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Providing psychiatric care for pregnant women who need help

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The Peripartum Clinic at VCU Health integrates psychiatric care and social work into the OB-GYN experience for expectant moms.

A pregnant woman walked into the Nelson Clinic at Virginia Commonwealth University Medical Center. It was not the fear of becoming a new mom that terrified her, it was thoughts of her previous pregnancy — a traumatic experience that ended in the death of her baby.

“Unfortunately, there are many stories like this,” said Bushra Shah, M.D., a psychiatrist at VCU Medical Center.

Shah is part of a small group of clinicians who have created a resource, the Peripartum Clinic, for women in situations like this one. The clinic is recognized by Postpartum Support Virginia as the only program in the greater Richmond area that integrates psychiatric care and social work into the OB-GYN experience for expectant moms with complex mental health needs.

The clinic began as a collaboration among a maternal-fetal medicine specialist, a psychiatrist and a clinical social worker who saw a common thread of untreated mental health conditions among expectant women. It was this team that helped the woman overcome emotional triggers that reminded her of the darkest time in her life. The care was an important part of her journey to the delivery of a healthy baby. 

Care in the Peripartum Clinic can begin in the early stages of pregnancy. All expectant patients at VCU Health fill out a questionnaire that can identify possible mental health needs. If the results of the screening reveal that a patient might require additional support, a social worker coordinates mental health services tailored to the patient’s needs.

“We knew we needed quality psychiatric care embedded in the OB clinic so that patients could be treated and have the tools to maintain mental health during and after the pregnancy,” said Fidelma Rigby, M.D., the maternal-fetal medicine specialist who helped launch the Peripartum Clinic.

Even though the need for psychiatric care increases during pregnancy, coordinating the specialized care can be complicated, Shah said. 

“It’s difficult for a pregnant woman to get an appointment with a psychiatrist in the community, due to the complications that surround medication and pregnancy. This can be discouraging for a mom who is already dealing with depression, anxiety or a mood disorder,” Shah said.

Mental health support at the Peripartum Clinic can include sessions with a psychiatrist, support group participation, closer-interval visits and mood surveillance. The clinic has served more than 100 women since it opened in late 2017.

“This process proactively assesses and tracks patients during the antepartum and postpartum period, preventing further complications and taking the guesswork out of treatment,” said Janet Abraham, a clinical social worker at VCU Health.

“Success looks for positive outcomes, positive birth experiences and eventually not having the need to see a psychiatrist because they have the tools to cope with the challenges of pregnancy and motherhood,” Abraham said.

The Peripartum Clinic is one of several resources available to women during their pregnancy and following the birth of a child, including postpartum support groups with sessions in both English and Spanish. The Peripartum Clinic is located at the Nelson Clinic, 401 N. 11th St., and is open on Tuesdays from 12:30-4:45 p.m. For more information, email janet.abraham@vcuhealth.org.