The preconception needs of women with severe mental illness: a consecutive clinical case series

Abstract

Introduction: Women with severe mental illness (SMI) are having babies at an increasing rate, but continue to face many challenges across the perinatal period. There is little research into the preconception needs of women with SMI and the aim of this study was to investigate the social circumstances, general health, mental health and reproductive health care needs in these at risk women.

Method: Women with SMI referred for specialist preconception counselling at a tertiary obstetric hospital in 2012 were eligible to participate. The data source was a semi-structured study-specific interview schedule with open-ended questions incorporated into the routine assessment protocol.

Results: In a one-year period, 23 women were referred to the service and 22 consented to data from the interview being pooled for the study. All women were taking at least one psychotropic medication at the time of referral. Overall, 40% (n = 9) were aged at least 35 years, 36% (n = 8) smoked cigarettes daily and over half (54.5% n = 12) reported their body mass index as being in the overweight or obese range. Thematic analysis revealed the importance of maternal desire, and concerns relating to age and biological time pressure, the impact of the illness and medication on pregnancy and motherhood.

Conclusion: Our data indicate that preconception counselling should be routine in the care of women with SMI of reproductive age, and should take into account the potential centrality of motherhood in the woman’s rehabilitation, as well as the complex appraisals of risks, general health and support.

• Perinatal metal health
• preconception counselling
• severe mental illness

Declaration of interest

The authors report no conflict of interest.

This work was supported by the West Australian Perinatal Mental Health Unit Research Mentorship Program.

Current knowledge on this subject

• Women with SMI are having babies at an increasing rate.

• They often have complex needs and are at increased risks during pregnancy and the postpartum.

• Very little is known about the preconception environment including the needs and desires of women with SMI, who are planning to have a baby.

What this study adds

• Women with SMI who contemplate family planning appear to have strong maternal desires and see motherhood as central to their recovery.

• These women often have to negotiate complex risk appraisals, such as heightened risks of relapse as well as the impact of mental illness on pregnancy and the postpartum, and the potential detrimental effects of medication.

• Mental health clinicians who work with women with SMI may also need to explore age and fertility concerns, in addition to optimizing general health, as part of their comprehensive management.

• Preconception counselling is an ideal setting to explore these complex issues and plan for appropriate support.