Co-design and feasibility testing of a midwife-led birth debrief: an implementation science project

BACKGROUND: The period spanning pregnancy, birth and postpartum is characterised by psychosocial as well as physiological changes: many women experience new or worsening mental ill-health during the perinatal period. Midwives play a critical role in supporting and promoting psychosocial health by providing mental health education, counselling and screening. Often this includes a post-birth conversation, guided reflection, or debrief. Information about the effectiveness and experiences of specific and structured midwife-led birth debrief is scant. AIM: Our study aimed to assess the perceived effectiveness, experiences and implementability of a midwife-led birth debriefing intervention in one Australian maternity unit. METHODS: A Type II hybrid effectiveness – implementation design, specifically convergent mixed methods combining quantitative statistical methods with qualitative thematic analysis, was employed to simultaneously evaluate the clinical impact of a birth debriefing guide and its implementation within one Australian tertiary maternity service. ‘Effectiveness’ participants included women who had given birth in the nine months prior to study commencement, and ‘implementation’ participants included midwives and managers. Data were collected between January 2025 and September 2025. Ethical considerations approval to conduct the study was obtained from two Human Research Ethics Committees. RESULTS: The ‘effectiveness’ sample comprised 105 postnatal women. Satisfaction with the midwife-led post birth debrief intervention was consistently high across all measured domains and across models of care. Of eleven Likert-scale questions, eight achieved median scores of 5.0 (strongly agree), with the remaining three achieving median scores of 4.0 (agree). Near-unanimous agreement was found for universal service availability, with 87% of responses at the maximum score. Three themes were derived from qualitative data to describe the positive and powerful impact of midwife-led birth debrief on women. In terms of implementability, midwives unanimously endorsed the standardised birth debrief as a valuable tool and emphasised the need for trauma-informed care as its foundation, and sustainability assessments by managers scored highly, confirming the feasibility of translating midwife-led birth debriefing into routine practice. CONCLUSIONS: This study highlights the significance of midwife-led birth debriefing in supporting women’s perinatal mental health during the liminal perinatal period and underscores its potential to inform maternity care practice, policy and impact.