Abstract

Background: Pregnancy, birth and adjusting to a new baby is a potentially stressful time that can negatively affect
women’s mental and physical health. Expressive writing, where people write about a stressful event for at least
15 min on three consecutive days, has been associated with improved health in some groups but it is not clear
whether it is feasible and acceptable for use with postpartum women. This study therefore examined the feasibility and acceptability of expressive writing for postpartum women as part of a randomised controlled trial (RCT).
Methods: The Health After Birth Trial (HABiT) was an RCT evaluating expressive writing for postpartum women
which included measures of feasibility and acceptability. At 6 to 12 weeks after birth 854 women were randomised
to expressive writing, a control writing task or normal care, and outcome measures of health were measured at
baseline, one month later and six months later. Feasibility was measured by recruitment, attrition, and adherence to
the intervention. Quantitative and qualitative measures of acceptability of the materials and the task were
completed six months after the intervention.
Results: Recruitment was low (10.7% of those invited to participate) and the recruited sample was from a restricted
sociodemographic range. Attrition was high, increased as the study progressed (35.8% at baseline, 57.5% at one
month, and 68.1% at six months) and was higher in the writing groups than in the normal care group. Women
complied with instructions to write expressively or not, but adherence to the instruction to write for 15 min per
day for three days was low (Expressive writing: 29.3%; Control writing: 23.5%). Acceptability measures showed that
women who wrote expressively rated the materials/task both more positively and more negatively than those in
the control writing group, and qualitative comments revealed that women enjoyed the writing and/or found it
helpful even when it was upsetting.
Conclusions: The feasibility of offering expressive writing as a universal self-help intervention to all postpartum
women 6 to 12 weeks after birth in the HABiT trial was low, but the expressive writing intervention was acceptable
to the majority of women who completed it.
Trial registration: ISRCTN58399513, 10/09/2013.
Keywords: Feasibility, Acceptability, Expressive writing, Postpartum, Postnatal, Maternal