Hands Off! Care of the Woman and Her Baby in the Acute Inpatient Unit
Purpose: To identify the management issues for women who have psychosis and are pregnant or post partum in the acute inpatient setting and to explore the optimism of clinicians with regard to positive outcomes for mother and baby.
Method: A mixed methodology using a descriptive exploratory approach 46 interviews of mental health nurses, midwives and doctors were conducted and the Elsom Therapeutic Optimism (ETOS) questionnaire was also completed by clinicians in three health services in Victoria.
Results: The findings highlighted difficulties with use of medications; fear of harm by the woman to the baby; fear of harm to the staff; to the woman and baby by other inpatients; as well as fear of harm to mother and/or baby by staff in situations requiring chemical and/or physical restraint or seclusion. Difficulties in providing a safe environment for women who are psychotic and pregnant were identified, staff often in a dilemma as to the best management in an acute situation.
The optimism of staff was shown to vary with significant differences being identified between the professions and sites. While the ETOS shows a general agreement that mental health clinicians have the capacity to positively influence outcomes for women who have a history of psychosis and are pregnant, there are however many challenges for those providing care for this vulnerable population of women, requiring a ‘hands off’ approach.
Conclusion:
1. Collaboration required between mental health and maternity services is important to ensure holistic approach to care
2. There is a clear need to identify the safety of medication use in women who are psychotic and pregnant. The National Register of Antipsychotic Medication in Pregnancy (N-RAMP) based at the Alfred Psychiatry Research Centre will monitor this vulnerable group of women.