Psychiatric Consultation in Childbirth Settings, Softcover reprint of the original 1st ed. 1988
Parent- and Child-Oriented Approaches

The primary purposes of this volume are: 1. To provide mental health practitioners with a current overview of our knowledge about normal parental development during pregnancy and its relation to fetal development, with particular emphasis on the impact of acute and chronic stress on these developmental processes. 2. To provide an understanding of the general state of the field of pregnancy and childbirth care both in conventional health systems and in alternative options. 3. To provide an understanding of models of consultation and liaison that are adapt­ ed to the special conditions of pregnancy and childbirth care, as contrasted to the more traditional modes that characterize these activities in medical and surgical hospitals. If there prove to be secondary gains as a result of pursuing these goals, so much the better. The most desirable of these would be a heightening of awareness of the mental health needs of "pregnant families" and of the risks they incur in transition from non­ parenthood to parenthood, and a more effective level of primary and secondary prevention of childhood mental disorders. These latter goals are more global and perhaps even a bit grandiose. Their attainment could only be documented through a series of carefully designed research projects aimed at measuring long-range developmental outcome in children and families who have experienced appropriate and early intervention during the pregnancy period.

I: Introduction and Background.- 1. Purpose and Rationale.- Needs of the Field of Childbirth Care.- Conceptual Approach.- Other Sources of Assistance and Information.- References.- Annotated Bibliography.- Consumer Bibliography.- 2. A Brief History of the Relationship between Obstetrics and the Mental Health Professions.- The Historical Background.- References.- Supplementary Reading Lists.- 3. The Impact of Prenatal Stress on the Developing Fetus and Child.- Maternal Stress and Pregnancy Outcome.- Prenatal Stress and Fetal Outcome.- Maternal Stress and Neonatal Activity.- Mechanisms of Prenatal Stress.- Summary and Conclusions.- References.- 4. The Epidemiology of Mental and Emotional Disorders during Pregnancy and the Postpartum Period.- Review of Modern Literature.- Theories of Causation.- Normal Psychological Reactions to Pregnancy and Motherhood.- Subclinical States and Adjustment Disorders.- Psychophysiologic Conditions.- Psychiatric Disorders.- Conclusion.- References.- Selected Readings on Puerperal Mental Disturbances.- II: The Building Blocks.- 5. Developmental Tasks of Pregnancy and Transition to Parenthood: An Approach to Assessment.- Developmental Model of Pregnancy.- Other Components of the Developmental Interview.- Organizing and Formulating Information Gathered.- References.- 6. Emotional Disorders and Mental Illness Associated with Pregnancy and the Postpartum Period.- Major Psychiatric Disorders.- Conditions in Which Stress and/or Emotional Factors May Contribute to the.- Disorder.- Conditions or States That May Interact Adversely with Pregnancy.- An Alternate Conceptualization.- References.- 7. Current Childbirth Options and Parental Decision Making.- Factors Influencing Maternal Choice of Childbirth Alternatives.- A Comparative Study of Women Choosing Two Different Childbirth.- Alternatives.- Conclusions.- References.- III: Consultation Practice.- 8. Models of Consultation and Liaison: General Principles.- Entrée into the System.- Overview of Models Ill.- References.- 9. Direct Case Consultation.- Case Histories.- Conclusion.- 10. Staff Education, Liaison, and Program Consultation.- Educational and Liaison Activities.- Program Consultation to Conventional or Traditional Childbirth Services….- Program Consultation to Special Projects or Services.- Program Consultation for Extramural Programs and Out-of-Hospital.- Nontraditional Services.- Summary.- References.- Additional Readings of Interest to the Liaison Psychiatrist.- 11. Psychiatric Services in the Neonatal Intensive Care Unit.- Common Sources of Parental and Staff Stress in an NICU.- The Role of the Psychiatrist in the NICU.- Difficulties and Rewards Encountered by the Psychiatrist Working in the NICU.- One Model of a Consultation-Liaison Service for an NICU.- Services Provided by the Child Psychiatrist.- References.- 12. Psychopharmacologic Agents and Electroconvulsive Therapy during Pregnancy and the Puerperium.- Antipsychotic Agents during Pregnancy.- Antidepressant Medication.- Lithium.- Electroconvulsive Therapy (ECT).- The Benzodiazepines.- Pregnant and Puerperal Women: Treatment Recommendations.- References.- 13. The Effect of Prenatal Exposure to Alcohol and Other Drugs.- Alcohol Abuse.- The Effect of Tobacco Use during Pregnancy.- The Effect of Other Drug Use during Pregnancy.- References.- 14. Principles of Genetic Counseling for Psychiatric Liaisons.- Reasons to Refer for Genetic Counseling.- Prenatal Diagnosis.- General Genetic Counseling Issues.- Specific Mental Health Counseling Issues.- References.- IV: Areas of Special Concern.- 15. Variations.- Developments Complicating Genetic, Gestational, and Social Parenting.- Prenatal Diagnosis and Counseling and Genetic Engineering.- Legal Trends in Reproductive Decision Making.- Implications for the Psychiatric Consultant.- References.- 16. The Current Controversy in Childbirth Care: A Consultant’s Viewpoint.- Interviews with the Principal Actors.- References.- 17. Professional Responsibility for the Welfare of Potential Life.- Evolution of Fetal Rights.- Competing Interests of Maternal and Fetal Rights.- Medical Malpractice.- Suggested Guidelines for Case Management.- The Future.- References.- V: Summary and Conclusions.- 18. Conclusions and Future Directions.