Maternal blood pressure
Taking and recording blood pressure (BP) is a task that many midwives and maternity support workers undertake daily. This article is an excellent review of blood pressure in pregnancy, which reminds the reader of the importance of being able to measure blood pressure accurately. It also discusses the choice of device, as well as the evidence-based hypertension BP thresholds at which there is increased risk of morbidity and mortality in pregnancy. The review suggests that in clinical practice, BP measurement is often not performed correctly, due to inadequate training and equipment, time constraints or lack of awareness of the importance of BP monitoring as a screening and diagnostic test. This point draws me to the newly published Nursing and Midwifery Council Code, which came into force in the UK in March 2015. The new Code provides greater clarity around the delegation of duties and tasks. This means that midwives will need to confirm that the outcome of any task delegated meets the required standard. I urge all midwives to read this review and ensure that they are using the correct equipment and method when recording blood pressure. If you are not using the correct equipment you have a duty to report this, as one of the authors, Professor Andrew Shennan, reminds us of our responsibilities:
‘There are several things clinicians can do to increase the accuracy of their BP measurement, such as becoming more aware of the advantages and disadvantages of the various available devices; having the confidence to raise concerns regarding any devices that are inaccurate for use in pregnancy; and correcting any poor techniques they've observed.’
Telephone-based peer support for postnatal depression
A new study suggests that telephone-based peer support could help reduce postnatal depression in new mothers. The study is a quasi-experimental evaluation of telephone-based peer support intervention for maternal depression. The study, conducted in Canada between May 2011 and October 2013, included 64 new mothers who were experiencing postpartum depression up to 24 months after giving birth. The average age of mothers was 26 years, with 77% reporting depressive symptoms prior to pregnancy and 57% having pregnancy complications. There were 16 women (35%) who were taking medication for depression since the birth. Volunteers who had recovered from postpartum depression were recruited and trained on how to offer telephone-based peer support to the participants. Over an average follow-up period of 14 weeks, the participants received approximately nine calls from the volunteers. At the start of the study all mothers were moderately depressed, but this dropped after telephone peer support to 8.1% (3/37) depressed at midpoint, rising to 11.8% (4/34) at the end of the study, suggesting some relapse.
The authors conclude that the findings offer promise that telephone-based peer support is effective for both early postpartum depression and maternal depression up to 2 years after birth. Letourneau N, Secco L, Colpitts J, Aldous S, Stewart
Childbirth-related fear in Sweden
This study aimed to investigate the prevalence of childbirth-related fear (CBRF) in early pregnancy among both Swedish-born and foreign women living in Sweden. The study design was a cross-sectional prevalence study of women attending antenatal ultrasound screening. Recruitment took place during a 2 month period. Women were asked to complete a fear of birth scale (FOBs). In total, 606 women completed the survey, 78% were born in Sweden and 22% in a foreign country. In the study, 22% (n=133) of women were identified as having CBRF. Of these, 18% (n=85) of women born in Sweden reported CBRF. Among foreign-born women, 37% (n=49) reported CBRF. The study highlighted that CBRF was almost three times as common among foreign-born women when compared to Swedish women. This suggests that foreign-born childbearing women are an extremely vulnerable group in Sweden, who need culturally sensitive and targeted support from caregivers. However, the study was designed to report the prevalence of CBRF; therefore, no reasons for why foreign-born women in the study had an increase in the prevalence CBRF was postulated, although female genital mutilation was offered as a possible explanation. This research provides further evidence for the provision of culturally sensitive midwifery care in the UK.