EFFECTIVENESS OF MIDWIFE LED DEBRIEFING ON POSTPARTUM DEPRESSION IN WESTERN, KENYA

Abstract

Childbirth is a stressful event in women’s lives and could influence emotions which may lead to mental ill health like depression in the postnatal period if not resolved. Depression is a common mental disorder with serious consequences especially during the postpartum period. Many African countries have not explored interventions to reduce or prevent postpartum depression, though the prevalence of postpartum depression has been the focus and there is evidence that it exists among postpartum women. Postpartum midwife-led debriefing has not been explored in low-Middle Income Countries including Kenya. Therefore, this study aimed to investigate the effectiveness of midwife led debriefing on Postpartum Depression in Western region, Kenya. Specifically, to examine the effectiveness of approaches used in midwife-led debriefing, to assess factors influencing Midwife led debriefing, to determine the outcome of midwife led debriefing on postpartum depression and to develop Midwife led debriefing protocol on Prevention of postpartum depression. The study was a quasi-experimental design with pre and post-test assessments. Systematic random sampling was used to identify and allocate participants to both intervention and control groups of the study. The target population were the women of child bearing age. The study participants were women who gave birth during the study period, of which a sample of 212 participated in the study. The 165 participants were allocated to the intervention group while 47 participants being in the control group. Data was collected using standard questionnaire. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 26. Chi-square was used to test association between dependent and independent variables, odds ratio was used to determine the strength between variables that were more likely to influence the debriefing outcome. Logistic regression model was used to assess the influence of time-based outcome variables, social cultural and demographic characteristics of women on midwife-led debriefing. Following midwife-led debriefing, depression levels were found to have decreased according to the study's significant findings on group approach, parity, and social support (p=0.02; p=0.004; p=0.001). Additionally, it showed that debriefing lead by a midwife significantly reduced the risk of postpartum depression (t-statistic=14.672, pvalue= 0.003< 0.05). The Odds ratio (OR= 5.41) indicated association between the intervention of midwife led debriefing and the outcome being reduced signs and symptoms of depression as compared with the standard care. In conclusion, at the 5% significance level, the null hypothesis was rejected (p=0.003), suggesting that postpartum depression might potentially be prevented using midwife-led debriefing. The coefficient of B=0.871 shows a proportional shift in postpartum depression prevention of 0.871 units for every unit increase in midwife-led debriefing. Women's postpartum depression scores could be significantly lowered by midwife-led debriefing following delivery. A proposed protocol from this was recommended for early identification of symptoms of postpartum depression and to improve the quality of life for both the mother and the child.