Development of a Care Plan for a Pregnant Woman With Severe Mental Illness

Abstract

The purpose of the case study is to demonstrate the complexity of care for a pregnant woman with a severe mental illness under civil commitment and requiring hospitalization for her entire pregnancy. A 32-year-old, gravida 1 para 0 woman admitted to the adult behavioral unit at 8 weeks gestation for bipolar type schizoaffective disorder and intellectual disability presented with concerns of worsening psychosis and impulsivity as well as medical comorbidities. While under civil commitment for mental health, she received optimal care from a collaborative intraprofessional team who met routinely to review her progress and ensure patient and care provider safety. Her collaborative care included nursing, behavioral management, environment of care, pharmacology, obstetric and medical management, patient rights, legal issues, and safety of the newborn. Her obstetric and nursing care needs were provided on the adult behavioral unit to ensure optimal mental health support and safety. On transfer to the labor and delivery unit and for the duration of her postpartum stay, the behavioral health team supported her care with a constant presence of familiar team members. Nursing supported the birth process and postpartum care as well as breastfeeding support with the late-preterm infant. The patient’s legally appointed guardian was included in team huddles and offered advice for providing a supportive environment for this patient. Social workers from Behavioral Health and Birthplace were integral to the exploration of community resources for the patient’s potential parenting skills and discharge. Successful outcomes included vaginal birth, no behavioral emergencies, and a safe transition of care to the community for mother and baby. A detailed intraprofessional plan of care provides a shared mental model for all care team members. Plans for staffing, communication, and de-escalation strategies; prenatal and parenting education; documentation of behaviors; and care team safety provide a therapeutic environment of care with the central focus on the patient and her newborn. Nursing is a key discipline for care coordination.