Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 143 No. 3536 (2013)

Predictors of early postpartum mental distress in mothers with midwifery home care – results from a nested case-control study

  • Katharina Staehelin
  • Elisabeth Kurth
  • Christian Schindler
  • Monika Schmid
  • Elisabeth Zemp Stutz
Cite this as:
Swiss Med Wkly. 2013;143:w13862


PRINCIPLES: The prevalence of early postpartum mental health conditions is high. Midwives and other health professionals visiting women at home may identify mothers at risk. This seems crucial given decreasing trends of length of hospital stay after childbirth. This study aimed to identify predictors of maternal mental distress in a midwifery home care setting.

METHODS: Using the statistical database of independent midwives' services in Switzerland in 2007, we conducted a matched nested case-control study. Out of a source population of 34,295 mothers with midwifery home care in the first ten days after childbirth, 935 mothers with maternal distress and 3,645 controls, matched by midwife, were included. We analysed whether socio-demographic, maternal and neonatal factors predict maternal mental distress by multivariable conditional logistic regression analysis.

RESULTS: Infant crying problems and not living with a partner were the strongest predictors for maternal distress, whereas higher parity was the most protective factor. Significantly elevated risks were also found for older age, lower educational levels, breast/breastfeeding problems, infant weight gain concerns, neonatal pathologies and use of midwifery care during pregnancy. A lower likelihood for maternal distress was seen for non-Swiss nationality, full-time employment before birth, intention to return to work after birth and midwife-led birth.

CONCLUSION: The study informs on predictors of maternal mental distress identified in a home care setting in the early postpartum period. Midwives and other health care professionals should pay particular attention to mothers of excessively crying infants, single mothers and primipara, and assess the need for support of these mothers.


  1. Luyben AG, Kinn SR, Fleming VEM. Becoming a mother: women’s journeys from expectation to experience in three european countries. International Journal of Childbirth. 2011;1(1):13–26.
  2. Halbreich U. The association between pregnancy processes, preterm delivery, low birth weight, and postpartum depressions – the need for interdisciplinary integration. Am J Obstet Gynecol. 2005;193(4):1312–22.
  3. Beck CT. Postpartum depression: a metasynthesis. Qual Health Res. 2002;12(4):453–72.
  4. Jomeen J. The importance of assessing psychological status during pregnancy, childbirth and the postnatal period as a mulidimensional construct: A literature review. Clin Eff Nurs. 2004;8:143–55.
  5. Halbreich U. Postpartum disorders: multiple interacting underlying mechanisms and risk factors. J Affect Disord. 2005;88(1):1–7.
  6. Henshaw C. Mood disturbance in the early puerperium: a review. Arch Womens Ment Health. 2003;6(Suppl 2):S33–42.
  7. Miller RL, Pallant JF, Negri LM. Anxiety and stress in the postpartum: is there more to postnatal distress than depression? BMC Psychiatry. 2006;6:12.
  8. Brockington I. Postpartum psychiatric disorders. Lancet. 2004;363(9405):303–10.
  9. Romito P, Saurel-Cubizolles MJ, Lelong N. What makes new mothers unhappy: psychological distress one year after birth in Italy and France. Soc Sci Med. 1999;49(12):1651–61.
  10. Austin MP. Antenatal screening and early intervention for “perinatal” distress, depression and anxiety: where to from here? Arch Womens Ment Health. 2004;7(1):1–6.
  11. Fisher JR, Feekery CJ, Rowe-Murray HJ. Nature, severity and correlates of psychological distress in women admitted to a private mother-baby unit. J Paediatr Child Health. 2002;38(2):140–5.
  12. Brand SR, Brennan PA. Impact of antenatal and postpartum maternal mental illness: how are the children? Clin Obstet Gynecol. 2009;52(3):441–55.
  13. Dennis CL, Chung-Lee L. Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review. Birth. 2006;33(4):323–31.
  14. Hall PL, Wittkowski A. An exploration of negative thoughts as a normal phenomenon after childbirth. J Midwifery Womens Health. 2006;51(5):321–30.
  15. Foulkes M. Enablers and barriers to seeking help for a postpartum mood disorder. J Obstet Gynecol Neonatal Nurs. 2011;40(4):450–7.
  16. Nagel-Brotzler A, Bronner J, Hornstein C, Albani C. Mental disorders in the peripartum period – early detection and multi-professional cooperation. Z Geburtshilfe Neonatol. 2005;209(2):51–8.
  17. Logsdon MC, Tomasulo R, Eckert D, Beck C, Dennis CL. Identification of mothers at risk for postpartum depression by hospital-based perinatal nurses. MCN Am J Matern Child Nurs. 2012;37(4):218–25.
  18. Razurel C, Bruchon-Schweitzer M, Dupanloup A, Irion O, Epiney M. Stressful events, social support and coping strategies of primiparous women during the postpartum period: a qualitative study. Midwifery. 2011;27(2):237–42.
  19. Schweizerischer Hebammenverband. Tätigkeitserfassung der freipraktizierenden Hebammen der Schweiz 2007 [Statistical Database of Independent Midwives’ Services in Switzerland 2007] 2008. Available from:
  20. Bundesamt für Statistik. Medizinische Statistik der Krankenhäuser 2011 Neuchâtel. Bundesamt für Statistik; 2013. Available from:
  21. Bundesamt für Statistik. Medizinische Statistik der Krankenhäuser 2000 Neuchâtel. Bundesamt für Statistik; 2002. Available from:
  22. UniversitätsSpital Zürich. Jahresstatistik der Geburtshilfe 2007. Klinik für Geburtshilfe. Available from:
  23. UniversitätsSpital Zürich. Jahresstatistik der Geburtshilfe 2010. Klinik für Geburtshilfe. Available from:
  24. Bartkowski R. Length of hospital stay due to DRG reimbursement. Ther Umsch. 2012;69(1):15–21.
  25. Beck CT. A meta-analysis of predictors of postpartum depression. Nurs Res. 1996;45(5):297–303.
  26. Beck CT. Predictors of postpartum depression: an update. Nurs Res. 2001;50(5):275–85.
  27. Leigh B, Milgrom J. Risk factors for antenatal depression, postnatal depression and parenting stress. BMC Psychiatry. 2008;8:24.
  28. Mayberry LJ, Horowitz JA, Declercq E. Depression symptom prevalence and demographic risk factors among U.S. women during the first 2 years postpartum. J Obstet Gynecol Neonatal Nurs. 2007;36(6):542–9.
  29. Nielsen Forman D, Videbech P, Hedegaard M, Dalby Salvig J, Secher NJ. Postpartum depression: identification of women at risk. BJOG. 2000;107(10):1210–7.
  30. Righetti-Veltema M, Conne-Perreard E, Bousquet A, Manzano J. Risk factors and predictive signs of postpartum depression. J Affect Disord. 1998;49(3):167–80.
  31. Milgrom J, Gemmill AW, Bilszta JL, Hayes B, Barnett B, Brooks J, et al. Antenatal risk factors for postnatal depression: a large prospective study. J Affect Disord. 2008;108(1–2):147–57.
  32. Robertson E, Grace S, Wallington T, Stewart DE. Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry. 2004;26(4):289–95.
  33. Patel M, Bailey RK, Jabeen S, Ali S, Barker NC, Osiezagha K. Postpartum depression: a review. J Health Care Poor Underserved. 2012;23(2):534–42.
  34. Horowitz JA, Murphy CA, Gregory KE, Wojcik J. A community-based screening initiative to identify mothers at risk for postpartum depression. J Obstet Gynecol Neonatal Nurs. 2011;40(1):52–61.
  35. Bergant AM, Heim K, Ulmer H, Illmensee K. Early postnatal depressive mood: associations with obstetric and psychosocial factors. J Psychosom Res. 1999;46(4):391–4.
  36. Bloch M, Rotenberg N, Koren D, Klein E. Risk factors for early postpartum depressive symptoms. Gen Hosp Psychiatry. 2006;28(1):3–8.
  37. Britton JR. Maternal anxiety: course and antecedents during the early postpartum period. Depress Anxiety. 2008;25(9):793–800.
  38. Dennis CL, Janssen PA, Singer J. Identifying women at-risk for postpartum depression in the immediate postpartum period. Acta Psychiatr Scand. 2004;110(5):338–46.
  39. Dennis CL, Ross LE. Depressive symptomatology in the immediate postnatal period: identifying maternal characteristics related to true- and false-positive screening scores. Can J Psychiatry. 2006;51(5):265–73.
  40. Giakoumaki O, Vasilaki K, Lili L, Skouroliakou M, Liosis G. The role of maternal anxiety in the early postpartum period: screening for anxiety and depressive symptomatology in Greece. J Psychosom Obstet Gynaecol. 2009;30(1):21–8.
  41. Gurel S, Gurel H. The evaluation of determinants of early postpartum low mood: the importance of parity and inter-pregnancy interval. Eur J Obstet Gynecol Reprod Biol. 2000;91(1):21–4.
  42. Skari H, Skreden M, Malt UF, Dalholt M, Ostensen AB, Egeland T, et al. Comparative levels of psychological distress, stress symptoms, depression and anxiety after childbirth – a prospective population-based study of mothers and fathers. BJOG. 2002;109(10):1154–63.
  43. Fenton TR. A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format. BMC Pediatr. 2003;3:13.
  44. Hosmer DW, Lemeshow S. Logistic regression for matched case-control studies. In: Hosmer DW, Lemeshow S, editors. Applied Logistic Regression, second edition. New York: John Wiley & Sons; 2000. p. 223–59.
  45. Miller AR, Barr RG, Eaton WO. Crying and motor behavior of six-week-old infants and postpartum maternal mood. Pediatrics. 1993;92(4):551–8.
  46. Kurth E, Spichiger E, Cignacco E, Kennedy HP, Glanzmann R, Schmid M, et al. Predictors of crying problems in the early postpartum period. J Obstet Gynecol Neonatal Nurs. 2010;39(3):250–62.
  47. Kurth E, Kennedy HP, Spichiger E, Hosli I, Zemp Stutz E. Crying babies, tired mothers: what do we know? A systematic review. Midwifery. 2011;27(2):187–94.
  48. Hung CH. Correlates of first-time mothers’ postpartum stress. Kaohsiung J Med Sci. 2006;22(10):500–7.
  49. Edge D. Ethnicity, psychosocial risk, and perinatal depression – a comparative study among inner-city women in the United Kingdom. J Psychosom Res. 2007;63(3):291–5.
  50. Moayedoddin A, Moser D, Nanzer N. The impact of brief psychotherapy centred on parenthood on the anxio-depressive symptoms of mothers during the perinatal period. Swiss Med Wkly. 2013 doi: 10.4414/smw.2013.13769.
  51. Cook JA. Employment barriers for persons with psychiatric disabilities: update of a report for the President’s Commission. Psychiatr Serv. 2006;57(10):1391–405.
  52. Munk-Olsen T, Laursen TM, Pedersen CB, Mors O, Mortensen PB. New parents and mental disorders: a population-based register study. JAMA. 2006;296(21):2582–9.
  53. Reck C, Hunt A, Fuchs T, Weiss R, Noon A, Moehler E, et al. Interactive regulation of affect in postpartum depressed mothers and their infants: an overview. Psychopathology. 2004;37(6):272–80.
  54. Dennis CL. Psychosocial and psychological interventions for prevention of postnatal depression: systematic review. BMJ. 2005;331(7507):15.
  55. Beck CT. Theoretical perspectives of postpartum depression and their treatment implications. MCN Am J Matern Child Nurs. 2002;27(5):282–7.
  56. Fish M, Stifter C. Mother parity as a main and moderating influence on early mother-infant interaction. J Appl Dev Psychol. 1993;14:557–72.
  57. Halbreich U, Karkun S. Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms. J Affect Disord. 2006;91(2-3):97–111.
  58. Cignacco E, Buchi S, Oggier W. Midwife-led labour in a Swiss hospital. Pflege. 2004;17(4):253–61.

Most read articles by the same author(s)

1 2 > >>