Clinical Practice Guidelines Antenatal Care — Module II
Understanding the woman’s perspective
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3.2Understanding the woman’s perspective“Primary care health professionals who do not deliver treatments can still provide ongoing support for women experiencing depression and related disorders. This is likely to involve assisting the woman and her significant other(s) to understand the condition and available treatments and providing ongoing psychosocial support.” (beyondblue 2011) Mental health disorders can complicate a woman’s experience of antenatal care. While levels of resilience and risk vary, a woman experiencing mental health disorders during pregnancy may benefit if health professionals have an understanding of how her situation affects her acceptance of and response to antenatal care. Attending antenatal care: Attending antenatal care visits may be difficult (eg due to lack of motivation in women experiencing depression, fears, perceptions of stigma). Physical contact: Women who have experienced physical or sexual abuse or complex traumas (eg in borderline personality disorder) may experience distress when touched, even by people who are close to them. Clinical assessments and screening tests: Women may be reluctant to accept the offer of assessments and tests for a range of reasons (eg anxiety about the results, risks associated with tests, belief in non-intervention, not wanting to reveal history of domestic violence). The antenatal care of women with mental health disorders can also present challenges for the health professionals involved (eg requests or demands for early birth and repeated self harm among women with borderline personality disorder). Section 3.3 includes resources that discuss specific issues associated with mental health disorders during pregnancy (eg psychotropic medications, attitude to the baby, sleep difficulties). 3.3ResourcesHealth professional resourcesbeyondblue (2011) Clinical Practice Guidelines Depression and Related Disorders — Anxiety, Bipolar Disorder and Puerperal Psychosis — in the Perinatal Period. A Guideline for Primary Care Health Professionals. Melbourne: beyondblue: the national depression initiative. beyondblue (undated) Perinatal Mental Health of Women from Culturally and Linguistically Diverse (CALD) Backgrounds. A Guide for Primary Care Health Professionals. Melbourne: beyondblue: the national depression initiative. beyondblue (undated) Perinatal Depression and Anxiety. Evidence Relating to Infant Cognitive and Emotional Development. Information for Health Professionals. Melbourne: beyondblue: the national depression initiative. beyondblue (undated) Puerperal (Postpartum) Psychosis. A Guide for Primary Health Care Professionals. Melbourne: beyondblue: the national depression initiative. beyondblue (undated) Bipolar Disorder During Pregnancy and Early Parenthood. A Guide for Primary Care Health Professionals. Melbourne: beyondblue: the national depression initiative. Galbally M, Roberts M, Buist A et al (2010) Mood stabilizers in pregnancy: a systematic review. Aust NZ J Psychiatry 44(11): 967–77. Galbally M, Snellen M, Walker S et al (2010) Management of antipsychotic and mood stabilizer medication in pregnancy: recommendations for antenatal care. Aust NZ J Psychiatry 44(2): 99–108. Nguyen TN, Faulkner D, Allen S et al (2010) Managing pregnant women with serious mental illness: using the Edinburgh Postnatal Depression Scale as a marker of anxiety and depressive symptoms. Aust NZ J Psychiatr 44(11): 1036–42. Paris J (2005) Borderline personality disorder. CMAJ 172(12): 1579–83. Solari H, Dickson KE, Miller L (2009) Understanding and treating women with schizophrenia during pregnancy and postpartum–Motherisk Update 2008. Can J Clin Pharmacol 16(1): e23–32. WA Dept Health (2008) Healthy Babies for Mothers with Serious Mental Illness: A Case Management Framework for Mental Health Clinicians.
SA Perinatal Practice Guidelines Workgroup (2010) Chapter 144 Eating disorders in pregnancy. In: South Australian Perinatal Practice Guidelines. Adelaide: SA Health. SA Perinatal Practice Guidelines Workgroup (2011) Chapter 146 Personality disorders. In: South Australian Perinatal Practice Guidelines. Adelaide: SA Health.
Adelaide University – mental health guidelines – personality disorders The Royal Women’s Hospital (drug information)
Black Dog institute — Depression in Pregnancy and Postnatal Children of Parents with a Mental Illness (COPMI) Mindhealthconnect Post and Antenatal Depression Association Inc (PANDA) — 1300 726 306
The headspace Knowledge Centre provides information about treatment interventions and models of care for young people with mental health and substance use issues. The Black Dog Institute offers education and training programs, resources and online learning for health professionals with a focus on depression and bipolar disorder. square — Suicide, Questions, Answers and Resources — is an integrated suicide prevention resource that is part of the National Suicide Prevention Strategy. The Living Is For Everyone (LIFE) website is a suicide and self-harm prevention resource designed for people across the community who are involved in suicide and self-harm prevention activities. GP Psych Support provides GPs with patient management advice from psychiatrists within 24 hours. Phone: 1800 200 588; Fax: 1800 012 422. Government funding to receive treatment from psychiatrists, psychologists, appropriately trained GPs, social workers, occupational therapists and mental health nurses can be accessed through initiatives including: Access to Allied Psychological Services (ATAPS) Better Access initiative (Medicare items) Better Outcomes in Mental Health Care Mental Health Nurse Incentive Program
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