pregnant psych patients?

Orca, ADN, ASN, RN · Jan 14, 2013

When we had a pregnant patient on my mental health unit, an OB/GYN was always called in to consult. This covered concerns about the health of the baby, and also about what medications could be safely given. Pregnant women with substance abuse problems is a common issue. Education is key. As far as protocols - none specific to pregnancy. The course of treatment was decided by the psychiatrist in consultation with the OB/GYN.

4Bnut · Jan 15, 2013

Just random questions..
How comfortable are you of taking care of a pregnant patient in a psych facility? (not med/ psych just a free standing inpatient psych setting)
For those that do take psych patients who are pregnant. Here are a few questions..
1- How do you determine the health of the baby?
2- Does your facility take pregnant patients that also have substance abuse problems?
3- Are there any protocols in place to protect the mother and child?
4- Is the pregnant patient being medicated?
just curious..

OB is called in

One facility I worked at did see pregnant pts

No different care other then placing the patient on the correct unit

The patients that were on pshyc Meds prior to pregnancy are evaluated by MD to see what they can take while pregnant. I have seen some pts continue there medications prior to pregnancy. It's an individual treatment team.

sleepdeprived1 · Jan 15, 2013

1. We request records from ob/gyn to determine current health of unborn baby (if pt. signs consent), and we also have transport. many times so that preg. patients can still attend their ob appts.

2. Yes.

3. Protocols in place... psych docs request info from ob doc on meds, patient signs waiver/consent for meds including pregnancy category a, b, or c .(never seen less than c given to preg.?) including educating and consent to potential risk/vs./benefit..-if i admit preg. patient. i dont admit them with nothing but prenatal and leave ordering/continuing/standing order meds for the doc.to review since i dont feel comfortable including standing orders if preg.

4. the pregnant patient receives a prenatal vitamin daily other than that it depends on her situation and what types of meds are needed ..and what is safe during trimester of pregnancy..

Meriwhen, ASN, BSN, MSN, RN · Jan 16, 2013

Just random questions..
How comfortable are you of taking care of a pregnant patient in a psych facility? (not med/ psych just a free standing inpatient psych setting)
For those that do take psych patients who are pregnant. Here are a few questions..
1- How do you determine the health of the baby?
2- Does your facility take pregnant patients that also have substance abuse problems?
3- Are there any protocols in place to protect the mother and child?
4- Is the pregnant patient being medicated?
just curious..

1. MD and/or OB-GYN consult.

2. Yes. Unfortunately, it's rather common to see pregnant CD patients.

3. In the places I've worked at, there hasn't been a set policy. Instead the patients are evaluated on a per-case basis and treatment is individualized

4. Yes, pregnant patients do get medications. HOWEVER what medication they receive--if any--is dependent on a lot of factors. The ideal goal is to minimize the medication given or to give the safest medications possible (keeping in mind that no medication is guaranteed to be 100% safe, not even Category A and B meds).

But there are times where potential risk vs. benefit have to be weighed. Trimester of pregnancy has to be taken into account. Same with the safety category of the medication. Patient wishes are also part of the equation: a patient may not wish to receive any medication. Or the patient may wish, after consulting with the prescriber, to continue on her current medications even if there is some risk to the child.

Patient acuity matters too: a very unsafe patient may need to be medicated against her will.

I've only encountered one case with a pregnant patient where it came down to such drastic measures being taken. Pregnant patient, psychotic, throwing furniture at both staff and windows. She initially refused both PRN medication and to stop throwing stuff. After a quick consult, we went with physical restraint.

I didn't like having to do it, but she was a clear danger to both herself and others, and less restrictive alternatives had been tried/offered and failed. Also, most benzos are Category D or X, so I suppose in this case, restraints may have been the best choice for her and the unborn child...not saying it was the safest or desired choice, just when considering the other options of giving a potential/definite teratogen and the patient injuring self and/or others.