Pregnancy And Mental Health

Pregnancy brings about a multitude of symptoms from morning sickness to fatigue, each and every mother is different with what they experience while expecting. Pregnancy websites and blogs will discuss every symptom under the sun at great length, but there is one medical condition that doesn’t seem to be covered as much, that being a mother facing pregnancy with a chronic mental illness diagnosis. This post will address the topic of mental health in pregnancy.

Women today have immediate information at their fingertips for any question they have regarding pregnancy; this information is found in the form of the above mentioned websites, phone applications, and even social media. A great deal of expectant mothers take to the internet to find information surrounding their pregnancy, and due to this immediate access, another feature that has become popular is the online mommy forum, these can be found on Facebook and pregnancy websites, were women can openly discuss their pregnancy and issues that arise. It is interesting to note that while information regarding mental health is limited on pregnancy websites, a quick search of public threads, comment sections, and groups you can find numerous posts asking questions regarding mental health. The questions run the gamut of emotional fluctuations, post-partum depression, and asking about medication. Reflecting on this resulted in having my own questions and observations. First clearly these are issues that pregnant women are dealing with, why is their limited information even at the most basic level? If even the basic information is obscure, does this mean at a professional level there is also a lack of information or psychoeducation regarding mental health in pregnant women? Second if women are taking to the internet to ask total strangers about their own condition, does this mean a dialogue is not occurring between doctor and patient?

In research conducted by Weinreb et al. (2014), pregnant women who were originally seen by their primary care providers (PCP) hit a snag once they became pregnant. The women were receiving medication for a mental diagnosis, these prescriptions were written by the PCP, but once they informed the PCP of the pregnancy the PCP was no longer comfortable writing prescriptions for them and referred them to their obstetrician for further care. The problem being the obstetrician did not want to write the prescription either, leaving the patients in a limbo of trying to figure out what was their best course of action. The issue at hand in this situation is twofold, medical providers are at times unaware of how different medications will affect an unborn baby, but also do not want the liability should something go wrong. Thus putting the patient in a back and forth situation where they as a patient cannot get a straight answer or the help they may need.

In M.V. Seeman’s article that focused on schizophrenia and pregnancy, a previous study is cited stating “In their 2004 review of sexuality and schizophrenia, Kelly and Conley noted that sexual functioning in individuals with severe mental disorders was receiving relatively little clinical attention. They noted that care team members were reluctant to discuss sexual concerns with patients for fear of triggering psychotic behavior (Seeman, 2013). I was surprised to read that care team members felt this way, it almost seemed like the myth of asking someone if they are contemplating suicide would then lead them taking their own life. This article makes the point that the notion that people with mental disorders are not sexually active is in fact false, and furthermore they’re at a greater risk for sexual assault. This emphasized the importance of having a dialogue with female patients on sexual relationships and ways to protect oneself from diseases and pregnancy. But when it comes to providers having an open dialogue with their patients they face obstacles “These barriers include a relative lack of knowledge about contraception, insufficient training in this area, personal discomfort with the topic of sex” (Seeman, 2013).

During Weinreb et al. (2014) study it was concluded that “94% told their provider of their pregnancy, 36% had no opportunity to discuss the risks and benefits of continued pharmacotherapy” (Weinreb et al. 2014). The article did not provide the reason that 6% did not inform their provider about the pregnancy. The women in the study also cited that some of their doctors did not seem very knowledgeable about the medication they were using and its effects on their unborn baby. This study had some interesting conclusions that “both mental health and primary care providers lack knowledge about depression medication” and “improved communication between OB providers and mental health clinicians, and proactive efforts to reach out and re-engage pregnant women in mental health treatment, could mitigate precipitous medication discontinuation prior to risk/benefit discussions” (Weinreb et al. 2014).

Where do we go from here? It could be easy to say that both medical and mental health providers need to do better, or become more knowledgeable on this subject, but that puts their actions into question. In the medical field where information is constantly changing it must be incredibly hard to keep up. New medications come out on the market frequently only later to discover that they have undesired side effects. I believe it would be beneficial if providers working in this area strive to know more, but I also think we as future mental health professionals need to be aware of the situation that some women may find themselves in while expecting. Perhaps even this small post will even make a mark in someone’s memory, that as a future clinician if they encounter an expectant mother, it will jog their memory, which may lead to a discussion with their client. When we know better, we can do better, and that’s applicable to both clinicians and clients. 

For a glimpse what women who are pregnant face watch this video, if you are further interested I recommend checking out the documentary.

 

Reference List

Seeman, M.V. (2013). Clinical Interventions For Women With Schizophrenia: Pregnancy. Acta Psychiatrica Scandinavica, 127(1), 12-22. Doi:10.1111/j.600-0447.2012.01897.x

Weinreb, L., Byatt, N.m Simas, T.M., Tenner, K., & Savageau, J. A. (2014). What Happens To Mental Health Treatment During Pregnancy? Women’s Experience With Prescribing Providers. Psychiatric Quarterly, 85(3), 349-355. doi: 10.1007/s11126-014-9293-7.

Fighters Of The NICU: Babies And Mothers

           Babies are born every single day, when all goes as planned they come into this world happy, healthy, and screaming. But the March of Dimes estimates that for 380,000 births in the United States per year, things don’t necessarily go as planned. As young adults we are taught in our health and biology classes that the human gestational period lasts approximately nine months, or 40 weeks to be more precise. According to the American College of Obstetricians and Gynecologist (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) “Babies born full term have the best chance of being healthy” (March of Dimes, 2016). Full term is now considered to be between 39 weeks, and one day shy of 41 weeks.

            In general having a baby when everything goes according to plan can be hectic and stressful, but what happens when that plan deviates to something that a mother may have never considered? Babies born premature are at risk for multiple complications, there little bodies have not developed to the level of a full term baby, and the basic needs for survival can prove difficult. The medical community does not always have a clear cut answer for why babies are born prematurely, but sometimes aside from the simple fact of being born early, the baby may have other health complications, adding on even more medical factors that come into play, and can greatly alter an infant’s Neonatal Intensive Care Unit (NICU) stay.
            No doubt these babies are fighters, but how do these scenarios affect mothers? According Friedman et al. (2013) in their article appearing in Acta Paediatrica in a NICU setting “150 mothers were referred for psychiatric evaluations and psychotherapeutic interventions” of those they were “referred because of depression (43%), anxiety (44%), and/or difficulty coping with their infant’s medical problems (60%)”. It is not uncommon in a NICU setting to not be able to hold your baby, and a post-partum time that is typically filled with caring for your newborn, family and friends visiting, and perhaps even becoming accustomed to breastfeeding; is instead spent attending care times, meeting with medical specialists, and trying to grasp all the information being thrown at parents. Mother’s to preterm babies are faced with the reality that they must return home, while their little one stays at the hospital. Additional stressors can be if the mother has additional children in the home, according to Friedman et al. (2013) “mothers who saw the psychiatrist had few living children”. This shows that family size alone can determine a woman’s ability to seek post-partum psychological care. That’s just one factor, some women have limited resources to address their own psychological needs, these barriers to treatment can come in the form of limited insurance, low income, and sometimes even just not enough hours in the day.

In Friedman et al. (2013) study the most common diagnoses amongst the mothers in their group were “depression (40%), anxiety disorders (31%), and post-traumatic stress disorder (5%)”. Women in this type of situation can only benefit from having access to post-partum mental health care. Our authors further explain “The rate of Post-Partum Depression in the NICU has an elevated range from 28 to 70%” (Friedman et al., 2013). This information further indicates the need for counseling services to be made available to NICU families.

            In conclusion one can clearly see the need for mental health services to be made available to NICU families. For future research I would like to spend time finding what sources are made available to NICU families and how easily they can be accessed by families who have a little one in the NICU here in Milwaukee and Waukesha County. According to the March of Dimes in 2013 in Milwaukee County 1,786 babies were born preterm that accounts for 12% of live births in the county. That is 1,786 families who were affect by a little one coming earlier than planned. Once again in my research many of the articles and studies I came across concerning this topic were conducted in other countries. The study referenced in this post was conducted in New Zealand. This further emphasizing that in the United States we need to have a more of a focus on post-partum mental health and the issues facing women and families during this very critical time in their life.
If you would like to learn more the purpose that March of Dimes serves, I would encourage you to watch the following video. 

Reference List

Friedman S, Kessler A, Yang S, Parsons S, Friedman H, Martin R. Delivering perinatal psychiatric services in the neonatal intensive care unit. Acta Paediatrica [serial online]. September 2013;102(9):e392-e397. Available from: PsycINFO, Ipswich, MA. Accessed March 16, 2016.

March of Dimes. (2016). March of Dimes PeriStats. Retrived from March of Dimes website http://www.marchofdimes.org/peristats/Peristats.aspx.