Psychiatric Consultation to the Postpartum Mother

Abstract

The immediate postpartum period is a time of acute vulnerability to mental illness, which presents unique challenges for the psychiatric consultant. Because the postpartum hospital stay is typically brief, the consultant must have a working knowledge of postpartum physiology and the myriad forms of mental illness that may emerge in this vulnerable time, in order to quickly make a diagnosis and formulate a treatment plan. This review aims to characterize the most common reasons for postpartum consultation, review postpartum physiology and psychiatric conditions, and propose an evidence-based, practical approach to treatment. A literature search using the terms "postpartum," "obstetric," "consultation," and "psychiatry" yielded six studies that identified reasons for psychiatric consultation to the obstetrics and gynecology services. These studies informed the structure of the article such that we review the most common reasons for consultation and how to approach each issue. The most common reason for consultation is past psychiatric history, often in the absence of current symptoms. For each clinical situation, including depression, adverse birth events, and psychosis, we present a differential diagnosis, as well as risk factors, clinical signs, and recommended treatment.

The correlation between postpartum stress disorder and maternal anxiety in different types of delivery (vaginal and cesarean section)

“…However, it is not clear whether the potential course and treatment of PTSD after delivery are similar to those of PTSD caused by other events (Gamble et al, 2002). Hence, more comparative studies are needed in this area (Anderson & Kim, 2015). Overall, the period of hospitalization after delivery is usually short due to psychiatric issues.…”

“…Overall, the period of hospitalization after delivery is usually short due to psychiatric issues. However, medical consultants must have the necessary knowledge about postpartum physiology and the myriad forms of mental illnesses that may occur during this period in order to be able to quickly develop a treatment approach (Anderson & Kim, 2015). Since motherhood is a period with pervasive emotions and feelings that affect mothers' mental health in the postpartum period and their relationships with the child and those around them, addressing the issue of maternal mental health by practitioners, midwives, and medical doctors is of particular importance (Logsdon & Koniak-Griffin, 2005).…”

Perinatal Psychopharmacology: Innovative Approaches to Care Delivery

“…Diagnostic clarification is one of the most common uses of a one-time psychiatric consultation. 20 Common diagnostic dilemmas that require perinatal psychiatric expertise include: Differentiating a presentation of perinatal depression from other PMH conditions. For example, the postpartum period is a time of increased vulnerability for the onset or exacerbation of OCD.…”

“…If the underlying diagnosis is BD, antidepressants can exacerbate or even switch depressive symptoms into mixed or manic ones. A psychiatric consultation can help determine the diagnosis, identify appropriate medications, and avoid potential harm. A general review of current treatment 20 . For instance, the Ob clinician may want to know if psychotropic medications are indicated.…”

Postpartum Psychosis: Risk factors and Management

“…Family support for the patient, baby and spouse are crucial to ensure adequate and timely recovery of the patient and good health of the baby. Postpartum consultation, postpartum physiology and psychiatric conditions are evidence-based practical approach to treatment [54]. The clinical situations including depression, adverse birth events, and psychosis as well as risk factors need to be accurately followed.…”