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 ORCID: 0000-0001-5877-2706, West, H ORCID: 0000-0001-8712-5890, Thomson, G, Lane, S, Spiby, H, Edwards, RT, Charles, JM, Garrett, C, Flanagan, B, Treadwell, M
et al (show 2 more authors) (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). pp. 886-896.

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Abstract

<h4>Objectives</h4>To test whether providing psychological self-help materials would significantly lower the incidence of post-traumatic stress disorder (PTSD) at 6-12 weeks postnatally.<h4>Design</h4>Open-label randomised controlled trial, with blinded outcome assessment.<h4>Setting</h4>Community midwifery services in two National Health Service (NHS) trusts in the North West.<h4>Sample</h4>A cohort of 2419 women receiving normal NHS postnatal care.<h4>Methods</h4>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.<h4>Main outcome measure</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.<h4>Tweetable abstract</h4>Self-help information alone does not reduce the number of women developing PTSD after a traumatic childbirth.

Item Type: Article
Uncontrolled Keywords: Childbirth, Post-traumatic stress disorder, postnatal, prevention, randomised controlled trial
Depositing User: Symplectic Admin
Date Deposited: 04 Feb 2020 14:15
Last Modified: 19 Jan 2023 00:05
DOI: 10.1111/1471-0528.16163
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3073411