Perceptions and Prescriptions: Findings From a National Survey of Psychopharmacology Decision-Making Among Pregnant and Postpartum Women and Health Providers
In many practice settings, social workers help clients make decisions around psychopharmacology (Bentley, Walsh & Farmer, 2005). For pregnant and postpartum women in particular, they often serve as brokers and advocates when emergent mental health concerns are medically managed by primary health care providers, such as obstetricians/gynecologists (Price, 2010). While these providers may rely on published reviews, consensus guidelines and clinical judgment when prescribing psychiatric medication, little is known about how women and health providers actually experience decision-making processes in the real world, especially given the controversial context of this time period (Jain & Lacey, 2005). This study presents findings from the authors’ national survey of women and health care providers around three key areas: 1) perceived costs and benefits of taking mental health medication during and around pregnancy, 2) common and disparate experiences of communication between the two groups, and 3) comparative responses to two case scenarios.
Key informant interviews (presented previously at SSWR) and formal pilot testing informed the data collection instrument. We used publically available email addresses from 131 academic medical centers to target women’s health care providers; from this sampling frame we used a randomization algorithm to select 300 providers from 50 institutions who were sent the survey weblink; we achieved a physician sample N=88 (29% response rate). We directly recruited a purposive sample of currently and recently pregnant women via internet and social media (N=83). Mixed methods data was analyzed using IBM SPSS Statistics 19 concurrent with thematic qualitative analysis of open-ended responses around key themes of costs and benefits, communication experiences, and decisional influences.
While both groups endorsed similar perceived benefits of psychiatric medication that related to quality of life, perceived costs differed between groups. Over 80% of women endorsed items related to the negative impact on fetus/infant as extremely important, which markedly differed from providers (χ2<.005). Regarding communication, attentive listening and open communication were the highest ranked “positive” statements from the two groups; however, “negative” statements varied greatly with a troubling 21% of women indicating they did not feel they were given choices about medication, and 31% of providers indicating they felt they were practicing beyond their expertise. In the case scenarios, health providers' prescribing recommendations were guided by issues of self-harm, implied child welfare concerns, or “uncharacteristic deep sadness”; women’s recommendations in both cases reflected a deep concern for the authenticity and humaneness of the milieu of the client-provider encounter.
Conclusions and Implications
Social workers, who value self-determination and shared decision-making, can use this information as a catalyst for conversation with pregnant and postpartum women and health care providers regarding their perceptions and expectations about psychiatric medication use and related interactions with each other. While the research design and sample size preclude us from causal assertions, the findings broaden the dialogue around key issues influencing informed psychopharmacology decision-making for pregnant and postpartum women. We are currently using these results to develop educational materials for women and providers which will guide more compassionate and collaborative care.