CLINICAL DILEMMAS DUE TO THE LACK OF INPATIENT MOTHER-BABY UNITS

Objective: Epidemiologic studies have demonstrated the dramatic increa se in the rates of new episodes of psychiatric illness in postpartum w omen. Mother-Baby joint admission inpatient units serve the needs of w omen with psychiatric illness related to childbearing in other countri es. Such units have been rare experiments in the United States, This a rticle explores the clinical dilemmas that clinicians who treat postpa rtum women face when mother-baby units are not available. Barriers to the implementation of these units are also discussed. Methods: A surve y of mothers admitted to general adult units was performed to study th eir satisfaction with the experience. The authors also discuss their e xtensive clinical experience in the treatment of women with postpartum disorders and provide examples of the clinical dilemmas which occur b ecause of mother-only admissions. Results: Clinical dilemmas were: sep aration from infants causes mothers to refuse admission, undermines br eastfeeding, complicates the diagnostic evaluation, precludes particip ation of the infant in dyadic psychotherapy, produces longer lengths o f hospital stay, and places the responsibility of caring for the baby on the spouse and extended family. Post-discharge readjustment to cari ng for the baby can contribute to maternal relapse. Conclusions: Altho ugh admission to Mother-Baby units offers significant advantages to mo thers and families, firm data to support the cost-effectiveness of the se units is not available and is a major barrier to implementation.