Susan Hatters Friedman, MD Dr. Friedman is Senior Instructor, Departments of Psychiatry and Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio. She is on sabbatical at the Mason Clinic, Waitemata District Health Board, Auckland, New Zealand.
Jaina Amin, MD, BSN Dr. Amin is affiliated with the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Psychological issues abound, and may include a history of sexual and psychological trauma, an attempt to avoid religious prohibitions against unwed intercourse, anger at the father of the infant, and even homicidal urges toward the baby.24 There may be more going on under the surface than “only” a failure to recognize the pregnancy, and the patient may need further mental health treatment.
Consider how well this young woman can be a mother. When she did not even recognize that she was pregnant for 9 months, how well will she be able to attend to her baby’s needs? Psychiatry can evaluate the patient to help determine her capacity for parenting and whether child protective services should be alerted. Of additional concern is the distress of the patient’s parents. Family support will be extremely important.
Be sure to conduct thorough contraceptive education and planning at the time of discharge because this patient is at risk for future denied or concealed pregnancies.22
CASE 5 RESOLVED
The patient is seen by psychiatry. She has no major mental illness, but her denial appears to be related to problems with her boyfriend, her attempts to be the perfect daughter, and fear of being disowned. After the initial shock, the patient’s parents become more supportive and begin to bond with their new grandchild. The new mom is educated about birth control and agrees to follow up with a counselor and take parenting classes. The baby is discharged to his mother and grandparents.
