Abstract

Introduction The current literature highlights that the key treatment and management of women with psychosis is with atypical antipsychotic medications. However, many clinicians lack the knowledge and confidence in the management of the woman who is pregnant or planning to be, whilst taking antipsychotic medication. To maintain her optimal mental health status they require access to the most current evidence at the time when decisions must be made about ongoing care. Clinicians who provide care for this vulnerable group of women, their families and their babies during pregnancy, birth and postpartum encompasses those in both maternity and mental health services. They work in a variety of different ways with their clients, however most recognise that they work to achieve the best outcome for both mother and baby, but struggle at times to know how best to achieve this because working with this group of women requires specialist skills and knowledge. Method A qualitative descriptive design, using semi structured interviews to explore and describe the experiences of clinicians in three health care settings in Victoria, Australia was adopted. The emergent themes related to the current management, issues and problems that arise for clinicians, particularly in relation to the management of medications. Findings An optimal outcome was described by clinicians as ‘both mother and baby were well and healthy and that mother and baby developed a good bond and who remain together as a family’. Clinicians are clearly concerned that harm could be caused particularly to the baby, with the use of medications. Clinicians ask ‘can we really use that?’ and state that ‘we just don’t know!’ Discussion Clearly there is a need for further education of all clinicians in the management of women with serious mental illness during pregnancy and postpartum. Particularly important is the need for development of a specialist clinician to act as the key professional in initiating and maintaining care and contact with women and their clinicians. A Perinatal Mental Health Nurse Practitioner would be available to work with women in both services and to act as a professional resource for clinicians in providing the optimal care for women and their babies.

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