Feasibility and Preliminary Efficacy of Enhanced Midwifery Care to Support Women Experiencing Subclinical Depression: A Pilot Randomised Controlled Trial

Abstract

Highlights: Public health relevance—How does this work relate to a public health issue? Subclinical depression in the perinatal period is common and under-recognized, and may increase risk for later clinical depression and adverse outcomes for mothers and infants. This study focuses on women from ethnically diverse communities in South Western Sydney, where barriers to mental health and maternity care are well documented. Public health significance—Why is this work of significance to public health? This pilot RCT shows that enhanced midwifery care can be delivered with good fidelity in a hard-to-reach population, underscoring its potential to reduce perinatal mental health inequities. The findings provide early, implementation-relevant evidence to inform scalable, integrated models of perinatal mental health support within routine antenatal care. Public health implications—What are the key implications/messages for practitioners, policy makers, and researchers? The findings of this study reiterate the importance of early identification and proactive support for women with subclinical depressive symptoms, highlighting the need to strengthen early intervention pathways in antenatal care. Integrating enhanced midwifery continuity with multidisciplinary support may represent a promising, feasible framework to strengthen engagement among vulnerable groups; adequately powered trials are needed to determine effectiveness and optimise retention. This study investigated the feasibility and preliminary effects of enhanced midwifery care in reducing subclinical depression symptoms among women in ethnically diverse areas of the South Western Sydney Local Health District (SWSLHD). A pilot randomised controlled trial was conducted among pregnant women attending the Fairfield and/or Liverpool antenatal clinic with an Edinburgh Depression Scale (EDS) score of 10–12 (i.e., just below the generally accepted clinical cut-off score of 13 to indicate subclinical depressive symptoms) during the first antenatal visit (i.e., before 26 weeks gestation). Participants were randomly allocated to either the intervention group which received continuous and coordinated support from a dedicated Registered Midwife (RM) trained in counselling and linked with a multidisciplinary team, or the usual care group, which received standard maternity care from various providers without continuity or additional coordinated support. Primary outcomes included feasibility of recruitment, randomisation, intervention delivery and fidelity, and retention and follow-up. The secondary outcomes were improvement in depressive symptom severity assessed via EDS, psychological distress (Kessler’s psychological distress scale—K10), and parenting confidence (Karitane Parenting Confidence Scale (KPCS). Descriptive analyses were used to assess the feasibility outcomes, whereas mixed-effects models were used to examine the effects of treatment on secondary outcomes. Thirty-seven mothers were recruited into the study, of which eighteen were randomised to the intervention group and nineteen to the usual care group. The intervention was delivered with good fidelity, and remote adaptations during COVID-19 ensured both continuity of care and high retention at 6-month follow-up. Findings of the mixed-effects models showed significant within-group reduction in EDS scores over time, with scores at 8 weeks postpartum (T2) significantly lower than at baseline (T0; β = −2.77, SE = 1.36, p < 0.05) but no significant differences between the groups (β = −0.02, SE = 1.63, p = 0.992) or time-by-group interactions at any timepoint for EDS, K10, and KPCS. These findings demonstrate the feasibility of enhanced midwifery care in a “hard to reach” population of SWSLHD and highlight the need for adequately powered trials to determine its effectiveness on maternal mental health and parenting outcomes.