A two-centred pragmatic randomised controlled trial of two interventions of postnatal support

Objectives: To establish whether providing additional postnatal support during the early postnatal months influences women's physical and psychological health and to identify health service benefits. Design: Pragmatic randomised controlled trial with a 2 × 2 factorial design with two interventions. Setting: Community centres, Ayrshire and Grampian, Scotland. Population: One thousand and four primiparous women, 83% completed the baseline questionnaire, 71% at six months. Methods: (1) An invitation to a local postnatal support group run weekly with a facilitator, starting two weeks postpartum. (2) A postnatal support manual, posted two weeks postpartum. Main outcome measures: Data regarding primary outcome postnatal depression (Edinburgh Postnatal Depression Scale, EPDS), secondary outcomes, general health measures (SF-36), social support (SSQ6), use of health services and women's views of interventions were collected at two weeks postpartum and at three and six months. Results: There were no significant differences in EPDS scores between the control and trial arms at three and six months, nor were there differences in the SF-36 and the SSQ6 scores. The 95% CI for the difference in EPDS effectively excluded a change in mean score of more than 10% with either intervention. There were no differences in health service attendances in primary or secondary care between the control and trial arms. Of those women who attended the groups, 40% attended six or more. Women reported favourably on the ‘pack’ with the majority reading it a few times and feeling that it was aimed at them. Conclusions: Wide-scale provision by the National Health Service of either support groups or self-help manuals is not appropriate if the aim is to improve measurable health outcomes