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Psychiatric Consultation in Childbirth Settings: Parent- and Child-Oriented Approaches PDF

278 Pages·1988·8.5 MB·English
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Psychiatric Consultation in Childbirth Settings Parent- and Child-Oriented Approaches Psychiatric Consultation in Childbirth Settings Parent- and Child-Oriented Approaches Richard L. Cohen, M.D. Western Psychiatric Institute and Clinic University oj Pittsburgh Pittsburgh, Pennsylvania With Contributions by: Marie D. Bloom, Ph.D. Patricia A. Coble, R.N., B.A. Nancy L. Day, Ph.D. Lorraine R. Herrenkohl, Ph.D. George A. Huber, J.D. Margaret F. Jensvold, M.D. Klaus K.Minde, M.D., FRCP (C) Kathleen R. Negley, M.H.A. James M. Perel, Ph.D. Loren H. Roth, M.D., M.P.H. M. Anne Spence, Ph.D. Donna E. Stewart, M.D., D.P., FRCP (C) Ann P. Walker, M.A. Katherine L. Wisner, M.D., M.S. PLENUM MEDICAL BOOK COMPANY NEW YORK AND LONDON Library of Congress Cataloging in Publication Data Psychiatric consultation in childbirth settings. Includes bibliographies and index. 1. Pregnancy-Psychological aspects. 2. Childbirth-Psychological aspects. 3. Psy chiatric consultation. I. Cohen, Richard L. (Richard Lawrence), 1922- . [DNLM: 1. Mental Disorders-psychology. 2. Pregnancy-psychology. 3. Referral and Consulta tion. 4. Stress, Psychological. WQ 200 P9735] RG560.P76 1988 616.89 88-6005 ISBN-13: 978-1-4684-5441-3 e-ISBN-13: 978-1-4684-5439-0 DOl: 10.1007/978-1-4684-5439-0 © 1988 Plenum Publishing Corporation Softcover reprint of the hardcover 1st edition 1988 233 Spring Street, New York, N.Y. 10013 Plenum Medical Book Company is an imprint of Plenum Publishing Corporation All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher This volume is dedicated to the hundreds of women who gave so freely of their time and energies during the past 25 years in an effort to help the author better understand the experiences of pregnancy, labor, and delivery. Contributors MARIE D. BLOOM, Ph.D., Research Principal, Drug and Alcohol Epidemiology, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania PATRICIA A. COBLE, R.N., B.A., Assistant Professor of Psychiatry, Co-Director, Sleep Center, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pitts burgh, Pennsylvania RICHARD L. COHEN, M.D., Emeritus Professor of Psychiatry and Consultant, Preg nancy and Parent/Infant Program, Director of Education, Western Psychiatric In stitute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania NANCY L. DAY, Ph.D., Associate Professor of Psychiatry, Director, Drug and Alcohol Epidemiology Program, Western Psychiatric Institute and Clinic, University of Pitts burgh, Pittsburgh, Pennsylvania LORRAINE R. HERRENKOHL, Ph.D., Professor of Psychology, Temple University, Philadelphia, Pennsylvania GEORGE A. HUBER, J.D., Vice President and Counsel, Medical and Health Care Division, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pitts burgh, Pennsylvania MARGARET F. JENSVOLD, M.D., Medical Staff Fellow, Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, Maryland KLAUS K. MINDE, M.D., FRCP (C), Professor and Chairman, Department of Psychi atry, Professor, Department of Pediatrics and Psychology, Queen's University, Kingston, Ontario KATHLEEN R. NEGLEY, M.H.A., Staff Associate, Vice President for Health Sci ences, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsy Iv ania vii viii CONTRIBUTORS JAMES M. PEREL, Ph.D., Professor of Psychiatry and Phannacology, Director, Clinical Phannacology Program, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania LOREN H. ROTH, M.D., M.P.H., Professor of Psychiatry, Director of Law and Psychiatry Program, Western Psychiatric Institute and Clinic, University of Pitts burgh, Pittsburgh, Pennsylvania M. ANNE SPENCE, Ph.D., Professor, Departments of Psychiatry and Biomathematics, Division of Medical Genetics, UCLA School of Medicine, Los Angeles, California DONNA E. STEWA RT, M.D., D.P., FRCP (C), Associate Professor of Psychiatry and Obstetrics and Gynecology, Chief of the Psychiatric Consultation/Liaison Service, University of Toronto, St. Michael's Hospital, Toronto, Canada ANN P. WALKER, M.A., Assistant Professor of Pediatrics, Director, Genetic Counsel ing Program, University of California at Irvine, Irvine, California KATHERINE L. WISNER, M.D., M.S., Assistant Professor of Child Psychiatry, Director, Pregnancy and Infant/Parent Program, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania Preface The primary purposes of this volume are: 1. To provide mental health practitioners with a current overview of our knowledge about normal parental development during pregnancy and its relation to fetal development, with particular emphasis on the impact of acute and chronic stress on these developmental processes. 2. To provide an understanding of the general state of the field of pregnancy and childbirth care both in conventional health systems and in alternative options. 3. To provide an understanding of models of consultation and liaison that are adapt ed to the special conditions of pregnancy and childbirth care, as contrasted to the more traditional modes that characterize these activities in medical and surgical hospitals. If there prove to be secondary gains as a result of pursuing these goals, so much the better. The most desirable of these would be a heightening of awareness of the mental health needs of "pregnant families" and of the risks they incur in transition from non parenthood to parenthood, and a more effective level of primary and secondary prevention of childhood mental disorders. These latter goals are more global and perhaps even a bit grandiose. Their attainment could only be documented through a series of carefully designed research projects aimed at measuring long-range developmental outcome in children and families who have experienced appropriate and early intervention during the pregnancy period. This is quite literally a book about obstetrics and childbirth care. Obstetrics is commonly linked with gynecology and the medical and surgical diseases associated with the female pelvic region. These disorders lend themselves more easily to conventional methods of consultation and liaison approaches and are not, therefore, addressed in any special way in this volume. ACKNOWLEDGMENT. The untiring efforts and careful attention to detail of Karen Hickey Rhinaman in the production of this volume are gratefully acknowledged. Richard L. Cohen, M.D. ix Contents PART I: INTRODUCTION AND BACKGROUND 1. Purpose and Rationale 3 Richard L. Cohen Introduction ......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Needs of the Field of Childbirth Care ................................ 5 Conceptual Approach ............................................. 6 Other Sources of Assistance and Information .......................... 7 References ........ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Annotated Bibliography ........................................... 8 Consumer Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2. A Brief History of the Relationship between Obstetrics and the Mental Health Professions ••..........••••...........••............•••... 13 Richard L. Cohen The Historical Background ......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 References ...................................................... 17 Supplementary Reading Lists ....................................... 17 3. The Impact of Prenatal Stress on the Developing Fetus and Child 21 Lorraine R. H errenkohl Introduction .................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 21 Maternal Stress and Pregnancy Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 22 Prenatal Stress and Fetal Outcome ....... . . . . . . . . . . . . . . . . . . . . . . . . . . .. 24 Maternal Stress and Neonatal Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 27 Mechanisms of Prenatal Stress ...................................... 31 Summary and Conclusions ......................................... 33 References ................................ . . . . . . . . . . . . . . . . . . . . .. 33 xi xii CONTENTS 4. The Epidemiology of Mental and Emotional Disorders during Pregnancy and the Postpartum Period . . . . . . . • . • • • . . . . . . . . . • • • • • . . . . . . . . • • . . . . 37 Patricia A. Coble and Nancy L. Day Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 37 Review of Modem Literature ....................................... 39 Theories of Causation ............................................. 39 Normal Psychological Reactions to Pregnancy and Motherhood ........... 41 Subclinical States and Adjustment Disorders .............. , . . . . . . . . . . .. 41 Psychophysiologic Conditions ...................................... 42 Psychiatric Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 43 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 44 References ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 44 Selected Readings on Puerperal Mental Disturbances ............. , . . . . .. 46 PART II: THE BUILDING BLOCKS 5. Developmental Tasks of Pregnancy and Transition to Parenthood: An Approach to Assessment . . . . . . . • • . • • • . • • . • • . . . . . . . . . . . . • • • • . • . . 51 Richard L. Cohen Introduction ..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 51 Developmental Model of Pregnancy ................................. 54 Other Components of the Developmental Interview ..................... 66 Organizing and Formulating Information Gathered . . . . . . . . . . . . . . . . . . . . .. 67 References .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 68 6. Emotional Disorders and Mental Illness Associated with Pregnancy and the Postpartum Period .......••••.........••.........••.......... 71 Richard L. Cohen Introduction .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 71 Major Psychiatric Disorders ........................................ 73 Conditions in Which Stress and/or Emotional Factors May Contribute to the Disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 76 Conditions or States That May Interact Adversely with Pregnancy ..... . . .. 78 An Alternate Conceptualization ..................................... 79 References .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 81 7. (lurrent Childbirth Options and Parental Decision Making 85 Richard L. Cohen Introduction .................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 85 Factors Influencing Maternal Choice of Childbirth Alternatives ........... 86 A Comparative Study of Women Choosing Two Different Childbirth Alternatives ................................................... 95 Conclusions .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 103 References ...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 103 CONTENTS xiii PART III: CONSULTATION PRACTICE 8. Models of Consultation and Liaison: General Principles • • • • • . . • • • • • • •• 107 Richard L. Cohen Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 107 Entree into the System ............................................ 108 Overview of Models .............................................. 111 References ...................................................... 113 9. Direct Case Consultation •••.•••••••.•••••••...••••••.•••••••••••• 115 Richard L. Cohen and Katherine L. Wisner Introduction .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 115 Case Histories ................................................... 117 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 136 10. Staff Education, Liaison, and Program Consultation 137 Richard L. Cohen Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 137 Educational and Liaison Activities ................................... 138 Program Consultation to Conventional or Traditional Childbirth Services ... 139 Program Consultation to Special Projects or Services. . . . . . . . . . . . . . . . . . .. 145 Program Consultation for Extramural Programs and Out-of-Hospital Nontraditional Services ......................................... 145 Summary ....................................................... 146 References ...................................................... 146 Additional Readings of Interest to the Liaison Psychiatrist ............... 147 11. Psychiatric Services in the Neonatal Intensive Care Unit 151 Klaus K. Minde and Donna E. Stewart Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 151 Common Sources of Parental and Staff Stress in an NICU ............... 152 The Role of the Psychiatrist in the NICU ............................. 154 Difficulties and Rewards Encountered by the Psychiatrist Working in the NICU ........................................................ 155 One Model of a Consultation-Liaison Service for an NICU . . . . . . . . . . . . . .. 158 Services Provided by the Child Psychiatrist ........................... 161 References ...................................................... 163 12. Psychopharmacologic Agents and Electroconvulsive Therapy during Pregnancy and the Puerperium ••••••••••.••••••••.•.•••••••••••••• 165 Katherine L. Wisner and James M. Perel Introduction ..................................................... 165 Antipsychotic Agents during Pregnancy .............................. 170

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