Revised: 05-27-10

Mental Healthcare for Antepartum Patients

'Antepartum Psychosis' is a colloquial term among nurses who work in High Risk/Level 3 Antepartum/L&D Units. You will not find it in a medical dictionary. It's an area that could use more exploration. Post graduate research topic anyone?

Women with high risk pregnancies, on hospital bedrest face psychological challenges of boredom and powerlessness. This can lead to a condition similar to 'ICU psychosis'. Social isolation from friends and family often make it worse. Separation from young children at home can become especially unbearable.

Women with a history of infertility issues and previous pregnancy losses are known to be fearful, anxious, and prone to depression. These patients may focus on each twinge of physical discomfort, not knowing the difference between normal discomforts of pregnancy, and potential warning signs.

Subject to periodic fetal monitoring, and vital sign assessments at all hours of the day and night, sleep deprivation can become a problem as well. High Risk OB patients may experience frequent blood draws or invasive exams. They may ruminate about the past and wonder what they could have done differently, and carry burdens of guilt.

Eventually, they may begin to feel like a diagnosis, instead of a person.

When Antepartum patients are angry, difficult to please, and have what seem to caregivers like irrational fixations, it is possible that some form of so-called "Antepartum Psychosis" is beginning to take shape.

'Antepartum Psychosis' is charcterized by several trademark behaviors that can become frustrating for caregivers:

1. Frequent use of call light.
2. Vague physical complaints
3. Extremely specific instructions about how they want the room arranged (a chair, a tissue box, anything)
4. Failure to remember that you already did something (gave Terbutaline, brought icewater, usually something routine)
5. Crying because the ice water has too much ice in it, she needs to drink more fluids, or some other thing that is small to the caregiver, but the patient responds to as if the caregiver is somehow purposefully undermining their well being, suspiciously
6. Distorted time perception, confusion (such as whether it is morning or evening on waking from a nap)
7. Staring into space, flat affect, withdrawn behavior, self imposed isolation
8. Anger about shift/staff changes, firing certain caregivers, staff splitting (staff member is either all good, or incompetent)

Often these patients have poor coping skills to begin with, or have trust issues that cause exaggerated fears of loss of control.