Clinical dilemmas due to the lack of inpatient mother-baby units.
OBJECTIVE
Epidemiologic studies have demonstrated the dramatic increase in the rates of new episodes of psychiatric illness in postpartum women. Mother-Baby joint admission inpatient units serve the needs of women with psychiatric illness related to childbearing in other countries. Such units have been rare experiments in the United States. This article explores the clinical dilemmas that clinicians who treat postpartum women face when mother-baby units are not available. Barriers to the implementation of these units are also discussed.


METHODS
A survey of mothers admitted to general adult units was performed to study their satisfaction with the experience. The authors also discuss their extensive clinical experience in the treatment of women with postpartum disorders and provide examples of the clinical dilemmas which occur because of mother-only admissions.


RESULTS
Clinical dilemmas were: separation from infants causes mothers to refuse admission, undermines breastfeeding, complicates the diagnostic evaluation, precludes participation of the infant in dyadic psychotherapy, produces longer lengths of hospital stay, and places the responsibility of caring for the baby on the spouse and extended family. Post-discharge readjustment to caring for the baby can contribute to maternal relapse.


CONCLUSIONS
Although admission to Mother-Baby units offers significant advantages to mothers and families, firm data to support the cost-effectiveness of these units is not available and is a major barrier to implementation.
Wisner
K L
KL
Case Western Reserve University, Cleveland, Ohio, USA.
Jennings
K D
KD
Conley
B
B
D000328:Adult; D005192:Family Health; D005260:Female; D019538:Health Care Surveys; D006301:Health Services Needs and Demand; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008425:Maternal Behavior / Q000523:psychology; D008430:Maternal-Child Health Centers / Q000458:organization & administration*; D001523:Mental Disorders / Q000628:therapy*; D009034:Mother-Child Relations; D010342:Patient Acceptance of Health Care; D011644:Puerperal Disorders / Q000628:therapy*; D014481:United States