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 x 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.