One of the chronically mentally ill young women in our outpatient program is pregnant and due to deliver at any moment. Hers is considered a high-risk pregnancy because of her medical conditions and a history of substance abuse.
The obstetricians wanted to induce her delivery a few days ago, but she wouldn't cooperate. Fortunately, as the mother of several children, she is familiar with labor and knows what to expect when delivering a baby. We're certain that she'll be willing to go to the hospital when the time inevitably arrives.
We're delighted when some of our patients have desired pregnancies. But for others it can be challenging and frustrating — sometimes because of medication issues and sometimes because they don't care for themselves so well.
Naturally we are concerned that they get good obstetrical care. We also work with them to stabilize their mental health while minimizing the potential harmful effects that any of her medications might have on the growing fetus.
Juggling these two goals can sometimes be a delicate balance. Some medications are known to be safe during pregnancy and a few have significant risks.
Most are in between. I've previously written about the Food and Drug Administration's A, B, C, D, and X pregnancy categorization for medications. It is a useful guide but it is based on limited information.
We always have special concern for the unborn children. We know that sometimes these patients make bad decisions that have bad consequences for them. My patient's relapsing cocaine use is a good example. So is her inconsistency in taking medications and her poor dietary habits. Her health has suffered as a result.
While patients can make choices, obviously the newborns cannot. The best we can do is help the mothers live as stably and as healthily as possible. If some medications are necessary, we'll aim for the safest selections and doses.
We'll transport the patients to the outpatient program for regular prenatal visits and make sure their refrigerators at home are stocked with appropriate foods. We'll coordinate with the hospital's labor and delivery services and, after the baby is born, arrange for extra care at home.
We also recognize that the postpartum period — the first few weeks to months after delivery — is a time of greater risk for depression and mania in women with mood disorders. In fact, such women often have their first episode of a mood disorder during the postpartum period.
The relationship between pregnancy and mental health is complex. My friend, Stephanie Durruthy, M.D., has written a book for the public, titled, "The Pregnancy Decision Handbook for Women with Depression: 70 Important Questions to Consider". Among the topics she discusses are expectations about pregnancy, depression symptoms and diagnoses, risk factors for women developing depression, financial considerations, treatment options, medication concerns, and planning for life with the new baby.
We're hopeful about the future of our patient's new baby. We've helped her make plans for the baby's care, and we'll make sure that our patient has the resources she will surely need. The biggest problem may be her choice not to take advantage of them.
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