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.
