Elena (not her real name) was admitted in March 2023 due to postpartum psychosis, with symptoms such as hallucinations, delusions, disorganized behavior and depression.
After arriving by ambulance during a crisis, she remained admitted to the Llerena Hospital (Badajoz) for 17 days.
There she received specialized care and during her stay at the center she had the opportunity to be with her two and a half year old daughter and her three month old baby, which she describes as a very positive experience: “Being able to be with my children helped me a lot. to recovery.”
In December 2022, this hospital implemented a care model in the mental health area according to which mothers with serious mental illnesses are hospitalized with their babies, based on the evaluation of the patient's needs.
“The intention is to maintain this approach, since it has proven to be highly satisfactory due to its results and the benefits it has had for both the mother and the baby,” says Carmen Ayala, the supervisor of this area.
As she explains, this type of more respectful stay offers a safe and supportive environment, facilitates clinical recovery and strengthens the mother-baby bond.
Although in Spain, except in the case of the Llerena Hospital, these units are still a non-existent model, in other countries such as the United Kingdom - a world reference in the field of maternal mental health -, France, Canada and Australia they have been implemented. implemented this care model successfully.
“It is very difficult to understand that almost nothing has been done in Spain when it is an issue that is linked to moments—pregnancy, childbirth and the postpartum—in which there is a psychological vulnerability,” says Lluïsa García-Esteve, psychiatrist and creator from the Perinatal Mental Health Unit of the Hospital Clínic of Barcelona.
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With the arrival of children, married life is no longer what it was.
According to the Maternal Mental Health Alliance, an organization to educate and inform about issues related to perinatal mental health and motherhood in general, at least one in five women develops a mental illness during pregnancy or in the first years after birth. to have a baby.
The answer to this gap in health care, despite the data, is found by García-Esteve in that “there has been a historical negligence of inattention to women's health.”
A mother-baby day hospital
García-Esteve highlights the importance of perinatal mental health care programs, which are the previous step to the creation of mother-baby units.
In Spain, although there is no national plan, there are some public health programs initiated by professionals aware of this need.
The Barcelona Clinic, led by this doctor, is considered a pioneer, which in 1989 responded to the lack of attention to the mental health of pregnant and postpartum women at a time when there was nothing.
“We began to realize that there were women with mental disorders who wanted to be mothers.
We needed to know how they were medicated during pregnancy, what type of support they needed, what follow-up they would require in the postpartum…,” she explains.
Other women, according to the psychiatrist, debuted during this period with some disorder, despite having had a normal pregnancy and not having a previous diagnosis.
“Being with them, I realized that mental health was neglected.”
Perinatal Mental Health Unit of the Hospital Clínic of Barcelona where mothers can receive psychological treatment and be with their babies.
Thus, they began to treat patients with disorders in the perinatal stage on an outpatient basis, but it was not until 2018 when the project
,
called the Perinatal Mental Health Unit, began in two phases.
The first phase consisted of the consolidation of the existing outpatient clinic and the creation of a mother-baby day hospital, inspired by what the psychiatrist had seen in London, knowing first-hand the mother-baby units with total hospital admission, and in the experience and knowledge that he had acquired at the Clínic.
“We saw that having a day hospital could be very useful, cheaper, and that it did not interrupt the mother's coexistence with her environment,” recalls her promoter.
The day hospital was inaugurated with a capacity for 10 mothers and 10 babies, but currently its capacity has tripled.
A second phase is planned, consisting of the creation of a joint hospital admission unit for the most serious cases of maternal mental health (postpartum psychosis, decompensated bipolar disorder, severe depression in which the mother and baby are at risk).
“The day hospital must be understood as a halfway device: it is not an admission, nor a meeting place for mothers, but instead therapeutic interventions are generated with different specialists,” says García-Esteve.
Multidisciplinary interventions are carried out here, from psychiatry, clinical psychology, child and adolescent psychology, mental health nursing, pediatric nursing and social work.
A concrete example of intervention is in the case of mothers who experience impulsive phobia, a fear of drowning the baby during bathing.
In this situation, an approach is carried out that involves exposing yourself to the task of bathing your child, but with the support and accompaniment of specialized professionals.
The importance of the link
Ana (fictitious name) was also admitted to the Llerena Hospital unit.
She stayed for almost a month in 2022 due to severe postpartum depression.
She says that having the baby close to her allowed her to hold on to a reason for her to get better and leave the hospital.
“We have a totally normal mother and son bond.
I guess not being separated for that time helped us maintain it,” she says by phone.
“You cannot think about mental health care for mothers without taking the baby into account,” highlights García-Esteve.
According to the expert, the evidence is clear: contact with the baby and breastfeeding favor the bond and recovery of the mother.
“Science says it and it is confirmed by the experience we have of mothers themselves,” she points out.
Promoting and working to achieve a secure bond is, for García-Esteve, a way to promote healthy neurodevelopment and, therefore, a form of prevention at an early age of diseases of adulthood.
Lluïsa García-Esteve, psychiatrist and creator of the Perinatal Mental Health Unit at the Hospital Clínic of Barcelona.
Mónica Díaz de Neira, a clinical psychologist who participates in the Perinatal Psychiatry and Mental Health Program at the Puerta de Hierro Hospital in Majadahonda (Community of Madrid), agrees that perinatal mental health care has a preventive focus in itself.
This care affects not only the suffering of families and their children, but also the relationship and bond that will be established between them.
“We know that bonding will determine the type of attachment that children develop and, in turn, there is a lot of scientific evidence about the relationship between secure attachment and mental health.”
In the perinatal mental health program at their medical center, they care for women with complicated pregnancies at different levels that cause suffering;
to mother-baby dyads in complex situations that may put bonding at risk, such as hospitalization of the baby, traumatic experiences around childbirth or maternal psychopathology after birth;
as well as families facing the death of their child during pregnancy or after birth.
Here there is still no mother-baby unit, although for Díaz de Neira it would be desirable.
They do provide specialized psychological and/or psychiatric support when required during a hospital admission for the mother or baby.
Carmen Ayala Lebron encourages other hospitals to follow in her footsteps: “We adapted the resources we had to change the care of mothers.
Other units can do it the same way.”
Likewise, she maintains that, if this were not possible, it would be a matter of assessing what resources are necessary (whether structural or human) and exposing the needs to managers.
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