be a phone call or text message which will last approximately 10 to 20 minutes. Part of this continuity of care will involve the delivery of questionnaires at three points in time to evaluate women’s experience of care. These assessments will include assessments on the woman’s mental health (e.g. EPDS), perceptions of care (e.g. qualitative interviews), health indicators (e.g. routinely collected data), and connectedness to local services (e.g. referrals, appointments attended). Services will be drawn from a pool of non-pharmacological interventions shown to have some efficacy in preventing postpartum depression or increasing service provision and engagement. This will include access to individualised care planning, home visiting, telephone support, the offer of debriefing after birth, social support and flexible care provision including outreach (Gamble et al., 2005; Grote et al., 2014; Matthey et al., 2004; Milani et al., 2015; Oommen et al., 2011; Reading, 2011). The RM providing continuity of care will receive light-touch training in mental health first aid strategies such as receptive listening, maintaining a supportive attitude, and sensitively querying about maternal mood. The RM was trained in pregnancy loss and complications and has done small counselling courses e.g., small miracles Grief counselling, SIDS pregnancy loss workshop. The courses were a day each and occurred several years ago in a face-to-face classroom setting. The intervention will take place at the Fairfield and Liverpool Hospital antenatal clinic. The intervention will include individual face-to-face and telehealth support. No fidelity measures will be used to monitor adherence to the intervention. The RM will have access to the women’s EMR records if there is a concern for follow up (e.g., they scored high on the surveys). As mentioned above, qualitative interviews will be conducted to explore participants' perception of care. The interviews will be semi-structured using a study-specific interview guide and will be completed by a member of the research team with experience in conducting interviews of this kind. The interviews will take approximately 30 to 60 minutes to complete, and the interviews will be audio-recorded and transcribed. All participants will be asked to participate following their Time 3 survey, with a minimum of 10 interviews required for analysis and the maximum number involving all participants. A similar number of participants will be approached from each site.