Perinatal Psychosocial Assessment-What are the Views of Health Professionals Working in the Private Obstetric Sector?

Abstract

Background: Women are not universally or routinely screened ante-or postnatally for psychosocial risk factors, depression and anxiety in the private sector in Australia. There are limited studies that explore health professionals’ views on screening or perceived barriers to the screening process. Aim: The aim of this study was to discuss the health professionals’ views of psychosocial screening and assessment who work in the private obstetric sector. Methods: Semi-structured face-to-face interviews were completed with 11 midwives, 1 social worker and 2 obstetricians. Three hospital sites were chosen, of which only one currently screens women for psychosocial risk factors. Thematic analysis was applied to interview transcripts. Three researchers then discussed reoccurring themes and a consensus in themes and subthemes was reached. Results: Only one hospital was screening women and had midwives trained in psychosocial assessment including depression screening. There were mixed views on the process and barriers to screening were identified, e.g. lack of support systems, cultural barriers, inaccurate answers, power barriers with obstetricians, husband interference, fear and powerlessness. Benefits were recognised: early identification of difficulties, standardisation and patient-focused care. Concerns were, however, also evident: suicide ideation, intrusiveness of questions, whether women responded honestly, not wanting to screen all women. Conclusion: There was an identified concern by midwives that obstetricians did not take seriously any concerns highlighted by the midwife about women’s psychosocial problems. There was a sense of a lack of ‘ownership’ of the women, therefore a feeling of helplessness in addressing their needs. Suggestions were made: appropriate education and training of midwives, flagging high risk women, more in-house resources and external resources/community links and employing a central midwife with interest and expertise in psychosocial screening.