Arch Womens Ment Health (2007) 10: 89

DOI 10.1007/s00737-007-0169-9

Printed in The Netherlands

Book Review

Psychiatric disorders and pregnancy

O’Keane V, Marsh M, Seveviratne G (eds), Taylor & Francis,

New York, 2006. 326 pp, hardcover, £79.00, ISBN 1-84184-

462-4

In the early years of perinatal psychiatry, Marc�ee wrote sig-

nificant works regarding the mental health of women during

pregnancy. Contemporary writers have focused more on the

puerperium. This book corrects this modern imbalance by pro-

viding clinicians with a comprehensive update of antenatal men-

tal health treatment and management issues.

The editors (an obstetrician=gynecologist and two psychia-

trists) advocate for coordinated efforts between obstetrics and

psychiatry in caring for women facing mental illness during

pregnancy, and the choice of contributors reflects the editors’

preference for a multidisciplinary approach. This book will be a

very helpful reference and guide for a variety of health profes-

sionals attending to the mental health needs of women facing

pre-conception planning, pregnancy and post-partum.

Chapters 2, 3, 4 and 5 draw attention to the effects of maternal

mental illness including increased maternal mortality, poorer

obstetrical outcomes, impairment in parenting, child abuse, re-

duced psychological, behavioural and cognitive performance in

offspring, and, in specific circumstances, infanticide. Chapter 2

presents a detailed antenatal screening tool and makes the logical

observation that improved resources will be required to meet the

needs revealed by the tool. It could be noted, at this point, that

references to existing services and legislation are focused on

those of the UK, and may have limited application for readers

from other nations. Chapters 3 and 4 discuss the assessment and

treatment needs of both the mother and the mother-infant dyad.

While Chapter 5 provides an important outline of the maternal

mental health risk factors for child abuse and infanticide.

Chapters 6, 7, 12 and 13 offer excellent management guide-

lines for treating patients with mood disorders and psychosis.

Etiology is examined, and preconception counselling and par-

enting assessments are advised for women with more severe

forms of mental illness. Chapters 12 and 13 offer a particularly

useful summary of the research regarding teratogenicity as well

as safety considerations for pharmacotherapy for women are

pregnant and=or wish to breast-feed their infants. This is accom-

panied by an intelligent discussion of the risks of untreated

mental illness.

Chapters 8, 9 and 11 deal with the issues of eating disorders,

personality disorders, and substance abuse disorders and give

practical strategies for identification and management during

pregnancy. The need for sensitive and skilled interventions, and

the need for increased support to patients during the postpartum

period are highlighted.

Whether a woman has a history of mental illness or not, preg-

nancy and birth will be accompanied by increased and unique

stressors. Chapters 10 and 16 consider the needs of women

experiencing both normal and traumatic levels of stress during

labour and delivery. Chapter 10 presents an interesting summary

of research regarding which patients are more likely to develop

a post traumatic stress disorder following (and in response to)

giving birth. Whereas, Chapter 16 describes the role of stress in

normal labour and delivery, and presents the results of investiga-

tions of ‘‘active management’’ and the role of ‘‘doulas’’ in birth

outcomes. The results are intriguing and the authors encourage

further study of the role of ‘‘doulas’’.

Pregnancy, birth and the puerperium are periods of increased

psychological vulnerability for most women. Chapter 14 de-

scribes the various forms of psychological therapies that can

support the needs of women (and their partners) during this

unique time of psychosocial stress and development. As with

the other forms of treatment, the author concludes that further

evidence-based research is warranted.

Larger, systemic issues of models of health care provision are

examined in Chapter 15. The author of this chapter acknowl-

edges that low-resource countries will require different models

of care than higher-resource countries. The care pathways and

protocols that are presented are models for countries similar to

the UK and the US.

In summary, Psychiatric Disorders and Pregnancy is a clearly

written and comprehensive book that accomplishes the editors’

goals of providing practical antenatal guidance for clinicians and

inspiring young researchers.

Stephanie Bissell, MSW, RSW

Hamilton, ON, Canada