Prenatal Anxiety and Depression: Treatment Uptake, Barriers, and Facilitators in Midwifery Care: Treatment Uptake, Barriers, and Facilitators in Midwifery Care

Pamela D. Browne, Rineke Bossenbroek, Arne Kluft, Emilie M. A. van Tetering, Carolina de Weerth

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Background: While many women experience prenatal symptoms of anxiety and/or depression (PSAD), treatment uptake rates are relatively low. Left untreated, symptoms can unfavorably affect maternal and infant health. The first aim of this study was to identify the treatment uptake rate and modalities of treatment received in a community sample of Dutch pregnant women. The second aim was to investigate reasons for not engaging in treatment and to describe facilitators for treatment uptake. The third aim was to determine facilitators and barriers for self-disclosure of feelings to midwives. Materials and Methods: Data were collected from a convenience sample of 1439 Dutch women with low-risk mid-term pregnancies in midwifery care. PSAD was assessed with online questionnaires on symptoms. Reasons, facilitators, and barriers were determined with checklists and open questions. Data were analyzed using conventional content analysis and open code quantification. Results: Only 15% of women with PSAD (scoring above cutoffs; 22% of the full sample) received treatment. Psychotherapy was the most commonly received treatment. The main reason for not engaging in treatment was regarding PSAD as a natural part of pregnancy (71%). The main facilitator to engage in treatment was referral by midwives (16%), and for self-disclosure was the midwife asking about PSAD (59%), whereas not asking formed the main barrier for self-disclosure (23%). Conclusions: Relatively few pregnant women received treatment for PSAD. Midwives play an essential role in identifying and referring women for treatment. Routine screening may be a starting point to offer support and, if needed, referral.
Original languageEnglish
Pages (from-to)1116-1126
Number of pages11
JournalJournal of women s health (2002)
Issue number8
Early online date23 Dec 2020
Publication statusPublished - 1 Aug 2021


  • maternal prenatal depression and anxiety
  • midwifery
  • treatment

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