Baker SR I felt as though I'd been in Jail': Women's Experiences of Maternity Care during Labour, Delivery and the Immediate Postpartum. Feminism Psychology. 2005; 15:(3)315-342

Bailham D, Joseph S Post-traumatic stress following childbirth: A review of the emerging literature and directions for research and practice. Psychol Health Med. 2003; 8:(2)159-168

Hodnett ED, Gates S, Hofmeyr GJ, Sakala C Continuous support for women during childbirth. Cochrane Database Syst Rev. 2007; 3

Mohammad KI, Gamble J, Creedy DK Prevalence and factors associated with the development of antenatal and postnatal depression among Jordanian women. Midwifery. 2011; 27:(6)e238-e245

Olde E, van der Hart O, Kleber R, van Son M Post-traumatic stress following childbirth: a review. Clin Psychol Rev. 2006; 26:(1)1-16

Raine R, Cartwright M, Richens Y, Mahamed Z, Smith D A qualitative study of women's experiences of communication in antenatal care: identifying areas for action. Matern Child Health J. 2010; 14:(4)590-9

Rowe RE, Garcia J, Macfarlane AJ, Davidson LL Improving communication between health professionals and women in maternity care: a structured review. Health Expectations. 2002; 5:(1)63-83

Think pink! A sticker alert system for psychological distress or vulnerability during pregnancy

02 August 2014
Volume 22 · Issue 8


The importance of good clinical communication to women during pregnancy and birth is clear. Poor communication in labour is associated with general dissatisfaction, more complaints and a range of perinatal mental health problems including post-traumatic stress disorder (PTSD) and postnatal depression. To communicate effectively, maternity staff need information about which women are vulnerable and require extra support. To address this, a pink sticker communication system to alert midwifery and obstetric staff to potential psychological difficulties experienced by some women was implemented and evaluated. Evaluation showed this system was viewed positively by women and midwifery staff. Audit of referrals to the perinatal psychology service during this period suggests no woman with a pink sticker developed birth trauma as a direct result of perceived poor care. In addition, the proportion of referrals to perinatal psychology for birth trauma significantly reduced during this period.

Effective empathic communication between midwives and women and their families is imperative to deliver good and effective clinical care. Women who report good communication from their health professional also report greater satisfaction with their care (Mohammad et al, 2011), whereas poor communication may lead some women to become reluctant to engage in services (Raine et al, 2010). Empathic communication is particularly important for women with previous or current mental health problems. In the words of one woman attending the Warwick hospital psychology service: ‘I don't want to have to keep explaining my situation over and over…it makes me more anxious if I have to go through the story lots of times’.

Warwick Hospital has a dedicated perinatal psychology service which provides clinical input and support to women and their partners during pregnancy and for up to 6 months after birth. Typical problems encountered include antenatal and postnatal depression and anxiety, grief following perinatal loss, specific fears interfering with medical care (e.g. needle phobia), high-risk pregnancies (e.g. multiple birth, placenta praevia), exacerbation or monitoring of severe and enduring mental health problems such as bipolar disorder, fear of childbirth and birth trauma reactions including post-traumatic stress disorder (PTSD).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month