Cases

Chapter 13 Perinatal mental health

Case 1: Perinatal mental health

A woman has had her first baby 2 days ago; her partner is very concerned because she will not allow anyone to wash her baby because she believes the water is 'dirty'.

Questions

• a) What would be the concerns about this behaviour?

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  Correct answer:
  Possible mental health concerns include obsessive compulsive disorder, anxiety or early onset of puerperal psychosis.

• b) What would the midwives immediate actions be?

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  Correct answer:
  The woman would need close observation and referral to perinatal mental health services.

Case 2: Misuse of substances

A primigravida in her early twenties attends the antenatal clinical at 28 weeks gestation. The midwife notices that there is a strong smell of alcohol, and the woman appears distracted. The midwife enquires about alcohol intake to which the woman admits to having a drink to 'calm her nerves' as she finds it difficult to travel on the bus.

Questions

• a) What would be the concerns about this behaviour?

  Show Answer

  Correct answer:
  Possible mental health concerns include substance misuse, severe anxiety and antenatal depression.

• b) What would be the midwives actions be?

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  Correct answer:

  • Close observation and involvement of other healthcare practitioners; consultant obstetrician, specialist drug misuse midwife, health visitor, social service support, General Practitioner, drug and alcohol services and/or perinatal mental health services.
  • Ensure the woman is aware of the risks to her own health and the impact on the fetus.
  • Assess fetal wellbeing e.g. growth scan, liquor volume assessment and Doppler.
  • Offer non-routine investigations to be undertaken to include liver function tests, blood alcohol levels.

Case 3: Edinburgh Postnatal Depression Score

A postnatal woman attends the clinical for her 6-week postnatal examination and as per routine the EPDS is undertaken. The woman is herself a doctor, and therefore knows what the questions are and also why they are asked. Despite feeling a little 'low', the woman gives the 'correct' answers and leaves the clinic.

Questions

• a) What are the possible mental health concerns in this case?

  Show Answer

  Correct answer:
  Possible mental health concerns include anxiety, postnatal depression, other long standing mental health problems not previously disclosed.

• b) What would be the health professional's actions?

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  Correct answer:
  If the health professional suspected the woman was low in mood she could arrange to visit the woman at home, disclose her concerns, offer information about local support services, referral to the perinatal health services and communicate concerns to the General Practitioner.