Post-partum Depression Study

Opportunity to Participate in a Research Study on Postpartum Depression

A study investigating women’s experiences of pregnancy after recovering from Postpartum Depression is being conducted. Candidates for participation are women who have been diagnosed with moderate to severe Postpartum Depression by a mental health or medical professional and then had a child after recovering from that depressive episode. All participants must have given birth between nine and twenty-four months ago (i.e. their most recent child is between nine months and two years old) and be free from symptoms of Major Depression at the time of participation.

This study is comprised of a short, 10-15 minute phone interview consisting of some demographic questions (e.g. age, ethnicity, date of initial diagnosis, current psychological functioning). Additionally, some women may be asked to participate in two 1-2 hour audiotaped interviews to take place in a private, convenient location of their choice. The first interview will consist of questions aimed at gathering information on the experience of pregnancy after recovering from Postpartum Depression. The follow-up interview will be used to clarify ideas that arise from the first interview and will provide a chance to gain new information that may have been left out in the first interview. Women who participate in the 1-2 hour interviews will be compensated with a $5.00 Target gift card after each interview. Additional benefits of the study include informing mental health professionals about the process of preparing for another child as well as another potential episode of Postpartum Depression. In this way, professionals can be better informed of what women find helpful, what is not helpful, and what they wish they would have done differently. This information has the potential to enable professionals to aid other women who are in similar situations. Your participation in this research is completely voluntary and confidential. You may choose to withdraw from the study at any time.

If you are interested in participating in this study, please contact Amanda Delsman, Doctoral Candidate at the American School of Professional Psychology/Argosy University, Twin Cities, via email at adelsman@msp.stu.argosy.edu or via telephone at 651-492-3572.

Less Cesareans with Induction of Labor? Read the Fine Print!

Cross-post from ICAN-Blog:

Media reports this past week have hyped a recent study claiming that induction of labor may actually reduce the need for cesarean. These findings appear to contradict previous research and generally held opinion.

However, these reports have underplayed and underreported the substantial caveats offered by the researchers about their findings. Although the authors do report a 22% reduction in cesareans in women who had elective inductions after 41 weeks, they temper their findings with the following:

1) These findings may not translate to many, if any, hospitals in the U.S. because of how obstetricians tend to practice in reality. According to the press release, “Prior research has indicated that doctors often tend to proceed from starting an induction to cesarean fairly quickly.” Thus, in order for these findings to be relevant, doctors must have patience to allow inductions to work. (Which begs the question: Why not just wait for spontaneous labor to occur?)

2) Induction of labor, on the whole, remains vastly understudied and further analysis is needed. As one of the lead researchers on the study states, "It’s pretty surprising that something obstetricians do all the time hasn’t been studied all that well."

With these substantial caveats in mind, it’s far too soon to rush to the conclusion that induction of labor is “safer” than spontaneous labor, even in post-dates pregnancies. The fact remains that women must be aware of the risks associated with any obstetrical intervention and have the freedom to make choices that they believe are best for themselves and their babies, not doctors’ protocols and hospital time clocks.

Early Elective Repeat C-sections Dangerous for Babies

Cross-post from ICAN Blog:

A new study published in The New England Journal of Medicine reports that elective repeat cesareans performed prior to 39 weeks of gestation significantly increase the risk or respiratory problems and other adverse outcomes for babies. According to the study, "The rates of adverse respiratory outcomes, mechanical ventilation, newborn sepsis, hypoglycemia, admission to the neonatal ICU, and hospitalization for 5 days or more were increased by a factor of 1.8 to 4.2 for births at 37 weeks and 1.3 to 2.1 for births at 38 weeks."

Read the full abstract here. Read the related article in TIME here.

Maternity Leave Before Delivery Decreases Likelihood of Cesarean

Cross-post from ICAN Blog:

Researchers at the University of California, Berkeley have found that women who take maternity leave prior to delivery are less likely to have cesarean sections. Women who started their maternity leave in the last month of pregnancy, rather than working up to the point of delivery, were nearly four times less likely to have c-sections. Read the full article here.

C-section & malpractice suits - some evidence for a link

Researcher studies rates of cesarean sections, malpractice suits
by Kristina Goodnough - September 2, 2008

There may be a relationship between cesarean delivery rates and medical malpractice rates, according to research by Dr. Jeffrey Spencer, a fellow in maternal fetal medicine at the Health Center.

As the state’s medical malpractice premiums increased, the number of cesarean deliveries also rose, according to Spencer, who reviewed the deliveries at Hartford Hospital from 1991 to 2005.

During that time, there were 64,767 deliveries, of which 15,021 (23 percent) were cesarean deliveries. Of the 15,021 cesarean deliveries, 8,045 (59.5 percent) were primary or first-time cesarean deliveries, while 6,076 (40.5 percent) were repeat cesarean deliveries.

During the same time period, medical malpractice rates increased substantially. Spencer obtained mean malpractice premiums for obstetricians from the hospital’s major medical malpractice provider and adjusted them for inflation.

The mean premiums for medical malpractice insurance for obstetricians increased from less than $80,000 for an individual physician to more than $120,000.

“When I compared the malpractice rates to cesarean delivery rates prior to 1999, both were declining at a similar rate,” says Spencer. From 1999 to 2005, however, both were increasing. “I can’t say one led to the other or visa versa,” he says, but he speculates that rising medical malpractice rates are driving up cesarean delivery rates.

Normal vaginal delivery is considered safer than a cesarean delivery for both mother and baby if the birth is uncomplicated. Cesarean deliveries are recommended for complications, such as slow or long labor or indications of fetal distress during labor.

Maternal fetal medicine specialist Dr. Jeffrey Spencer of the UConn Health Center performs an ultrasound.

Photo by Lanny Nagler

“Most of the large malpractice cases result from a poor fetal outcome, that is, an expected ‘normal’ baby is born with health problems or has a bad outcome for whatever reason,” says Spencer. “The MDs get sued because they didn’t do all that was possible for the baby – meaning perform a cesarean.”

“Malpractice premiums are a huge expense for physicians,” says Spencer. “It’s difficult for them not to practice defensive medicine. But although cesarean deliveries are less risky for the baby, they are more risky for the mom, with longer recovery times, generally, than vaginal deliveries. It’s important to consider whether every cesarean delivery is truly necessary.”

It’s possible that there are other factors that may also account for the association,” says Spencer, who presented his research at the American College of Obstetricians and Gynecologists annual meeting last spring. “With our data, we cannot prove a causation but only suggest an association.”

Nationwide, cesarean deliveries accounted for 30.2 percent of all deliveries in 2005, compared to 20.7 percent of deliveries in 1996. The rising rate of cesarean deliveries has triggered a debate over whether the increase can be attributed to medical necessity.

Source