- December 29, 2015
- Posted by: emobile
- Category: Uncategorized
Childbirth contributes a substantial risk to the mental health of women. Although the period of pregnancy is not generally considered a high risk time from the onset of new severe psychiatric disease, milder disorders do affect a significant minority of pregnant women and about a third of women presenting with severe depression during pregnancy have no previous psychiatric history. However, in the year following childbirth, women who were previously well have a greatly increased risk of being admitted to a psychiatric hospital,
being referred to a psychiatrist/behavioral scientist, suffering from psychotic illness or developing severe depression. This risk is higher than their lifetime risk and is much greater for other women and men. More than 80% of women with postpartum psychiatric disease will be suffering from their first ever psychiatric illness.
Pregnant women with pre-existing mental illness or those who book with previous history, are at significant risk of antenatal or post-natal recurrence or exacerbation. Pregnancy, childbirth and the stresses of life as a new parent may destabilize conditions that have previously being under control. Certain pharmacological treatments may be contraindicated in pregnancy and suitable alternatives have to be found. Optimizing the new relationship between mother and baby may require help from specialist services.
The impact of psychiatric disease in pregnancy has been emphasized repeatedly by the Confidential Enquiries into Maternal and Child Health (CEMACH). One of the reports, ‘Saving mothers’ lives’ covered the triennium 2003-5. It reported on 37 suicides occurring during pregnancy, or within one year of delivery. Most suicides occurred in association with post-natal mental illness. A further 22 women died from overdose of drugs of abuse, of which at least 6 may have been intentional, rather than accidental. Of special note, suicide during pregnancy is unusually violent (shootings, hangings), in contrast with suicide attempts in younger women, which commonly take the form of overdose and are less frequently successful. This emphasizes the severity of mental health problems occurring after delivery, when most maternal suicides take place.
Psychiatric disease is also commonly found in cases of violent maternal death. Life-threatening medical disorders may arise as a direct result of substance misuse, or may be misdiagnosed as perinatal mental health problems leading to delay in appropriate treatment, and, in some cases, death. Pregnancy therefore impacts significantly on the incidence and presentation of psychiatric disorders, but it also poses unique treatment challenges. The safety of the fetus must also be considered, and the focus of therapy may ideally be away from drug treatments and toward psychological alternatives. However, failure to treat mental health issues rapidly may put both mother and baby at greater risk and drug treatment is often required. Strategies which are safe for the fetus are best recommended by specialist perinatal psychiatrists with particular skills in the field.