Perinatal psychosocial screening is well established as best practice to enable service providers to identify risk factors and current mental health issues and offer support and referral in a timely manner [10, 2, 1] Never the less, implementation of perinatal psychosocial screening and assessment across service providers remains uneven .
Aims of the Study
In this study the researcher sought opinions regarding their personal psychosocial screening experience from women in one small regional private hospital in NSW.
This aspect was part of a wider study: "Psychosocial assessment and depression screening in private obstetric care". The women (n=215) were followed up by telephone postpartum. Discussion included using the EPDS  and they were invited to comment on their experience and opinions regarding their antenatal session. A total of four groups of participants were recruited during the implementation phase of the wider study. Apart from the 255 women participants (Group 1) described here, booking-in midwives (Group 2) and obstetricians, midwives and other health professionals employed by the regional private hospital study site (Group 3) were recruited to semi-structured qualitative interviews to explore barriers to Guideline implementation during the Phase 3 implementation study.
Two hundred and fifty-five women were contacted and 209 were followed up postpartum. Forty women were lost to follow up for various reasons (uncontactable, did not have time, not interested). During the follow-up telephone interview, the 209 women agreeing to continue with the study had the opportunity to expand upon their EPDS responses. Specifically, they were asked about their experience of booking-in to the private hospital study site, about their experiences at the hospital and of motherhood more generally. The women were also asked about their experience of the psychosocial risk questionnaire conducted during the booking-in visit and were offered as much time as they needed to comment. Women were also recommended additional supports if a psychosocial need or risk was identified during this conversation. Nine women offered the following comments (Table 6.8) during the telephone conversation and of these, seven had total EPDS scores greater than 10 (3.3%). Their postnatal EPDS profile is also given, as is the researcher's response to their comment. The remaining participants had no further comment. As above, Question 10 of the EPDS (The thought of harming myself has occurred to me)  can be answered 'yes quite often' (score of 3); 'sometimes' (2); 'hardly ever' (1); or 'never' (0) .
Various Negative Themes Emerged in the Follow-Up, Namely
• Disappointment with the booking-in screening process
• Feeling let down by obstetricians
• The personal nature of the psychosocial questions
Of all the participants in the study 15 women (7.2%) had either a total postnatal EPDS score above nine (indicating some level of risk for perinatal depression) or had expressed concerns during the follow-up phone call. Many women were grateful for the psychosocial screening process, but some women expressed concern. This study sought to represent the concerns of women about the screening process. The three emerging themes need to be considered when screening women for psychosocial risk factors and current possible illness.
Disappointment with The Booking-In Screening Process
Some women felt disappointment with the booking-in screening process, and the failure to identify obvious issues and ensure referral." Why didn't someone talk to me antenatally. I am a nurse, my husband is a DR. I knew that I was depressed during the pregnancy and no one did anything or told me anything. I went and saw my GP myself".
Feeling Let Down by Obstetricians
Some women indicated that they were disappointed with obstetric care from private obstetricians and a lack of recognition of issues. "I was completely let down by the hospital and my OB". This is echoed in literature in the public sector .
The Personal Nature of the Psychosocial Screening Questions
Some women were concerned about the personal nature of the psychosocial screening questions: "I found the questions extremely personal and unexpected and they were not asked sensitively".
Relevance of Findings/Contribution to the Literature
This study supports that wider literature in that the majority of women reported that the screening experience was acceptable and not upsetting . However, preparing women for screening is also important. Women indicate that they would like a 'pre-warning' of the sensitive nature of the booking-in questions so that they know what to expect (Table.1) . Strategies for ongoing care must emphasise that utilising support and accessing services is inherent in perinatal care.
The postnatal EPDS was conducted by asking the mother to respond to the questions over the telephone with 209 of the 255 (82%) participants completing follow-up. Forty-six women were lost to follow-up for various reasons. Six of the original 255 women (2.3%) reached by telephone refused to continue in the study and the remaining 40 (15.6%) were uncontactable. Women were contacted up to five times by phone and messages were left with return telephone details before participants were categorised as 'lost to follow-up'. Difficulty contacting women during the postnatal period is clearly an important factor and acts a barrier to completion of perinatal screening. The six participants refusing any further follow-up responded by text message or in person over the telephone. Their comments are included below in (Table 6.7). For at least one woman who chose not to continue with the study, the screening process had failed to identify her mental health needs or trigger an appropriate referral. The Table also outlines the researcher's response to their comments. During the follow-up telephone interview, the 209 women agreeing to continue with the study had the opportunity to expand upon their EPDS responses. Specifically, they were asked about their experience of booking-in to the private hospital study site, about their experiences at the hospital and of motherhood more generally. The women were also asked about their experience of the psychosocial risk questionnaire conducted during the booking-in visit and were offered as much time as they needed to comment. Women were also recommended additionalsupports if a psychosocial need or risk was identified during this conversation. Nine women offered the following comments (Table 6.8) during the telephone conversation and of these, seven had total EPDS scores greater than 10 (3.3%). Their postnatal EPDS profile is also given, as is the researcher's response to their comment. The remaining participants had no further comment. As above, Question 10 of the EPDS (The thought of harming myself has occurred to me)  can be answered 'yes quite often' (score of 3); 'sometimes' (2); 'hardly ever' (1); or 'never' (0) .
Strengths of the study
A large number of women (255) participated in the study and were followed up (215 women).
Limitations of the study
Views were gathered from one cohort of women only, therefore may not be generalisable to the whole population. Patients were recruited as part of the wider study antenatally and followed up post-partum. They were therefore not randomly selected. Nevertheless, the feedback from the women must be taken into account when implementing such programs. Further training of all relevant staff and monitoring of the process are essential.
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