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

278 Pages·1988·8.5 MB·English

by  Richard L. Cohen M.D. (auth.)

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