Pregnancy, Parenting and Psychiatric Medication: Low income women's perspectives on psychopharmacology during pregnancy and the postpartum

Background and Purpose

Pregnant and postpartum women with mental health concerns face complex decisions about whether or not to initiate or continue psychiatric medications. While the medical literature outlines safety and prescribing details (ACOG, 2008), women's own decision making may be influenced by a variety of personal, familial, and social messages (Eberhard-Gran, Eskild & Opjordsmoen, 2005; Nonacs & Cohen, 2003). Low income women in particular may feel compelled to consider psychopharmacology when other treatment options are not available, accessible, or affordable (Miranda et al., 2003; Song, Sands & Wong, 2004). This exploratory, qualitative study aims to inform ongoing intervention development and research by understanding the nuances of low income women's experiences and distilling the central themes around which women engage in psychopharmacology decision-making.

Methods

The study uses two sources of data obtained from a purposive sample of pregnant or post-partum low-income women. The first sample were participants in a key informant study specifically examining psychopharmacology decision making via in-depth interviews (N=6). The second sample is abstracted from a wider study examining depression and loss experiences of pregnant and newly parenting women using focus groups to explore treatment experiences, including psychopharmacology (N=14). The study's interpretive, qualitative methodology employed open-ended questions in both samples of women, asking them to narrate their experiences in considering and/or taking psychiatric medication when pregnant or postpartum. Data was recorded via digital recorder and/or direct transcription and subject to thematic analysis across in both domains of common experiences among participants and key issues in psychopharmacology decision making.

Results

Common experiences: Low income women were mostly prescribed psychiatric medications by Ob-Gyn providers (vs. specialty mental health), based on established safety profiles. Women often adjusted their medication regimens in order to maximize their sense of balance between symptom management and avoidance of side-effects that negatively impacted parenting. Women refrained from revealing the intensity and severity of their symptoms or the self-adjustment of their medications with their providers.

Key issues in decision-making: Women who took medications did so because the cost-benefit of enjoying their pregnancy and providing high-quality parenting won out over their worries regarding fetal/infant effects. Women who did not take medications reported that side effects (“grogginess” and “sleepiness”) and a concern about long-term impact of medications on their child outweighed personal benefit. Women were swayed towards decision-making that they believed minimized risks to the well-being of their children.

Conclusion and Implications

The results of this exploratory study revealed key themes and experiences which will propel future research on decision making processes between providers and consumers. The striking degree to which Ob-Gyn physicians prescribe psychotropic medications, the overwhelming agreement regarding the importance to women of adjusting their own medication timing and dosages, and the balance of personal symptom management with being attentive and quality parents will be central themes in the next wave of quantitative survey research. Ultimately, our research will inform the development of educational materials and interventions that articulate the specific roles in which social workers can perpetuate responsive, collaborate, and compassionate care.