Abstract
Unplanned pregnancies are a unique, yet significant risk factor in perinatal mental health. Our aim was to create an assessment tool to assess mother’s views on contraception as part of the discharge planning process. We used a quantitative-qualitative approach. A clinician-guided questionnaire was completed by patients prior to their discharge from hospital and analysed using Microsoft Excel. Semi-structured interviews were used to explore views regarding family planning in greater depth. Interviews were recorded and transcribed verbatim onto Microsoft Word. Emerging themes were identified using a grounded theory thematic analysis approach. Eighteen inpatients were assessed at the Bethlem Mother and Baby Unit over a 4-month period (May–August 2015). Half of the women stated that the pregnancy was unplanned. The most common contraception methods used were condoms, followed by no method/natural cycle technique. Forty-four percent felt unsure of contraception options available and were keen for further advice and referral to family planning services. Interestingly, almost all the women interviewed stated that their experience of perinatal mental illness had changed their views on having more children. The contraception assessment tool is a short, simple questionnaire that can be adopted across inpatient and community settings. In cooperating family, planning into the discharge care plan could be protective in preventing future unplanned pregnancies in women at high risk of perinatal mental illness relapse. Performing the assessment also provided an added opportunity for psycho-education regarding reproductive health and medication use during the perinatal period. The tool also encouraged liaison with GPs and local family planning services.
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References
Allison SK (2008) Psychotropic medication in pregnancy: ethical aspects and clinical management. J Perinat Neonatal Nurs 18(3):194–205
Austin MP, Mitchell PB (1998) Psychotropic medications in pregnant women: treatment dilemmas. Med J Aust 169(8):428–31
Bauer A, Parsonage P, Martin Knapp M, Iemmi V, Adelaja B (2014) The cost of perinatal mental health problems. London School of Economics andCentre for Mental Health
Black A, Guilbert E; Co-Authors, Costescu D, Dunn S, Fisher W, Kives S, Mirosh M, Norman WV, Pymar H, Reid R, Roy G, Varto H, Waddington A, Wagner MS, Whelan AM; Special Contributors, Ferguson C, Fortin C, Kielly M, Mansouri S, Todd N; (2015) Canadian contraception consensus (Part 1 of 4) J Obstet Gynaecol Can 37(10):936–42
Blanc AK, Rutenberg N (1991) Coitus and contraception: the utility of data on sexual intercourse for family planning programs. Stud Fam Plan 22(3):162–76
Blanc AK, Way AA (1998) Sexual behavior and contraceptive knowledge and use among adolescents in developing countries. Stud Fam Plan 29(2):106–16
Bowlby J (1952) Maternal care and mental health, world health organisation, 1952
Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101
Byrne A, Morgan A, Soto EJ, Dettrick Z (2012) Context-specific, evidence-based planning for scale-up of family planning services to increase progress to MDG 5: health systems research. Reprod Health 9:27. doi:10.1186/1742-4755-9-27
Cantwell R, Knight M, Oates M and Shakespeare J (2015) on behalf of the MBRRACE-UK mental health chapter writing group. Lessons on maternal mental health. In: Knight M, Tuffnell D, Kenyon S, Shakespeare J, Gray R, Kurinczuk JJ (eds) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care - Surveillance of maternal deaths in the UK 2011-13 and lessons learned to inform maternity care from the UK and Ireland Con dential Enquiries into Maternal Deaths and Morbidity 2009-13. Oxford: National Perinatal Epidemiology Unit, University of Oxford, p22-41
Cohen LS, Rosenbaum JF (1998) Psychotropic drug use during pregnancy: weighing the risks. J Clin Psychiatry 59(Suppl 2):18–28
Collins S, Arulkumaran S, Hayes K, Jackson S, Impey L (Eds) (2013) Oxford handbook of obstetrics and gynecology (Oxford Medical Handbooks) 25 Jul 2013
Coote A, Campbell B, Roche C (1982) Sweet freedom: struggle for women’s liberation (Picador Books 1982)
Dennis A, Grossman D (2012) Barriers to contraception and interest in over-the-counter access among low-income women: a qualitative study. Perspect Sex Reprod Health 44(2):84–91. doi:10.1363/4408412
Everett S (2014) Handbook of contraception and sexual health paperback 17 Jan 2014
Faisal-Cury A, Menezes PR, Huang H (2013) The relationship between perinatal psychiatric disorders and contraception use among postpartum women. Contraception 88(4):498–502. doi:10.1016/j.contraception.2013.02.003
Galbally M, Snellen M, Lewis AJ (2011) A review of the use of psychotropic medication in pregnancy. Curr Opin Obstet Gynecol 23(6):408–14. doi:10.1097/GCO.0b013e32834b92f3
Goodman D (2015) Improving access to maternity care for women with opioid use disorders: colocation of midwifery services at an addiction treatment program. J Midwifery Womens Health 60(6):706–12. doi:10.1111/jmwh.12340
Guze BH, Guze PA (1989) Psychotropic medication use during pregnancy. West J Med 151(3):296–8
Henshaw C, Cox J, Barton J. (2009) Modern management of perinatal psychiatric disorders paperback 1 Apr 2009
Hogg S (2014) National Society for the Prevention of Cruelty to Children (NSPCC) All babies count: spotlight on perinatal mental health report, everyone’s business campaign
Huang Y, Merkatz R, Zhu H, Roberts K, Sitruk-Ware R, Cheng L (2014) The free perinatal/postpartum contraceptive services project for migrant women in Shanghai: effects on the incidence of unintended pregnancy. Contraception 89(6):521–7. doi:10.1016/j.contraception.2014.03.001
Jarrett P (2014) Attitudes of student midwives caring for women with perinatal mental health problem. Br J Midwifery 22(10)
Kendell RE, Chalmers JC, Platz C (1987) Epidemiology of puerperal psychoses. Br J Psychiatry 150:662–673
Kimani J, Warren C, Abuya T, Mutemwa R, Mayhew S, Askew I (2015a) Family planning use and fertility desires among women living with HIV in Kenya. BMC Public Health 15(1):909. doi:10.1186/s12889-015-2218-z
Kimani J, Warren CE, Abuya T, Ndwiga C, Mayhew S, Vassall A, Mutemwa R, Askew I (2015b) Use of HIV counseling and testing and family planning services among postpartum women in Kenya: a multicentre, non-randomised trial. BMC Womens Health 15:104. doi:10.1186/s12905-015-0262-6
Knight M, Tuffnell D, Kenyon S, Shakespeare J, Gray R, Kurinczuk JJ (Eds) (2015) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care - Surveillance of maternal deaths in the UK 2011–13 and lessons learned to inform maternity care from the UK and Ireland Con denial Enquiries into Maternal Deaths and Morbidity 2009–13. Oxford: National Perinatal Epidemiology Unit, University of Oxford
Lopez LM, Grey TW, Chen M, Hiller JE (2014) Strategies for improving postpartum contraceptive use: evidence from non-randomized studies. Cochrane Database Syst Rev 11:CD011298. doi:10.1002/14651858.CD011298.pub2
Maternal mental health (2014) The royal college of midwives, January 2014
McLaren A (1992) History of contraception—from antiquity to the present day. Blackwell publishers
Mehata S, Paudel YR, Mehta R, Dariang M, Poudel P, Barnett S (2014) Unmet need for family planning in Nepal during the first two years postpartum. Biomed Res Int 2014:649567
National Institute of Health and Care Excellence (NICE) (2014) Antenatal and postnatal mental health, clinical management and service guidance
National Institute of Health and Care Excellence (NICE) (2016) Diabetes in pregnancy pathway, clinical management and service guidance
North East London Strategic Health Authority 2003 Report of an independent inquiry into the care and treatment of Daksha Emson MBBS, MRCPsych, MSc, and her daughter Freya. North East London Stragetic Health Authority
Pariante C, Conroy S, Dazzan P, Howard L, Pawlby S, Seneviratne T (eds) (2014) Perinatal psychiatry: the legacy of Channi Kumar Hardcover 2014. Oxford University Press, New York, NY, USA. https://global.oup.com/academic/product/perinatal-psychiatry-the-legacy-of-channi-kumar-9780199676859?cc=us&lang=en
Pasha O, Goudar SS, Patel A, Garces A, Esamai F, Chomba E, Moore JL, Kodkany BS, Saleem S, Derman RJ, Liechty EA, Hibberd PL, Hambidge K, Krebs NF, Carlo WA, McClure EM, Koso-Thomas M, Goldenberg RL (2015) Postpartum contraceptive use and unmet need for family planning in five low-income countries. Reprod Health 12(Suppl 2):S11. doi:10.1186/1742-4755-12-S2-S11
Petersen I, Gilbert RE, Evans SJ, Man SL, Nazareth I (2011) Pregnancy as a major determinant for discontinuation of antidepressants: an analysis of data from The Health Improvement Network. Clin Psychiatry 72(7):979–85. doi:10.4088/JCP.10m06090blu
Royal College of Psychiatrists Care and Quality Commissioning (2015) Quality network for perinatal mental health services, service standards for mother and baby units, 4th Edition, January 2014
Royal College of Psychiatrists Care and Quality Commissioning (2015) Quality network for perinatal mental health services, service standards for community perinatal services, 2nd Edition, April 2014
Stevenson F, Hamilton S, Pinfold V, Walker C, Dare CR, Kaur H, Lambley R, Szymczynska P, Nicolls V, Petersen I (2016) Decisions about the use of psychotropic medication during pregnancy: a qualitative study. BMJ Open 6(1), e010130. doi:10.1136/bmjopen-2015-010130
Trixler M, Gáti A, Fekete S, Tényi T (2005) Use of antipsychotics in the management of schizophrenia during pregnancy. Drugs 65(9):1193–206
Warren CE, Abuya T, Askew I (2013) Family planning practices and pregnancy intentions among HIV-positive and HIV-negative postpartum women in Swaziland: a cross sectional survey. BMC Pregnancy Childbirth 13:150. doi:10.1186/1471-2393-13-150
Watanabe O (2014) Current evaluation of teratogenic and fetotoxic effects of psychotropic drugs. Seishin Shinkeigaku Zasshi 116(12):996–1004
World Health Organisation (2005) WHO, Mothers and children, 2005
Acknowledgments
We would like to thank all the mothers that participated; as without their courage and honesty, this study would not have been possible. We also would like to thank the Royal College of Psychiatrists Perinatal Faculty, whom awarded Dr. Chrishanthy Jayarajah the Daksha Emson Perinatal Poster Prize 2015, on presentation of this study at their National Annual Perinatal Psychiatry Faculty Conference in November 2015.
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The research study was proposed and approved by the South London and Maudsley (SLAM) research group ethics committee.
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Appendices
Appendix A. Mother and baby inpatient unit contraception assessment tool questionnaire
Appendix B. Consent form for recorded interviews
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Jayarajah, C.G., Seneviratne, T. Development of a mother and baby unit contraception assessment tool. Arch Womens Ment Health 19, 1129–1140 (2016). https://doi.org/10.1007/s00737-016-0665-x
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DOI: https://doi.org/10.1007/s00737-016-0665-x