Integration of a Mental Health Professional in a Multidisciplinary Team Caring for the Pregnant Woman after Diagnosis of Fetal Anomaly

Abstract

Poster Presentation Purpose for the Program Pregnancy is a time of psychologic change for women and their families. Even women with uncomplicated pregnancies report increased rates of depression, stress, and anxiety during the perinatal period. In addition, maternal mental health conditions may complicate 13% to 25% of all healthy pregnancies. The prenatal diagnosis of a fetal structural or genetic abnormality may further compound the psychologic effect on the pregnant woman. The Center for Fetal Diagnosis and Treatment and the Garbose Family Special Delivery Unit are outpatient and inpatient programs dedicated to caring for women experiencing pregnancies complicated by fetal anomalies. With increasing evidence that prenatal stress, anxiety, and preexisting mental health conditions may have long‐term sequelae for the pregnant woman, her fetus, and the family, it was imperative that these concerns be addressed. Proposed Change To add a mental health professional to our multidisciplinary team. Philanthropic funding was generated and a clinical psychologist with perinatal experience was hired in 2012. This embedded provider partners with nursing staff and is in the unique position to offer assessment and immediate intervention to support women and families during the prenatal course, into intrapartum care, and throughout the postpartum period while their newborns are in the neonatal intensive care unit (NICU). Implementation, Outcomes, and Evaluation To better understand the base rate of maternal mental health risks, the psychologist initiated a standardized screening tool to identify those expectant mothers and fathers at greatest risk of psychologic distress in response to the diagnosis of fetal abnormality. The goal of screening is to provide prenatal intervention at the earliest possible point in care to reduce symptoms in the postpartum period. Patients demonstrating risks of depression, anxiety, or traumatic stress are connected to therapeutic services offered in the same location as prenatal care. Nursing staff continue to evaluate patient well‐being during routine prenatal care and can make direct referrals to the psychologist as needed. Implications for Nursing Practice Nurses are ideally situated to provide family‐centered obstetric care for these women and their families. A woman's preexisting mental health diagnosis or an acute psychologic challenge related to the fetal anomaly may entail a higher level of psychosocial intervention than nurses are trained to provide. Close collaboration between the nurse and the mental health professional ensures that obstetric management will be coordinated with psychologic care to optimize outcomes for the woman and her family.