When To Treat And When To Refer? Understanding The Diagnostic Process

As with all new cases, supervision can be the best source of support when you may have concerns about whether to treat or refer a client onwards. As with many mental health difficulties, it is often the case that the diagnostic process is not as clear cut. This can also be the case with perinatal women due to the added fears related to pregnancy, childbirth and caring for a baby.

Labour can be a traumatic time for a woman, especially if there were complications that put her health, her baby’s health or both of them at risk. As a consequence, this traumatic experience can stay with her for a long time afterwards, affecting how she feels about herself and her baby.

A client may well bring up her birth story during the assessment if she is aware that her current mood is focused on that particular event. This may not always be the case though; if you hear symptoms related to Post Traumatic Stress Disorder (PTSD), use funnelling to gather as much information as you can to take to supervision. If it is PTSD, refer her to secondary care for trauma focussed Cognitive Behaviour Therapy (CBT) or Eye Movement Desensitization and Reprocessing (EMDR), preferably with a clinician who specialises in perinatal care.

However, it may be too soon after giving birth to be diagnosed as PTSD. It may be that the woman needs to talk about her childbirth experience. Explore these feelings and how they affect her. This treatment can offer ways in which these can be explored. Be sure to normalise these feelings with your client; not every labour goes according to the birth plan. The final activity of Week 1 and the start of Week 2 of this course will consider how the mother can identify the factors that trigger thoughts and feelings related to her birthing experience and how her actions are then effected.

Regularly assess to ensure it has not developed into PTSD. If you discover it has, follow the steps outlined above or per your service protocol for identifying PTSD.

It may also be the case that your client feels these problems related to the labour are a primary factor in her low mood. It may be worth considering stepping up or possibly referring to counselling at low-intensity level if the problems are mild. This can also be related to sexual problems with her partner. It may be helpful to ask your client directly about how the birth may 
or may not have affected the sexual relationship. Gather as much information as possible around the relationship problems and discuss possible referrals to behavioural couple’s therapy/ counselling with your supervisor if this is a primary concern for her.

Perinatal Obsessive-compulsive Disorder (OCD) is an under-recognised difficulty that new mothers can experience. Cases of Perinatal OCD are similar to OCD with the experience of intrusive thoughts but can be focused on the baby. This leads to/pairs with by compulsive behaviours that can then focus on ensuring the baby’s health/safety etc.

For example- a thought maybe around harming the baby- “I have a horrible image of pushing the baby under the water when I bathe her.” The mother then may refuse to bathe the baby or may enact a series of routines and checks when bathing the baby.