Identifying and supporting women with psychosocial issues during the postnatal period: Evaluating an educational intervention for midwives using a before-and-after survey Helen L. McLachlan, GradDipAdvNurs (Mid), MNurs, PhD (Senior Lecturer, Senior Research Fellow) a,c,n , Della A. Forster, BHealth Sci, MMid, PhD (Senior Research Fellow) a,b , Rebecca Collins, BN/BM, MMidSci (Midwife) c , Jane Gunn, MBBS, FRACGP, PhD, DRANZCOG (Professor) d , Kelsey Hegarty, MBBS, FRACGP, PhD, DRANZCOG (Associate Professor) d a Mother and Child Health Research, Melbourne, Victoria 3000, Australia b The Royal Women’s Hospital, Parkville, Victoria 3052, Australia c Division of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia d Primary Care Research Unit, Department of General Practice, University of Melbourne, Carlton, Victoria 3053, Australia article info Article history: Received 7 August 2009 Received in revised form 23 December 2009 Accepted 5 January 2010 Keywords: Psychosocial issues Postnatal Communication skills Midwife Education abstract Objective: women experience a range of psychosocial issues during pregnancy, childbirth and the postnatal period. A review of hospital postnatal care in Australia found that many midwives who provide postnatal care find dealing with psychosocial issues a challenge, further complicated by heavy workloads that reduce the opportunity for quality interactions between midwives and women. This study aimed to evaluate an advanced communication skills education package for midwives caring for women during the postnatal period. Design: a before-and-after survey design was used. Midwives attended seven sessions over a six-month period in 2006 and completed a survey before and after the sessions to evaluate the programme. Surveys included items about communication skills, willingness to change, learning style, and knowledge of and attitudes towards psychosocial issues. Setting: the programme was implemented at two sites in Victoria, Australia: a tertiary metropolitan referral hospital and a regional hospital. Participants: 25 midwives participated in the study. Findings: 21 of the 25 participating midwives (84%) completed both the pre and post survey. Following the educational intervention, participants were more likely to feel competent at identifying women in an abusive relationship (p =0.002); encouraging women to talk about any psychosocial issues (p = 0.02); actively encouraging women to talk about things on their mind (p =0.01); and encouraging women to talk about how they are really feeling (p =0.02). Participants also felt more confident in their knowledge of psychosocial issues (p =0.01) and in supporting women experiencing psychosocial issues in the early postnatal period (p =0.02). Participants were very positive about the programme. Key conclusions and implications for practice: the advanced communication programme, implemented for the first time in the postnatal setting, increased the self-reported comfort and competency of midwives to identify and care for women with psychosocial issues during the postnatal period. The effect of this approach should now be evaluated in terms of women’s outcomes. & 2010 Elsevier Ltd. All rights reserved. Introduction Women may experience a range of psychosocial issues during pregnancy, childbirth and the postnatal period, such as depres- sion, partner violence, social isolation, lack of social support, a history of sexual abuse, substance abuse and mental illness (Gunn et al., 2006). Midwives play an important role in supporting women who are experiencing these issues; however, there has traditionally been little formal education for care providers in managing these issues (Kurtz et al., 1998; Gunn et al., 2006). Women may feel reluctant to disclose issues and care providers may feel unprepared to discuss them (Ramsay et al., 2002). A statewide review of hospital postnatal care conducted in Victoria, Australia (PinC: Postnatal in hospital Care) explored postnatal care provision from the perspective of care providers, Contents lists available at ScienceDirect journal homepage: www.elsevier.com/midw Midwifery 0266-6138/$ - see front matter & 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.midw.2010.01.008 n Corresponding author at: Division of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia. E-mail address: h.mclachlan@latrobe.edu.au (H.L. McLachlan). Midwifery 27 (2011) 723–730