According to Dr. Marcela Almeida, attending physician in the Department of Psychiatry at Brigham and Women’s Faulkner Hospital, one in seven women suffers from perinatal depression. Dr. Almeida, who served as Director of the Women’s Mental Health and Reproductive Psychiatry Program at the University of Illinois prior to joining the care team at BWFH, says these women clearly need access to services to protect them and their babies. Thus, she recently led the launch of a new program on 2 South, the hospital’s 24-bed inpatient psychiatry unit, specifically designed to care for this unique patient population.
“Pregnancy is a crucial moment in a woman’s life. There are hormonal changes and added psychosocial problems such as difficulties with relationships, physical changes and sleep deprivation that make pregnant women vulnerable,” says Dr. Almeida. “We know that mental illness in pregnancy is quite common and is associated with adverse outcomes and negative impacts, individually and for society in general, but, despite all the evidence, sadly these women remain a vastly underserved population.”
The new perinatal inpatient psychiatry program is part of the Brigham Health Women’s Mental Health and Reproductive Psychiatry Division. The inpatient program is designed specifically with the needs of first and very early second trimester pregnant and postpartum women in mind. It is the only such service in Massachusetts.
“We have a specialized multidisciplinary team that includes a perinatal psychiatrist, psychologists, social workers, occupational and recreational therapists, nurses, pharmacists, dieticians and spiritual counselors,” says Dr. Almeida. “Our goal is to identify each woman’s specific needs when creating a personalized treatment plan to help them and their families during the critical periods of early pregnancy and postpartum, with special focus on bonding and attachment, motherhood transition and family dynamics.”
Newly admitted patients to the program meet as a group to discuss recent events and goals for the day and become familiar with the professional staff, other patients and unit schedule. Patients are then assigned to specific psychotherapy groups and occupational/recreational therapy activities such as Life Skills, Managing Stress, Cognitive Behavioral Therapy, Mindfulness/Meditation, Pet Therapy and more. Patients meet individually with their assigned physician and have an opportunity to have a comprehensive discussion about medication options during pregnancy and lactation. The service collaborates with BWFH’s Chief of the Division of Gynecology and Obstetrics Dr. James Greenberg, and all pregnant patients receive obstetrical consultation and monitoring. Nutrition and lactation consultations are provided when applicable. A social worker or case manager will connect the patient with a personalized outpatient care plan after discharge.
“When a woman learns she is pregnant, the outpatient doctors, primary care physicians and even psychiatrists many times discontinue their medications because of a perceived liability or health risk, or because until relatively recently the literature wasn’t reassuring,” explains Dr. Almeida. “Consequently, the pregnant woman may psychiatrically decompensate and that increases the risk of suicide, postpartum psychosis and harm to the infant. These are the women we can help. We are able to safely treat them here with every treatment modality, including medication management, individual and group psychotherapy or electroconvulsive therapy (ECT).”
In fact, the team at BWFH just published the first protocol on ECT in pregnant women in the Archives of Women’s Mental Health. The abstract can be read here.
Dr. Almeida urges any healthcare provider struggling to treat a woman who is less than 18 weeks pregnant or who is postpartum with depression to refer them to the program for evaluation. “Whenever there is a question about safety assessment, it is better to send them our way and we can do a thorough evaluation and collaboratively develop a safe and effective treatment plan. In a lot of cases, we can prevent hospitalization and connect patients with a specialized team on the outpatient level,” she says.
To refer a patient to the perinatal inpatient psychiatry program, call Brigham and Women’s Faulkner Hospital’s Department of Psychiatry at 617-983-7060.
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