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APNA 26th Annual Conference Session 2025: November 8, 2012

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Diana Fryer BSN, RN-BC, BS PsychologyChristena Raines, RN MSN APRN-BC

UNC Center for Women’s Mood Disorders: Perinatal Psychiatry Inpatient Unit

Discuss the needs of this unique population that require a specialized free-standing, inpatient perinatal psychiatric unit.

Define the integrative nursing orientation process.

Describe the unit’s therapeutic environment including programming, interdisciplinary support and physical structure.


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Fall 2006Universal screening

Spring 2004Perinatal Clinic

established

Fall 2007Dual NP hired for OB/GYN; Psych

Fall 2006Established Resident

Perinatal Clinic

Fall 2009Satellite OfficeRex Hospital

Winter 2009Perinatal In-patient

Pilot Program

September 2011Free Standing

Perinatal In-patient Unit

UNC Perinatal Mood Disorders Clinic was established in 2004 by 2 psychiatrists with an interest in Perinatal Psychiatry

Established alliances within OB/GYN to facilitate the referrals

Worked on increasing awareness by providing psychoeducation: Psychiatric and OB providers Psychiatric and OB Nursing staff OB patients and families General public

Highlighted the need for a systematic and universal procedure for screening and treatment

After implementing universal screening, our perinatal outpatient services increased and we began to “identify” more women needing inpatient hospitalization.

We were unable to provide the specialized perinatal services for women requiring inpatient care on a general psychiatry unit including: Adequate time with baby

Nursing staff and other staff trained in perinatal issues

Specialized psychotherapy and psycho-education

Obstetrical and lactation services


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Our pilot program was a specialized unit embedded in our general geriatric psychiatric floor

The pilot program was able to demonstrate that we could recruit the numbers of patients needed to make this a viable option

It also gave us the opportunity to understand the need for dual trained nurses and a psychoeducation program to help fight the stigma associated with mental illness

Facilitators

Department of Psychiatry Administration

Success of UNC’s Perinatal Psychiatry Program we had documented patient flow and financial viability

Support of the Department of OB/GYN Hospital Director of Nursing Director of In-house Psychiatric Nursing Perinatal Community Supporters

Barriers

Financial climate

Changes in insurance coverage

Stigma of mental health

Lack of understanding of perinatal depression and the need for a specialized unit


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This unique unit required development of an innovative nurse driven training program.

Antepartum Education

Labor & Delivery Education

Post Partum Education

NICU Observation

Observe PMH-NP in Outpatient Clinic

Attend a Post Partum Outpatient Support Group

Monthly Unit Development Meetings

Monthly Team Outings

Monthly Supervision


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Nutrition Lactation Yoga Domestic Violence Substance Abuse Diabetes Spirituality Post Partum Complications Electronic Fetal Monitoring Attend NP Led Orientation

Our 5 bed in-patient unit provides tailored programming to meet the needs of our patients.


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Individualized and group therapy

Medication stabilization and management

Psycho-education

Skill Building

Mind Body Focus

Family Focus

Introduction to the Unit Understanding Perinatal

Mood Disorders

Medications used in the treatment

Types of Psychotherapeutic interventions

Consultation by OB/GYN team

Daily theme

Journaling

Discharge planning and after care

Active participation in treatment plan

with a multidisciplinary team


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Biofeedback Behavioral Therapy Nutrition Exercise Sleep hygiene Time management

YogaTherapeutic yoga tailored to the unique needs of pregnancy and postpartum by certified instructor

Meditation Spirituality

Spiritual support from hospital chaplains with expertise in the perinatal period

Mindfulness Art Music

Mother/Infant Attachment Psychotherapy group Protected sleep hours Extended visiting hours Family night

Lactation support Gliders in patient rooms Hospital grade breast

pumps, refrigeration and freezer storage

Certified Lactation Consultants


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Partner Assisted PsychotherapyFor women with a cooperative, committed partner

Educates and trains the partner to be a “co-therapist”

Initiated in our unit and extended into follow-up care

Weekly meetings on our inpatient unit Partner packets Partner Self-Assessment tools

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Patient Satisfaction Scores

“I feel good and better about myself. My depression is gone. When I came to the hospital, they made me feel like I’m someone and I’m not alone”

“I learned a lot about my postpartum depression” “Staff was great. I like the small unit and the one-to-one

interactions with the staff” “At first I really did not want to be here but….I would really like to

thank my nurses for giving me great advice and when I needed someone to talk to they were there and willing to listen”

“Nurses were all so caring and loving, they made sure you were satisfied with everything”

“All of the activities were excellent and their diversity was fantastic”

“I especially appreciate the individual attention and modification of activities that was offered”

The UNC Perinatal Psychiatry Inpatient Unit provides intensive psychiatric care in a safe and supportive setting and helps to reduce stigma by educating patients and families.

Nursing orientation with cross training modules in OB and Psychiatric Units prepares nurses to meet the holistic needs of Perinatal patients and fights stigma with accurate and research based information.

Success of program required many invested faculty and staff across the hospital system.

Program evaluation measured by patient participation in hospital surveys satisfaction demonstrates excellent treatment response and service satisfaction.


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For more information…www.med.unc.edu/psych/wmd/

Follow us on:Twitter: www.twitter.com/UNCWomensMoodFacebook: www.facebook.com/uncperinatalpsychiatryprogram

David Rubinow, MDChairman of Psychiatry & Director

of Women’s Mood Disorder ProgramSamantha Meltzer-Brody, MD MPH

Director of Perinatal Mood Disorder ProgramElizabeth Bullard, MD

Attending Inpatient Perinatal Psychiatry UnitLynne Burns, BSN, RN

Nurse Manager of Inpatient PerinatalPsychiatry Unit

Mary Tonges, PhD RN FAANCNO & SVP of Nursing at UNC

Anna Brandon, PhD, ABPPBarbara Bybel, DHA, MSN, NEA-BC, PMHNP-BC

References

Andrade SE, McPhillips H, Loren D, Raebel MA, et al. Antidepressant medication use and risk of persistent pulmonary hypertension of the newborn. Pharmacoepidemiol Drug Saf. 2009 Mar;18(3):246-52

Chambers C, Hernandez-Diaz S, VanMarter L, Werler M. 2006. Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Engl J Med. 354(6):579-87.

Cohen L, Altshuler L, Harlow B, Nonacs R. 2006. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 295(5):499-507

Delatte R, Meltzer-Brody S, Cao H, Menard K. 2009 “Universal Screening for Postpartum Depression: An Inquiry into Provider Attitudes and Practice American Journal of Obstetrics & Gynecology, 200(5):e63-4.

Einarson A, Choi J, Koren G 2009 Incidence of major malformations in infants following antidepressant exposure in pregnancy: results of a large prospective cohort study. Canadian Journal of Psych, 54(4):242-6.


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References

Gavin N, Gaynes B, Lohr K, Meltzer-Brody S. et al. 2005 Perinatal depression: a systematic review of prevalence and incidence.Obstet Gynecol. 106:1071-83

McKenna K, Koren G, Tetelbaum M, Wilton L et al. 2005 Pregnancy outcome of women using atypical antipsychotic drugs: A prospective comparative study. J Clin Psychiatry: 66:444-449.

Robinson GE, , Psychopharmacology in Pregancy and Postpartum; FOCUS The journal of Lifelong Learning in Psychiatry (2012) volXp1-12.

Warburton W, Hertzman C, Oberlander TF: A register study of the impact of stopping third trimester selective serotonin reuptake inhibitor exposure on neonatal health. Acta Psychiatr Scand 2010; 121:471-479.

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