Motherhood for women with serious mental illness: Pregnancy, childbirth, and the postpartum period.

Abstract

Although women with serious mental illness have normal fertility rates, the literature points to multiple risk factors and a paucity of emotional and economic support during the initial phases of parenthood. Since most research has focused on child outcomes, the extent and nature of parenting problems experienced by these mothers are not adequately understood. An emphasis on the context of parenting and the meaning of pregnancy and childbearing to these mothers is called for and implications for research and clinical practice are discussed.

Critical Issues for Parents with Mental Illness and their Families

“…The literature suggests parents with mental illness are quite vulnerable to losing custody of their children, with custody loss rates in some studies as high as 70% to 80% (Joseph et al, 1999;Mowbray et al, 1995b). Rates of custody loss may vary by diagnosis; women with affective disorder diagnoses are more likely to be primary caregivers than women with psychotic disorder diagnoses (White et al, 1995).…”

“…As noted above, however, parents with a mental illness identify parenting as an important and valued role in their lives, and reflect the same desire as non-ill adults, to be the best parents possible (Mallen, 1999;Mowbray et al, 1995b;Nicholson et al, 1998a).…”

“…Mothers with mental illness, more frequently studied than fathers, have numbers of children consistent with the general population (Caton, Cournos & Dominguez, 1999;Mowbray et al, 1995b;White, Nicholson, Fisher & Geller, 1995). Therefore, extrapolating from the NIDRR/RTC data convenience sample estimate of about one million parents with psychiatric disabilities whose children are under the age of 18, at least two to three million children in American have parents with self-reported psychiatric disabilities.…”

“…However, findings are limited in generalizability, given the characteristics of studies and study participants. Studies in the U.S. over the past 10 years have, for the most part, involved small samples of women recruited in hospital, clinic, or other treatment settings (Joseph, Joshi, Lewin & Abrams, 1999;Miller, 1990;Miller & Finnerty, 1996;Mowbray et al, 1995b;Nicholson, Sweeney & Geller, 1998a, 1998bRogosch, Mowbray & Bogat, 1992;Rudolph et al, 1990;Sands, 1995;Zemencuk, Rogosch & Mowbray, 1995). A smaller number of studies have drawn larger samples from pools of existing data (Gamache, Tessler & Nicholson, 1995;Kelly et al, 1999;White et al, 1995), or clinic or rehabilitation center populations (Ritsher, Coursey & Farrell, 1997).…”

“…Because of the reportedly high incidence of custody loss among these parents, particularly in the public sector, many may be parents in name only (Mowbray, Oyserman, Zemencuk & Ross, 1995b); their children are raised by others-foster or adoptive parents, relatives or strangers. Parents may be in contact with their young children, be reunited with older children when they become adults, or be totally estranged from family members over a lifetime.…”