8/10/2019 Maternal Capacity

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Maternal CapacityThere are times when a psychiatrist will be required to evaluate a mothers capacity toensure the care and safety of her newborn baby outside the hospital. Generally, themother has a history of mental illness or addiction. (Other red fla s for the obstetricteam include lac! of prenatal care, homelessness, isolation from supports, lac! of

preparation for the baby, or unusual behavior with the baby or staff after birth." This is

not an easy tas!, and if one e#pects to provide an absolute answer, it becomesimpossible. Over the years, the authors have arrived at certain uidelines to structurethis wor! more realistically.$irst, the most important mission here is not to predict the future based on a dia nosticevaluation, but rather to assist the mother, her family, health care wor!ers, and a enciessuch as C%& in plannin for the care and safety of a baby. 'deally, everyone to ether will be e#plorin supports and decidin on the level of intervention required for accomplishin this oal. The questions that arise are then fairly strai htforward )hat!ind of day*to*day supervision does this mother need+ oes she have difficultyfunctionin alone or under stress+ 'f so, would re ular therapy sessions and visits from

a nurse be sufficient, or would she require a case mana er and an intensive daytreatment pro ram+ )ould a supportive residence be appropriate+ 's a spouse, roup of relatives, or partner prepared to assume uardianship at times when she is unable to

parent+&econd, the mothers willin ness to ac!nowled e the need for support and monitorinis enerally even more important than the severity of her condition. enial and isolationare problematic for any mother- child pair, but fran!ly dan erous when the mother hasa mental illness or addiction. %erhaps the most worrisome presentation is of a mother who tests positive multiple times for cocaine and claims the tests are wron . 'n thiscase, there is enerally no opportunity for intervention or treatment plannin , and themother is essentially unpredictable. One can then only rely on observation from outsidea encies, such

T / )OM01 ) O 2/$3&/& T2/0TM/1T'n some cases, the psychiatrist must assess the capacity of a woman before she ives

birth, especially when she is refusin treatment and demandin to leave the hospitala ainst medical advice.0 common scenario is the woman who endures a lon period of bed rest, then insists onleavin the hospital. Often, there is a crisis at home or a toddler who needs her care.The stress of such conflictin demands is severe, but so is the ris! to mother and babyoutside the hospital. Most of these patients decide to stay after ventin their concernsand receivin additional support from their families and staff. 'n rare cases, however, awoman will ac!nowled e her condition and the ris!s involved, but remain determinedto leave4 sometimes promisin to return when the crisis at home is resolved. 'f she can

present an outpatient alternative for treatment, she will probably be released. owever,the staff should ma!e every reasonable effort to encoura e her to stay or return asquic!ly as possible.Occasionally, a woman may demand to leave, insistin there is no ris! or that she hasno concerns in this area. 'n this case, her 5ud ment mi ht be impaired, and she requiresa psychiatric evaluation.