Detection and management of perinatal depression by midwives.

The recent study by Jones et al. published in Woman and Birth concluded that, ‘‘Further training to ensure their competency in psychosocial assessment and management of women experiencing antenatal and postpartum depression.’’ However, the conclusion is not supported by their study because many of the findings in the study actually contradict the conclusion. In particular, it appears that this claim is primarily based on the 17.6% of midwives that did not obtain mental health treatment for a fictitious test case. The study states that Australian midwives need further education and training in order to effectively identify and manage women with antenatal and postpartum depression; however the findings of the study suggest the contrary. Approximately twothirds of the midwives who responded to the survey correctly identified antenatal depression or postpartum depression, and another 82.4% reported that the fictitious case needed assistance for this depression. In addition, the results demonstrate that the 70% were not only familiar with, but also actually used depression screening instruments in their practice, with 76.6% having previously identified women with postpartum depression or antenatal depression. These results are indicative that midwives are knowledgeable in their ability to detect women with antenatal or postpartum depression, rather than professionals who lack competency. On one hand, one cannot really disagree that further education by midwives in the area of postpartum depression and antenatal depression would be beneficial because everyone in any profession can generally benefit from further training. However, this general and obvious notion would only be supported by evidence if the study had included an education session, and that education session was found to be effective. There was no educational intervention with observed outcomes in the study, so the conclusion that further education would be beneficial is unsupported. To clarify our point, the conclusion section was constructed around the 17.6% of midwives that did not refer the fictitious case for assistance to treat depression. The Clinical Practice Guidelines for Depression and Related Disorders was cited, which states that, ‘‘routine psychosocial assessment of childbearing women is to be integrated into the midwifery practice.’’ First, this is only one guideline for perinatal depression among many. Second, clinical practice guidelines in general are sometimes wrong, as evidence by how they change through the years. Third, we would argue that