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.
Back to
top
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
Back to top
List of specialties
Back to student area home page
Page updated on 8
December 2010