'We just ask some questions...' : the process of antenatal psychosocial assessment by midwives

Objective: this qualitative ethnographic study describes the content and process of psychosocial assessment and depression screening undertaken by midwives in the antenatal booking visit in two maternity units in New South Wales (NSW), Australia. Study design: participants included 34 pregnant women and 18 midwives who agreed to be observed during the antenatal booking visit. A structured observation tool and field notes were used to record observations of the assessment and screening process including the midwives' approaches (actions and interactions) communication styles, and the interactive dynamics between the midwives and the women. Midwives also participated in a brief interview after the observation. Findings: midwives varied in their approach to psychosocial assessment. Some followed the structured format tending to deliver the questions in a directive manner, whereas others appeared more flexible in their approach and delivery of sensitive questions. In some instances midwives modified the questions. Modification appeared to occur to assist in the interpretation and comprehension of the questions. Conclusion: midwives were observed using a range of skills when undertaking psychosocial assessment including empathetic responding, however, modification of questions may reflect a level of discomfort on the part of the midwife in asking sensitive questions and may impact on the integrity of the assessment. Further training and support is required to 'fine tune' the process of assessment and better respond to disclosure of sensitive information. Implications for practice: midwives require organisational support for ongoing training and clinical supervision to effectively undertake routine psychosocial assessment.