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The Royal College of Psychiatrists Improving the lives of people with mental illness

Perinatal psychiatry

Background to perinatal psychiatry

Specialist perinatal services have been established to serve the needs of women who are or requiring management during pregnancy or in the postpartum period (usually up to one year post delivery). Perinatal teams may also offer advice on management of mental illness prior to conception. They tend to constitute both Mother and Baby Units and specialist community mental health team although there is great variation in service provision across the country.

Before the development of mother and baby units, when a mother required in-patient treatment in the postpartum period she would be separated from her child causing distress to both mother and baby (as well as other family members) and potentially causing detrimental effects on the child’s development. Mother and baby units have been established to provide support for both mothers and babies, with highly trained multidisciplinary staff (a nursery is often attached to the unit).

Mental illness following childbirth is relatively common. In the postpartum period, women are at increased risk of suffering from affective disorders, and those with pre-existing psychiatric disorders are at increased risk of relapse. There is an additional group of women who present for the first time in the postpartum period with a ‘puerperal’ psychosis.

One of the major challenges in dealing with this group of service users is management of risk of the illness not only to the mother but also to the baby (neglect, poor mother-baby bonding, reckless behaviour). Great care is required when weighing up the benefits of treating a woman’s illness (or medicating to avoid relapse) with pharmacological agents, and the risk of teratogenicity. Additionally, care must be given when prescribing to breast-feeding mothers. 

For these reasons, psychotherapy is of particular importance in this patient group.

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Personal perspective 

As a medical student I had given the two weeks of attachment in psychiatry a complete miss and my knowledge of psychiatry was limited to some facts about lithium and antidepressants. It was only later after graduating and while I was preparing for the US medical licensing examination (USMLE) that I started reading about psychiatry and I was hooked for life. I then tested this out with an unpaid attachment and haven’t looked back since.

I was initially fascinated by the mechanisms through which drugs could alter mood and later with the overlap of psychiatric and medical illnesses. Still later I developed an interest in psychotherapy, particularly interpersonal psychotherapy.

Not many illnesses have such disastrous consequences for the patient and family as an episode of severe mental illness. In my work as a perinatal psychiatrist, I treat women at the most sensitive period in their lives, either when they are pregnant or after they have had a baby. An episode of illness at this time has a profound effect on the patient, her views of herself as a mother, her relationships, her family and her child. Apart from working with my multidisciplinary team, my work involves close working with health visitors, midwives, general practitioners and obstetricians.

The most rewarding aspect of working within this field is being able to prevent episodes in those at risk by identifying them during pregnancy and closely monitoring them and making comprehensive treatment plans.
I have lost count of the number of occasions when medical colleagues have changed their chosen career path to one in psychiatry after working in the specialty for a brief period. Within psychiatry there are so many subspecialties to choose from to cater to all tastes. If you are caring and empathic and really want to change the lives of your patients, I would suggest you try an attachment in psychiatry. Even if you decide not to take it up as a career you will find it will change the way you look at the psychological well being of your patients for the rest of your life.

Dr Gopinath Narayan,

Consultant perinatal psychiatrist, Leeds

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