Saving the Life of a Pregnant Woman

Someone dear to me and my family recently experienced a major health crisis. After giving birth to a healthy baby boy, our friend developed a mental disorder known as postpartum psychosis. Like most people, I was vaguely aware of the risks of postpartum depression, but I had never heard of postpartum psychosis – a rather rare condition affecting about one to two persons per 1000 births.¹ The Cleveland Clinic offers this definition: “Postpartum psychosis is a mental health emergency,” and adds that this is a “reversible – but severe – mental health condition that affects people after they give birth.”²

Our friend’s psychotic break led her to jump from a third-story balcony onto concrete sidewalk – a fall only partially mitigated by first crashing into a bush. Remarkably, she survived, but she required months of intensive hospital care and a number of reconstructive surgeries.

The story has a good ending. A few days ago, we received photos of our friend with her husband and their adorable son. As with most people who experience postpartum psychosis, our friend has recovered her mental health, though her risk of recurrence is higher if she becomes pregnant again.

This story awakened me to the reality of the most frequently encountered health risk of pregnancy. In the words of a clinical psychologist, with extensive experience specializing in maternal mental health, “mental illness is the single most common complication of pregnancy.”³ According to the World Health Organization (WHO), one in five pregnant women develops a psychiatric disorder in conjunction with pregnancy and childbirth.⁴

For those who are devoted to the provision of “whole person care,” effective attention to mental health is essential. Unfortunately, the culture I know best still harbors attitudes toward mental health and mental illness that make whole person care difficult. Such attitudes are displayed in bold relief when it comes to the current wave of state laws designed to ban or greatly curtail abortion.

Most of these laws make provision for exceptional cases in which the life or health of the pregnant woman is in jeopardy. But risks to the woman’s mental health are often intentionally omitted from the exception-making criteria.

Consider, for example, the wording of proposed legislation in South Carolina in defining what counts as a medical emergency: “‘Medical emergency’ means in reasonable medical judgment, a condition exists that has complicated the pregnant woman's medical condition and necessitates an abortion to prevent death or serious risk of a substantial and irreversible physical impairment of a major bodily function, not including psychological or emotional conditions.”⁵

Similar language is used in Iowa’s abortion ban, currently being disputed in that state’s courts: “‘Medical emergency’ means a situation in which an abortion is performed to preserve the life of the pregnant woman whose life is endangered by a physical disorder, physical illness, or physical injury, including a life-endangering physical condition caused by or arising from the pregnancy, or when continuation of the pregnancy will create a serious risk of substantial and irreversible impairment of a major bodily function of the pregnant woman.”⁶

The case of a pregnant 18-year old who recently received care in the health system where I work illustrates how misguided the exclusive attention to “physical disorders” could be. Shortly after the beginning of her pregnancy, the patient began experiencing short-term memory loss and hallucinations.⁷ Diligent work of a multidisciplinary medical team finally uncovered the cause of the mental illness. A tumor on one of the patient’s ovaries had triggered a brain inflammation called anti-NMDA receptor encephalitis.⁸ However, surgery to remove the tumor did not relieve the mental health crisis for the patient. In some cases, such encephalitis can be exacerbated by pregnancy. Failure to achieve prompt and definitive treatment of the encephalitis may lead to permanent mental deficits or even death.

Finally, the decision was made to terminate the pregnancy after which the patient’s condition improved dramatically. The patient will continue to need long-term care for the underlying causes of her encephalitis. However, timely medical interventions helped to restore her mental health and may have saved her life.

Cases of this sort call into question the deliberate exclusion of mental health criteria when assessing the health needs of pregnant patients. The current political polarization caused by lightning-rod issues such as abortion should not be allowed to obscure the need for whole-person care, including special attention to the mental health needs of those who are pregnant.

Author Bio:

Gerald Winslow, PhD

Dr. Winslow is the Founding Director of the Institute for Health Policy and Leadership and the Research Professor of Religion and Ethics at Loma Linda University School of Religion. His research interests include biomedical ethics and the relationship of social ethics to health policy.

References

1. Cleveland Clinic, “Postpartum Psychosis,” available at https://my.clevelandclinic.org/health/diseases/24152-postpartum-psychosis Accessed July 24, 2023.
2. Ibid.
3. Aimee Danielson, “Opinion: We Don’t Talk Enough about the Single Most Common Complication of Pregnancy, CNN, July 14, 2023. Accessed July 24, 2023 at https://www.cnn.com/2023/07/14/opinions/motherhood-maternal-mental-health-programs-danielson/index.html
4. World Health Organization, “Launch of the WHO Guide for Integration of Perinatal Mental Health in Maternal and Child Health Services,” September 19, 2022, available at https://www.who.int/news/item/19-09-2022-launch-of-the-who-guide-for-integration-of-perinatal-mental-health Accessed July 25, 2023.
5. South Carolina proposed legislation, S474 available at https://www.scstatehouse.gov/sess125_2023-2024/bills/474.htm accessed July 24, 2023
6. Iowa State Code Chapter 146B Abortion – Postfertilization available at https://www.legis.iowa.gov/docs/code//146B.pdf
7. Molly Smith, “Multidisciplinary Team Saves Teen from Hallucinations with Astute Diagnosis,” Loma Linda University Health News, March 14, 2023, available at https://news.llu.edu/patient-care/multidisciplinary-team-saves-teen-from-hallucinations-with-astute-diagnosis. Accessed July 25, 2023.
8. For a detailed description of this disorder see Debopam Samanta and Forshing Lui,“Anti-NMDA Encepalitis,” National Library of Medicine, December 22, 2022, available at https://www.ncbi.nlm.nih.gov/books/NBK551672/ Accessed July 25, 2023.