Perinatal psychiatry focuses on the evaluation, diagnosis, and treatment of mental health disorders during the preconception, pregnancy, and postpartum periods. Mood disorders, anxiety disorders, and posttraumatic stress disorder are the most common mental health conditions that arise during the perinatal period.1 Mediating factors include hormone fluctuations, sleep deprivation, trauma exposure, financial stress, having a history of psychiatric illness, and factors related to newborn care.
During the perinatal period, a comprehensive psychiatric interview is crucial. Effective screening and identification of maternal mental health conditions necessitate more than merely checking off boxes on a questionnaire. It requires compassionate, informed, and individualized conversations between physicians and their patients.
In addition to asking about pertinent positive and negative psychiatric symptoms, the following screening questions could be asked during a structured interview to identify perinatal issues during pregnancy and the postpartum period.
During pregnancy
- How do you feel about your pregnancy?
- Was this pregnancy planned or unplanned, desired or not?
- Was fertility treatment needed or used?
- Did you think about stopping the pregnancy? If so, was your decision influenced by laws that restrict abortion in your state?
- Do you feel connected to the fetus?
- Do you have a room or crib at home for the baby? A car seat? Clothing? Baby supplies?
- Are you planning on breastfeeding?
- Do you have thoughts on future desired fertility and/or contraception?
- Who is your support system at home?
- How is your relationship with the baby’s father?
- How is the baby’s father’s mental well-being?
- Have you been subject to any abuse, intimate partner violence, or neglect?
- Are your other children being taken care of properly? What is the plan for them during delivery days at the hospital?
During the postpartum period
- Was your baby born prematurely?
- Did you have a vaginal or cesarean delivery?
- Did you encounter any delivery complications?
- Did you see the baby after the delivery?
- Do you feel connected to or able to bond with the baby?
- Do you have access to maternity leave from work?
- Have you had scary or upsetting thoughts about hurting your baby?
- Do you have any concerns about your treatment plan, such as medication use?
- In case of an emergency, are you aware of perinatal psychiatry resources in your area or the national maternal mental health hotline (833-852-6262)?
The American College of Obstetricians and Gynecologists clinical practice guidelines recommend that clinicians conduct depression and anxiety screening at least once during the perinatal period by using a standardized, validated tool.2 Psychiatry residents should receive adequate guidance and education about perinatal psychiatric evaluation, risk assessment, and treatment counseling. Early detection of mental health symptoms allows for early referral, close surveillance during episodes of vulnerability, and better access to mental health care during the perinatal period.