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What is the purpose of debriefing women in the postnatal period?

9 January, 2009

What is the purpose of debriefing women in the postnatal period?

Postnatal care appears to focus on the physical aspects often neglecting the psychological aspects. Some women are unable to finish their journey and make sense of events in childbirth, so debriefing has been introduced as a technique to address this issue.

EBM: July 2006



Rachael Collins BSc.
Midwife, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU England. Email: rachael.collins@uclh.nhs.uk



Abstract

Background. Postnatal care appears to focus on the physical aspects often neglecting the psychological aspects. Some women are unable to finish their journey and make sense of events in childbirth, so debriefing has been introduced as a technique to address this issue.
Method. The study was a literature review completed while the author was an undergraduate student, as part of a BSc in midwifery. The search strategy involved searching the electronic databases: MEDLINE, (1966-2005), CINAHL (Cumulative Index to Nursing and Allied Health Literature 1982-2005), the Cochrane Library, PsycINFO (1872-2005), EMBASE Psychiatry (1994-2005) and British Nursing Index (1985-2005). It also involved carrying out hand searches of books and recent professional journals including MIDIRS Midwifery Digest, British Journal of Midwifery, Midwifery, and Birth. The search was conducted using the key words ‘debriefing’, ‘talking’, ‘discussing’, ‘women’, ‘postnatally’, ‘after birth’ and ‘midwife’. Literature post 1994 only (unless a key source) was included to ensure that it was up to date. All articles chosen demonstrated ethical consideration, for example informed consent and ethics committee approval. Literature on counselling was excluded due to a time and word limit of 10 000 words. While debriefing is within the remit of all midwives, structured counselling is not necessarily, and may require referral. With fewer constraints it would have been possible to explore more of these issues that this study raises.
Findings. A total of 20 pieces of literature, comprising three randomised controlled trials, two cohort studies, five crosssectional surveys, five reviews, one professional opinion, two descriptive studies and two authors reflections were included. Five themes emerged: investigating the need for women to debrief, whether debriefing reduces childbirth trauma, if it helps women ‘finish the journey’, whether debriefing can act as a risk management tool and, finally, the organisation of debriefing services. The findings suggest that there is more than one purpose for debriefing and that existing healthcare practice provides a range of services.
Conclusion. This review concludes with recommendations to improve debriefing in practice and for further research. Key words: Debriefing, talking, discussing, women, postnatally, after birth, midwife

Key words: Debriefing, talking, discussing, women, postnatally, after birth, midwife


Introduction to debriefing

The concept of critical incident debriefing originated in the US in the early 1980s (Parkinson, 1997). It was developed as a method of intervention to reduce traumatic reactions for people following disturbing incidents. Since its introduction, debriefing has been the subject of many debates regarding its possible benefits. A Cochrane review carried out in 1998 concluded that there is no current evidence that psychological debriefing is a useful treatment for the prevention of posttraumatic stress disorder (PTSD) (Rose et al, 2003), yet it continues to be used in practice after traumatic events (Deahl, 2000; Emmerik et al, 2002).

The American Psychiatric Association (1994) define a traumatic event as one that happens suddenly and unexpectedly, disrupts one’s sense of control, beliefs, values and basic assumptions about the world. This definition can be likened to the experience of childbirth and it is valid to argue that some women have traumatic experiences, which may or may not lead to postnatal depression or PTSD.

Although Steele and Beadle (2003) express concern over ‘the appropriateness of comparing and associating childbirth with an abnormal event’ (Steele and Beadle, 2003: 131), the idea of debriefing women postnatally has been introduced to maternity services. Its introduction without reliable evidence causes its benefits to women to be questionable.


Search strategy

The search involved using electronic databases and carrying out hand searches of books and recent professional journals. The search was conducted using key words of the major concepts or variables in the question, and alternative terms (synonyms) that authors may use in order to identify all articles relevant to the subject. In order to limit the search, these key words were linked using Boolean operators (and/or). The key words used were ‘debriefing’, ‘talking’, ‘discussing’, ‘women’, ‘postnatally’, ‘after birth’ and ‘midwife’. The electronic databases searched were those accessible through Ovid. These included MEDLINE (1966-2005), CINAHL (Cumulative Index to Nursing and Allied Health Literature 1982-2005), The Cochrane Library, PsycINFO (1872-2005), EMBASE Psychiatry (1994-2005) and British Nursing Index (1985-2005). Hand searches were also carried out of published journals including MIDIRS Midwifery Digest, British Journal of Midwifery, Midwifery, and Birth. Books were also a source of information searched and once literature was obtained, more potentially relevant sources of information had to be located by means of ‘chaining back’ or ‘backward chaining’.

The relevant literature to be critically analysed had to meet the specified inclusion criterion in order to be included in the sample for the review. The criterion for inclusion in the sample was literature that had been published from 1994 onwards unless it was a key source of information, so that the literature review is based on up-to-date research. It had to be obtainable in English language, as any other language would involve a lengthy process of translation, and needed to be from a reputable source. Ethical approval must have been granted for primary research studies and informed consent must have been gained from all participants in order for the study to be ethical. The literature had to focus on the main topic of debriefing or talking after birth and to be either a primary source, i.e. first-hand accounts of experiment and investigation, original works and reports, or a secondary source, i.e. sources of information that summarised information from primary sources.

Literature that focused on counselling women and literature that discussed psychological issues but did not mention debriefing, were excluded. Including this literature would have made the area under investigation far too large to do it justice within the time and word limit constraints.

The sample of literature reviewed was a purposive sample, as the papers were included on the basis of knowledge of their relevance for the purpose of the study. This sample of literature was then critically appraised using the Critical Appraisal Skills Programme (CASP).

Aim

The aim of this literature review was to determine why women want to debrief and whether or not debriefing reduces trauma caused by events in childbirth. Other pertinent issues explored were, the role of debriefing in risk management and the organisation of debriefing services within the maternity services.

Findings

Five themes emerged after using mind maps and linking similar ideas together to produce a conceptual framework. These were investigating the need for women to debrief, whether debriefing reduces childbirth trauma, if it helps women ‘finish the journey’, whether debriefing can act as a risk management tool and, finally, the organisation of debriefing services.

Investigating the need for women to debrief
Women’s perceptions of childbirth

How a woman perceives her birth experience has a direct impact on her need for debriefing. A birth considered normal to the professional might be considered traumatic to the woman herself (Axe, 2000). Moreover, although childbirth is one of the most normal and natural processes a woman can go through (Smith and Mitchell, 1996), it is also recognised that despite it being a common daily occurrence to the maternity services, it is a rare or unusual event in a woman’s life (Ralph and Alexander, 1994; Smith and Mitchell, 1996).

Steele and Beadle (2003) express concern over associating childbirth with an abnormal event. However, considering the number of times in a lifetime that a woman gives birth it is certainly a fairly rare event. Furthermore, if this was not the case, then this implies that a woman’s views and opinions of her experience are invalid.

Mode of delivery

Some of the literature focused on whether the mode of delivery had a psychological impact. A traumatic birth experience can be characterised by mode of delivery, notably assisted and operative deliveries. This may be because a woman has other expectations, she felt left out of the decision-making involved (Baxter et al, 2003) or because important aspects of the experience are forgotten (Affonso, 1977). A woman may feel that her body has failed her if she is not able to give birth naturally, and she could feel a loss of self-esteem (Phillips, 2003). Conversely to these findings, Allen (1999), in a cohort study of 61 women, found that psychological outcome did not vary according to mode of delivery or parity. This finding was supported by Hammett (1997), who found that women are happy to have a caesarean section (CS) if necessary because their babies are then ‘safe’. Moreover, ‘focusing on the product of the labour, the baby, ignores the woman’s concerns about her birth experiences’ (Hammett, 1997: 138).

Previous psychopathology or trauma


Menage (1996) states that a previous traumatic birth will make a woman fearful of the next, as she may have unresolved issues before becoming pregnant again. There are many intimate procedures involved in the labour process and women who have been victims of sexual assault may react negatively when such procedures are carried out. This can be a very traumatising experience (Hatfield and Robinson, 2002). A woman who has suffered from psychopathologies prior to pregnancy may have the symptoms exacerbated due to the pregnancy (Phillips, 2003).

Gaps in memories

As early as 1977, Affonso found that three-quarters of the 85 women she interviewed stated that they had vague recollection of events of the birth, resulting in gaps in their memories causing distress. The study revealed that long labours could result in ‘confusion or lost sense of events’. Conversely, a rapid labour was found to be similar where events occur so quickly that women have trouble putting them in chronological order. Medications or drugs administered during labour, such as pethidine, can cause women to be sleepy or disorientated, which in turn results in memory gaps (Affonso, 1977).

Differences in expectations and reality

All women have an expectation of what labour and childbirth may be like, developed by their family, antenatal classes and the media. Affonso (1977) highlights that when women’s expectations are not met, they may begin to grieve the loss of
the birth they wanted. Their energies are redirected to this grief rather than integrating the experience that they are actually having. Inglis (2002) assessed a debriefing service that had been introduced in a unit in the north of England. Women were found to appreciate technical information about the labour using such visual aids as a doll and pelvis. Baxter et al (2003) also found that some women expressed
the need to understand about malpositions in labour.

Does debriefing reduce childbirth trauma?

Reducing maternal psychological morbidity


Three randomised controlled trials have been carried out on debriefing. One was conducted in the north-west of England, with a sample size of 120 postnatal primigravida women who had a normal vaginal delivery of a healthy baby (Lavender and Walkinshaw, 1998), one in Melbourne, involving 1041 women who had delivered by CS, forceps or vacuum extraction (Small et al, 2000) and one, including a cohort sample of 1745 women who delivered healthy term infants between April 1996 and December 1997 in Perth (Priest et al, 2003). Priest et al (2003) found that debriefing was not effective in reducing maternal morbidity or postnatal psychological disorders, while Small et al (2000) concluded that the possibility of it contributing to, rather than decreasing, maternal morbidity could not be ruled out. Rose et al (2004) raised the possibility of ‘secondary trauma’ from re-experiencing the events during a debriefing session.

Despite this, the majority of women in both studies (Small et al, 2000; Priest et al, 2003) rated debriefing as ‘very helpful’ and ‘helpful’. Moreover, Lavender and Walkinshaw (1998) concluded that debriefing was beneficial to the psychological wellbeing of mothers. Women in the experimental arm of the study (n=56) were less likely to have high anxiety and depression.

The characteristics and number of women included in these studies varied. Lavender and Walkinshaw (1998) only included primiparous women who had spontaneous vaginal deliveries (n=120), while Small et al (2000) only included women who had delivered by CS, forceps or vacuum extraction (n=1041). This implies that these researchers may have made assumptions about the type of women who may suffer psychological morbidity.

However, it should not be assumed that a second or subsequent pregnancy does not have the same impact upon a mother as that of a first pregnancy (Dennett, 2003), nor should it be assumed that only mothers who have had operative deliveries might be suffering psychological morbidity. Priest et al (2003) however, focused their trial on a stratified sample of 1745 women who had delivered healthy term infants. The sample was stratified for parity and mode of delivery. This would appear more reliable as it is representative of the whole population rather than a particular group of women.

All three of the studies professed to assess the use of a debriefing intervention carried out at 72 hours after delivery (Priest et al, 2003) or before discharge home into the community (Lavender and Walkinshaw, 1998; Small et al, 2000). The intervention used by the two latter studies was described as more of a discussion and listening service rather than that of a structured debriefing session based on the principles of critical incident debriefing (Mitchell, 1983). The conclusions regarding the effectiveness of debriefing may not be valid if debriefing methods are not being utilised.

Another important point raised by Gamble et al (2002) is that debriefing, as initiated by Mitchell (1983), was for use in reducing trauma symptoms and not necessarily aimed at reducing depression, although there is some overlap of symptoms. This is an important point because Small et al (2000) assessed reduction of psychological morbidity using the Edinburgh Postnatal Depression Scale (EPDS), which specifically assesses for postnatal depression. The study concluded that debriefing is not beneficial in reducing psychological morbidity because it does not reduce postnatal depression, yet it may not therefore follow to assume that debriefing is not effective for reducing trauma symptoms (Gamble et al, 2002).

Trauma symptoms include re-experiencing the trauma mentally and physically, bad dreams and nightmares, anxiety or fear and trouble falling or staying asleep. The results of the study by Priest et al (2003) may be more reliable as they used the revised Impact of Event Scale in conjunction with the EPDS. This is more appropriate as it asks questions that relate to symptoms of trauma and stressful life events. Lavender and Walkinshaw (1998) assessed psychological morbidity using the Hospital Anxiety and Depression Scale (HADS), which as they pointed out, has not been validated for use in this setting, but was used in a pilot study. It was preferred to the EPDS as it allowed for subgroup analysis defining anxiety and depression separately, but again it does not assess symptoms related to trauma.

Does debriefing help women ‘finish the journey’?


Alexander comments that ‘it is difficult to believe that giving newly postnatal women time and space to talk about their labour and birth can be harmful, after all most women appear to talk avidly on the subject with family and friends whenever they have the opportunity’ (Alexander, 1998: 122).

Change in the family unit

Research from 1977 to 2003 (Afonsso, 1977; Inglis, 2002; Baxter et al, 2003) has found that women have long expressed the need to discuss their experience with someone, as well as evidence of women voluntarily accessing services in order to do so. Smith and Mitchell (1996) state that ‘Telling one’s own story’ can be seen to appeal on a number of levels – it entertains, it evokes an emotional response, but it may also be cathartic on a deeper level for the woman. Yet there does not seem to have been any regard for the provision of such a service until recently. This is possibly due to the change in size, structure and location of family units within the last 50 years (Smith and Mitchell, 1996). Women do not necessarily live in close proximity to their family anymore and so find less opportunity to discuss their experience with family or friends and feel more isolated (Inglis, 2002). Therefore it could be that the midwife’s role is expanding to help take on this aspect (Smith and Mitchell, 1996).


Filling the gaps and making sense of events

Gaps in women’s memories of their experience can cause them distress (Affonso, 1977) and discussing their experience with a midwife may enable those gaps to be filled and make events clearer. Women who took part in a debriefing study (Inglis, 2002) stated that they required certain information during the debriefing. They felt a need to understand the technical aspects of their care and they also wanted to understand their experience, to put it in context and to help plan for future pregnancies.

Olin and Faxelid’s survey (2003) used questionnaires to describe 350 mothers’ and 343 fathers’ experiences and to gain their views on postpartum talks. They found that parents wanted to know if the delivery had been normal or not, why it had been prolonged and why complications had occurred. Some of the mothers also stated that ‘they had a different experience compared with their partners and wanted the midwife’s picture of the birth process’ (Olin and Faxelid, 2003: 156).

In the study by Allen (1999), women who had scored high on the EPDS and Impact of Events Scale wanted to share their negative feelings on the experience, whereas women with low scores wanted to share their positive feelings. This demonstrates that it is not only women experiencing a traumatic childbirth or women who need to make sense of events that want to share their experience.

Madden (2002) describes four processes of responding to women’s experiences. Normalising a woman’s experience involves making the woman realise that she is not alone in the way that she feels. Mediating the story involves using the notes to compare the woman’s version of events with what has been documented. Validating involves the midwife taking on board what the woman is saying without the need to mediate the version, thus implying that the woman’s story is clearly of concern and is ‘unique’. Finally, activating the story involves providing a channel for that woman to ‘politicise’ her experience.


Does debriefing act as risk management?

Reduction of complaints

Phillips (2003) suggests that psychological debriefing was introduced into the maternity setting as a means of risk management, to reduce the number of formal complaints leading to compensation after a traumatic experience. Baxter et al (2003) also highlight that the introduction of a liaison midwife was at a time when there was an increasing number of formal complaints. The role of the liaison midwife as discussed by Baxter et al (2003) was to debrief women following childbirth, support colleagues to do the same and coordinate compliments and complaints. Although complaint numbers did not reduce, their nature did (Baxter et al, 2003). Previously, complaints had been made by ‘very dissatisfied women who did not air their grievances’ (Baxter et al, 2003: 307), while complaints that are presently made are ‘prompted’ by the liaison midwife (Baxter et al, 2003: 307) when she recognises strong grounds for complaint. Inglis (2002) conducted a study of 46 women who used a northern England debriefing service. A number of women who expressed the wish to make a complaint rather than discuss their birth experience, were referred to the debriefing service. The results revealed that these women felt no better, but no worse for having had the debriefing. This implies that using debriefing solely to reduce complaints is ‘inappropriate’ (Inglis, 2002).

Hatfield and Robinson (2002) did observe fewer complaints arising since the introduction of a debriefing scheme, but there are no figures to support this finding. However, Smith and Mitchell (1996) found that of the 46 women seen in the pilot study in Oxford, 54% of women had grounds for potential complaint and 17% of the complaints were deemed to be of a serious nature. None of the women identified proceeded to make formal complaints, indicating that the debriefing of these clients may have discouraged them from making complaints. Baxter et al (2003) express that although women did not wish to make aformal complaint, they did want to know that something constructive would be done with the information.

Changes to practice and organisation of care


When women talk about their childbirth experiences, they enlighten professionals about the causes of distress and traumatic experiences (Dennett, 2003). This in turn can improve the organisation of care. The Birth Afterthoughts service set up in Winchester acted as a ‘quality assurance initiative and as a means of audit to influence practice and attitudes’ (Charles and Curtis, 1994). Baxter et al agree that the role of the liaison midwife allowed midwives to ‘view the world through the eyes of the women’ (Baxter et al, 2003: 308). When setting up the service, Charles and Curtis (1994) were aware that should they discover a case of malpractice, they would be obligated to seek further advice from a supervisor of midwives. If information of this kind were provided, it would be unethical not to take it further in order to stop it happening again either by a change in individuals or a change in the whole unit. Positive feedback instils more confidence in midwives that they are appreciated, yet negative feedback could make midwives feel targeted if it is specifically about the care that an individual had given. A scheme set up in East Kent involved midwives giving women the opportunity to discuss the labour and birth just hours afterwards (Hatfield and Robinson, 2002). The midwives therefore may hear elements of criticism as well as appraisal of their own practice.


Identifying women for further referral

Charles and Curtis (1994) identified that some women who accessed their service required more specialist help beyond the skills and knowledge of the midwives. Axe (2000) agrees that it is not the responsibility of midwives to counsel women
with more severe problems or take on the role of a psychiatrist – ‘they are merely the most appropriate person to identify those women at risk of psychological ill health’ (Axe, 2000: 630). Midwives need to work as part of the multidisciplinary team and have contact with, and access to individuals or services that may help upon referral (Axe, 2000).

What is the organisation of debriefing services?

Despite Phillips’ (2003) argument that the use of debriefing in the maternity setting should not be introduced until its benefits are demonstrated, it has been advocated by the Department of Health in the UK (1999) and has been introduced in some Trusts.

Range of services being offered

Over the last decade, there have been several different initiatives set up related to debriefing postnatal women. Steele and Beadle (2004) aimed to explore practices and the provision of postnatal debriefing in two health regions of England. Their survey found three distinct groups of services offered. The first group (14%) were units that provided a service that matched the descriptors of debriefing, but did not necessarily call it debriefing. The second group (20%) provided a service that is basically routine postnatal care and the third group (58%) provided a service that was inconsistent. Those that were inconsistent were units that selected combinations of descriptors that did not match debriefing or basic postnatal care.

Practitioner carrying out debriefing

Critical incident stress debriefing was originally facilitated by a trained mental health professional (Parkinson, 1997). After analysing the literature on debriefing women after childbirth, it appears that in most cases it has been a midwife facilitating the ‘debriefing’ (Small, 2002; Madden, 2002; Inglis, 2002). Axe (2000) states that this is because they have up-to-date knowledge of midwifery and obstetric practice, access to the notes and have good listening and communication skills.

The idea that a mental health professional originally facilitated debriefing suggests that midwives would require some prior training. The Birth Afterthoughts service in Winchester (Charles and Curtis, 1994) involved midwives having some training in the form of study days and courses. The trial carried out by Priest et al also involved midwives having had ‘extensive training in structured debriefing’ (Priest et al, 2003: 545). This study is the only one that actually specifically uses the recognised form of debriefing as defined by Mitchell (1983), which may account for why the other studies did not involve specialised training.

Dennet (2003) carried out a survey on a convenience sample of 100 women to discover if they had been given the opportunity to talk about the birth during normal postnatal care. It was found that the community midwife had facilitated the talk for the majority of women, and women felt this to be appropriate. However, women also expressed that the midwife who attended the birth may have been beneficial as they shared the experience and may be the only person who can really answer questions about events (Dennet, 2003). The scheme established by Hatfield and Robinson (2002) involved midwives giving women the opportunity to talk and listen within hours of the delivery. This therefore involved the midwife that was present for the delivery. However, that particular midwife may have been the cause of the bad experience and so a woman may not feel that this is the most appropriate person with whom to discuss the events.

Timing and location of debriefing

Axe (2000) suggests that ‘debriefing’ should be a one-to-one discussion in the home or hospital and within 48 hours of delivery. Hatfield and Robinson (2002) also support the idea that it should take place within hours of delivery, so that the memories of events are fresh for both midwife and the woman. However, Inglis’ (2002) phone-based service discovered that women accessed the service on average 12 months after delivery. Dennett (2003) found that women suggested talking about the events at a later date and Gamble et al agreed that women may be coping with the physical demands of childbirth and are ‘unprepared to fully engage in a review of the birth experience within the first few postpartum days’ (Gamble et al, 2002: 77). Most interesting was the Birth Afterthoughts service (Charles and Curtis, 1994), which experienced women telephoning some 40 years after their childbirth experience.

If debriefing is to take place within hours or a couple of days of delivery, then it is most likely that women will still be in hospital. This may cause women to hold back their feelings on some issues, as they are still under the care of professionals and an organisation that they may be criticising. Services that allow women to access the service when they feel ready, allow them the choice of environment within which the debriefing takes place.

Use of notes to aid debriefing


Many services that are offered use the maternity notes as a means of aiding the recalling of events. Often, as stated earlier, the debriefing midwife may not have been present at delivery or the debriefing may be carried out at a later date when events may not be easily recalled. Baxter et al (2003) and Madden (2002) retrace the birth experience using the notes. Dennett (2003) also found that women expressed the wish to be able to read the ‘written account of the birth’ and suggest the possibility of women retaining the notes into the postnatal period. Madden (2002) used the notes in debriefing as a means of ‘mediating’ the story. This process is about ‘negotiating one version of events with another’. However, midwives need to ensure that they validate a woman’s recollection of events and are not disempowering that woman’s story.

Conclusion

The findings of the review suggest that there is more than one purpose for the use of debriefing women or allowing them to talk in the postnatal period. The initial purpose for debriefing is because for some women, childbirth can be a traumatic experience. The literature highlights the multifactorial reasons for this, including women’s perception of events, the mode of delivery, disparity in what they expected and what occurred, and because they feel they were left with gaps in their memory of the event. All these factors may be due to a lack of information, knowledge and understanding.

There is insufficient evidence to suggest that debriefing reduces psychological morbidity. This is due to the confusion surrounding what debriefing is and how it should be implemented; however, it is conclusive to state that some women feel the need to discuss birth events with a professional. The literature clearly supports the view that whether or not debriefing has a measured benefit, women themselves find it helpful. In addition to the benefits to women, debriefing also serves a purpose in risk management, although there is little substantial statistical evidence that debriefing reduces complaints, the literature supports this stance.

Debriefing can contribute to risk management by using both negative and positive feedback to help improve and change care and practice, on an individual level and unit level. It also provides a means of identifying women who need referral to more specialised practitioners, for example, counsellors or psychiatrists; however, this is a controversial issue that raises ethical concerns. The focus of debriefing should be in the women’s best interest and not that of the maternity services. If it were openly researched with relation to risk management and reducing complaints, it could be argued that debriefing is being advocated in the interest of the maternity services and not the woman.

The literature identified a range of ‘debriefing type’ services being offered to women, ranging from midwives incorporating it into routine postnatal care to formal debriefing by trained professionals. The type of service offered will influence which practitioner facilitates the service, and whether that practitioner requires specialist training. In most of the literature reviewed, the facilitator was a midwife.

In conclusion, debriefing should be available for all women at a time when they feel ready to access it and in an environment where they feel most comfortable. Its purpose is to aid women to finish the journey into mother-hood while also aiding improvements in the provision of maternity care.

Recommendations for practice

  • Improve antenatal education to facilitate women’s understanding regarding the events of labour and childbirth

  • Encourage midwives and allow them time to visit women on the wards soon after delivery

  • Facilitate women’s ability to contact the midwife who was present at delivery if they require information or answers

  • Postnatal care should involve attention to psychological wellbeing as well as physical recovery

  • A debriefing service should be available for all women if and when they feel ready to access it and in an environment where they feel most comfortable.


Recommendations for future research

  • Ongoing or further research needs to be conducted to ensure that debriefing meets women’s needs with particular regard to psychological morbidity

  • The services and interventions that are most effective in facilitating women to finish their journey to motherhood need exploration. This should include an expansion of this literature review to cover interventions such as counselling


References


Affonso DD. (1977) ‘Missing pieces’ – a study of postpartum feelings. Birth
and the Family Journa
l 4(4): 159-64.

Alexander J. (1998) Confusing debriefing and defusing postnatally: the need for
clarity of terms, purpose and value. Midwifery 14:122-4.

Allen H. (1999) ‘How was it for you?’ Debriefing for postnatal women: does it
help? Professional Care of Mother and Child
9(3): 77-9.

American Psychiatric Association. (1994) Diagnosis and statistical manual of
mental disorders
. American Psychiatric Association: Washington DC.

Axe S. (2000) Labour debriefing is crucial for good psychological care. British
Journal of Midwifery
8(10): 626-31.

Baxter J, McCrae A, Dorey-Irani A. (2003) Talking with women after birth.
British Journal of Midwifery 11(5): 304-9.

Charles J, Curtis L, Winchester and Eastleigh Healthcare Trust. (1994) Birth
afterthoughts, setting up a listening service. Midwives Chronicle
107(1278): 266-8.

Deahl MP. (2000) Psychological debriefing: controversy and challenge.
Australian and New Zealand Journal of Psychiatry. 54: 929-39.

Dennett S. (2003) Talking about the birth with a midwife. British Journal of
Midwifery
11(1): 24-7.

Department of Health. (1999) Making a difference, strengthening the nursing,
midwifery and health visiting contribution to health and health care.
HMSO: London.

Emmerik AAP, Kamphuis JH, Hulsbosch AM, Emmelkamp PMG. (2002) Single
session debriefing after psychological trauma: a meta-analysis. The Lancet
360: 766-70.

Gamble JA, Creedy DK, Webster J, Moyle W. (2002) A review of the literature
on debriefing or non-directive counselling to prevent postpartum emotional
distress. Midwifery 18: 72-9.

Hammett PL. (1997) Midwives and debriefing: In: Kirkham M, Perkins E.
(Eds.). Reflections on midwifery. Balliere Tindall: London.

Hatfield A, Robinson E. (2002) The ‘debriefing’ of clients following the birth of
a baby. The Practising Midwife 5(5): 14-6.

Inglis S. (2002) Accessing a debriefing service following birth. British Journal of
Midwifery
10(6): 368-71.

Lavender T, Walkinshaw S. (1998) Can midwives reduce postpartum psychological
morbidity? A randomised trial. Birth 25(4): 215-9.

Madden I. (2002) Midwifery debriefing – in whose best interest? British
Journal of Midwifery 10(10): 631-4.

Menage J. (1996) Post-traumatic stress disorder in women following obstetric
and gynaecological procedures. British Journal of Midwifery 4(10): 532-3.

Mitchell JT. (1983) When disaster strikes... the critical incident stress debriefing
process. Journal of Emergency Medical Services 8: 36-9.

Olin RM, Faxelid E. (2003) Parent’s needs to talk about their experiences of
childbirth. Scandinavian Journal of Caring Sciences 17(2): 153-9.

Parkinson F. (1997) Critical incident debriefing: understanding and dealing with
trauma
. Souvenir Press: London.

Phillips S. (2003) Debriefing following traumatic childbirth. British Journal of
Midwifery
11(12): 725-30.

Priest SR, Henderson J, Evans SF, Hagan R. (2003) Stress debriefing after
childbirth: a randomised controlled trial. Medical Journal of Australia
178(11): 542-5.

Ralph K, Alexander J. (1994) Borne under stress. Nursing Times 90(12): 28-30.
Robinson J. (1998) Dangers of debriefing. British Journal of Midwifery 6(4): 251.

Rose S, Bisson J, Wessely S. (2004) Psychological debriefing for preventing
post-traumatic stress disorder (PTSD) (Cochrane Review)
: In: The Cochrane
Library Issue 1. John Wiley and Sons: Chichester.

Small R, Lumley J, Donohue L, Potter A, Waldenstrom U. (2000) Randomised
controlled trial of midwife-led debriefing to reduce maternal depression
after operative childbirth. British Medical Journal 321: 1043-7.

Smith J, Mitchell S. (1996) Debriefing after childbirth: a tool for effective risk
management. British Journal of Midwifery 4(11): 581-6.

Steele AM, Beadle M. (2003) A survey of postnatal debriefing. Journal of
Advanced Nursing
43(2): 130-6.





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