Citation

Silva V. J. Obstet. Gynecol. Neonatal Nurs. 2015; 44: S82.

Copyright

(Copyright © 2015, John Wiley and Sons)

DOI

10.1111/1552-6909.12588

PMID

unavailable

Abstract

BACKGROUND: Caring for a severely ill, suicidal pregnant woman with a history of concomitant drug abuse and violence is uncommon. When caring for such women and their families, diversions from standards of care may occur. Thus, to mitigate the potential challenges for such a woman, an interprofessional approach to care was developed to ensure not only optimal care for the woman and her fetus, but also to provide a safe, therapeutic, working environment for staff. Case: In this case, the woman was a homeless, multiparous, 39‐year‐old with a history of drug abuse, severe depression, multiple suicide attempts, and violence. Her obstetric history was significant for a previous term vaginal delivery. She arrived by ambulance at 23 weeks gestation to an obstetric triage setting with bleeding following cocaine use. She admitted the desire to kill herself during this stay. Immediate consultation was obtained from psychiatry, social work, and obstetrics. After a brief in‐patient stay, the woman was discharged to a homeless shelter and given prescriptions for psychiatric medications. As the pregnancy progressed, the woman's mental health deteriorated and violent, psychotic behavior was exhibited. Risk management, hospital security, ethics, and the obstetric care team met to develop a comprehensive plan. These meetings occurred throughout the pregnancy and included updates on condition, delivery, and postpartum planning. The decision to commit the woman involuntarily was made. The woman was scheduled for a term induction of labor and the interprofessional care plan was utilized throughout her stay. She had a normal vaginal delivery and provided skin‐to‐skin care for her healthy infant. A petition was filed for a child abuse and neglect form at the time of birth, which meant the woman would not have custody of the infant. The woman was eventually discharged to her psychiatric facility, and the infant was discharged to care of the maternal grandmother. Discharge to outpatient care occurred at 2 weeks postpartum. A follow up report was obtained of the woman's suicide shortly thereafter.

CONCLUSION: Utilizing concepts of ethical and moral care coupled with interprofessional coordination can minimize maternal and neonatal morbidity and provide a safe environment for the woman, family, and the care team. This case illustrates the need for early postpartum follow‐up for women with depression. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses

Language: en

Keywords

suicide; depression; psychosis; ethics; pregnancy