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STRAWB2 (Stress and Wellbeing After Childbirth): a randomised controlled trial of targeted self‐help materials to prevent post‐traumatic stress disorder following childbirth
Author(s) -
Slade P,
West H,
Thomson G,
Lane S,
Spiby H,
Edwards RT,
Charles JM,
Garrett C,
Flanagan B,
Treadwell M,
Hayden E,
Weeks A
Publication year - 2020
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.16163
Subject(s) - medicine , childbirth , traumatic stress , randomized controlled trial , postnatal care , incidence (geometry) , obstetrics , psychiatry , pregnancy , surgery , genetics , biology , physics , optics
Objectives To test whether providing psychological self‐help materials would significantly lower the incidence of post‐traumatic stress disorder (PTSD) at 6–12 weeks postnatally. Design Open‐label randomised controlled trial, with blinded outcome assessment. Setting Community midwifery services in two National Health Service (NHS) trusts in the North West. Sample A cohort of 2419 women receiving normal NHS postnatal care. Methods Midwives screened women for traumatic birth experience; 678 women who screened positively (28.1%) were randomly allocated to self‐help with usual care ( n = 336) or to usual care alone ( n = 342). The self‐help materials were a leaflet and online film designed to prevent the development of PTSD after trauma exposure through explaining how to manage early psychological responses. Main outcome measure The primary outcome was a composite of diagnostic and subdiagnostic PTSD at 6–12 weeks postnatally using the gold‐standard Clinician‐Administered PTSD Scale (CAPS‐5) interview. Results Of the 678 women correctly randomised plus the nine women randomised in error, 478 (70.5%) were followed up. Diagnostic or subdiagnostic PTSD rates at follow‐up did not differ between groups who received self‐help (26.7%, 65/243) or usual care alone (26.2%, 64/244) (intention‐to‐treat analysis: RR 1.02, 95% CI 0.68–1.53). Findings remained consistent in the per‐protocol analysis (RR 1.04, 95% CI 0.85–1.27). Women viewed the materials very positively. There were no adverse effects. Health economic micro‐costing indicated implementation would be very low cost. Conclusions Many women experience a traumatic birth and risk developing PTSD, but self‐help strategies without professional support are insufficient and should not be routinely introduced. Tweetable abstract Self‐help information alone does not reduce the number of women developing PTSD after a traumatic childbirth.