Higher Levels of Care
When to Consider Psychiatric Hospitalization in the Perinatal Period
Pregnancy
If a pregnant patient is ill enough that she is not caring for herself well (poor nutrition, poor attendance to appointments), this affects the health of her pregnancy. Therefore, threshold to admit or provide more extensive services should be lower.
Postpartum
A mother may not be ill enough to warrant admission if she were only responsible for taking care of herself. However, she must also care for her child(ren). Ask her questions about her ability to:
- Supervise child(ren) and protect them from harm
- Feed, change/toilet child(ren), and attend to other basic needs
- If she is unable to do these things and no other adult in the home can take over these responsibilities, admission should be encouraged
Psychiatric emergency: Postpartum psychosis
Because individuals with psychosis do not perceive their environment accurately, they are not equipped to appropriately care for an infant for many of the following reasons:
- They cannot accurately assess danger in the environment, so can put themselves and their child(ren) in dangerous situations
- They can perceive danger in safe environments, making them isolative and less likely to seek appropriate care
- They can become so preoccupied with hallucinations/delusions that they are not capable of being sufficiently attentive to child(ren)
- They can develop delusions/hallucinations that lead them to intentionally harm their child(ren) or themselves
For this reason, postpartum psychosis is a psychiatric emergency and requires admission.
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