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Pearls


How to prepare patients for your maternity leave

Allow time to explore the meaning of the pregnancy with patients and plan for how their needs will be met

Vol. 10, No. 02 / February 2011

Although a psychiatrist’s pregnancy can disrupt the continuity of a patient’s care, it also may be a catalyst for patients to address key therapeutic issues. Working with patients in advance can help ensure that they take advantage of this unique therapeutic opportunity.

How a patient reacts to a psychiatrist’s pregnancy depends on the patient’s personality structure and personal experiences,1 the depth of his or her relationship with the doctor, and how the psychiatrist addresses her pregnancy in the therapeutic context. For example, patients who fear abandonment may act out in unconscious anger at the clinician.1 They may create crises that demand the doctor’s attention, call more often or schedule more appointments than usual, miss appointments, or stop engaging therapeutically. Previously compliant patients may stop following treatment recommendations, including taking prescribed medication.

In contrast, many patients may react warmly to news of their psychiatrist’s pregnancy. They may ask questions about her family life and the baby. Although in some cases these warm feelings may be a patient’s attempt to defend against resentment of the pregnancy, often they can be taken at face value. Patients who are mothers may identify with and feel increased solidarity with pregnant physicians.2 Pregnant patients may feel greater comfort with pregnant psychiatrists, assuming that the clinician may be more closely attuned to their treatment needs.

Pregnant psychiatrists should explore the meaning of their pregnancies with patients. A clinician may be reluctant to do so because she fears her patients may become angry or because of fatigue associated with pregnancy. However, failing to explore what the pregnancy means to patients may prevent them from taking advantage of an opportunity to work through conflicts,2 such as sibling rivalry1 or body image issues for patients with eating disorders. It also can bring up issues related to sexuality, parenthood, and fertility.1

Pregnant psychiatrists should set a date by which they make all patients aware of the pregnancy.2 This will allow time to explore the meaning of the pregnancy and to plan for how the patient’s treatment needs will be met during the leave.

Disclosure

Dr. Troy reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

References

1. Nadelson C, Notman M, Arons E, et al. The pregnant therapist. Am J Psychiatry. 1974;131(10):1107-1111.

2. Tinsley J. Pregnancy of the early-career psychiatrist. Psychiatr Serv. 2000;51(1):105-110.

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