STRAWB2 (Stress and Wellbeing After Childbirth): a randomised controlled trial of targeted self?help materials to prevent post?traumatic stress disorder following childbirth

Slade, P; West, H; Thomson, G; Lane, Steven; Spiby, H; Tudor Edwards, R; Charles, J; Garrett, C; Flanagan, B; Treadwell, M; Hayden, E; Weeks, A

Abstract

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.

Citation

Slade, P., West, H., Thomson, G., Lane, S., Spiby, H., Tudor Edwards, R., …Weeks, A. (2020). STRAWB2 (Stress and Wellbeing After Childbirth): a randomised controlled trial of targeted self‐help materials to prevent post‐traumatic stress disorder following childbirth. BJOG: An International Journal of Obstetrics and Gynaecology, 127(7), 886-896. https://doi.org/10.1111/1471-0528.16163

• Journal Article Type: Article
• Acceptance Date: Jan 30, 2020
• Online Publication Date: Feb 7, 2020
• Publication Date: 2020-06
• Deposit Date: Mar 3, 2020
• Publicly Available Date: Feb 8, 2021
• Journal: BJOG: An International Journal of Obstetrics & Gynaecology
• Print ISSN: 1470-0328
• Electronic ISSN: 1471-0528
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 127
• Issue: 7
• Pages: 886-896
• DOI: https://doi.org/10.1111/1471-0528.16163
• Keywords: post traumatic stress disorder, postnatal, childbirth, prevention, randomised controlled trial
• Public URL: https://nottingham-repository.worktribe.com/output/3946359
• Publisher URL: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/1471-0528.16163
• Additional Information: This is the peer reviewed version of the following article: Slade, P, West, H, Thomson, G, Lane, S, Spiby, H, Edwards, RT, Charles, JM, Garrett, C, Flanagan, B, Treadwell, M, Hayden, E, Weeks, A. STRAWB2 (Stress and Wellbeing After Childbirth): a randomised controlled trial of targeted self?help materials to prevent post?traumatic stress disorder following childbirth. BJOG 2020, which has been published in final form at https://doi.org/10.1111/1471-0528.16163. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.