"Pregnant women suffer some kind of psychological issue in 25% of cases"

 

There is an ever-growing interest in all mental health-related issues, to the point that healthcare is already starting to tackle areas that had previously received little attention, such as pregnancy, birth and the postpartum period. This is the focus of the Social Obstetrics and Mental Unit of the Vall d'Hebron University Hospital, a pioneering department that seeks to tackle each case from a clinical standpoint, while also taking into account the social dimension. Elena Sánchez Echevarría is a medical social worker in the unit and an adjunct instructor for the UOC's Master's Degree in Medical Social Work.

 

There is an ever-growing interest in all mental health-related issues, to the point that healthcare is already starting to tackle areas that had previously received little attention, such as pregnancy, birth and the postpartum period. This is the focus of the Social Obstetrics and Mental Unit of the Vall d'Hebron University Hospital, a pioneering department that seeks to tackle each case from a clinical standpoint, while also taking into account the social dimension. Elena Sánchez Echevarría is a medical social worker in the unit and an adjunct instructor for the UOC's Master's Degree in Medical Social Work.

This is a very new area within psychiatry. Its mission is to treat psychiatric disorders over the course of pregnancy, the postpartum period and breastfeeding. It's also a new specialist field within medical social work, which we're starting work on now.

According to WHO data, pregnant women suffer some kind of psychological issue in 25% of cases and one in five mothers will experience a mental health condition during pregnancy or in the year after the birth. Aside from the clinical diagnosis, it's important for women to also benefit from a social assessment and a medical social diagnosis.

We find problems like anxiety, depression, substance abuse during pregnancy and severe mental disorders: borderline personality disorder, bipolar disorder and schizophrenia, among others.

The lack of support, detection and treatment can have long-term consequences for the woman, the baby and the rest of the family. 

There are an increasing number of perinatal psychiatry units and specialists. For me, though, the main change is also being able to tackle the social side, and offer the necessary support for mothers, newborns and the rest of the family. A social approach should be the priority, and every team should include a medical social worker to deal with the psychosocial issues arising for the women and the family.

Over time, we're realizing that the care with which we provide people needs to be holistic. In the case of maternal mental health, it should be a priority in every field, because it affects the entire family. Studies indicate that the link between mother and baby is key in a child's development. If we work on this basis, we'll be establishing some prevention measures, and it could be said that healthy mothers mean healthy babies – and healthy babies, healthy children. And this helps us build a society that is healthier in general.

It's essential for us to anticipate certain situations that may arise at the time of childbirth. Childbirth is a time of enormous life changes for women and so we need to ensure that work is coordinated between the different teams and professionals in the environment in which the woman is living.

Every perinatal team should consider having a medical social worker, as I've said. A few hours of social work are not enough. The complexity of the cases we sometimes deal with calls for a lot of intervention with the woman and a huge amount of interdisciplinary coordination with the primary healthcare services, childcare teams, voluntary sector organizations, etc. If we want to work using a biopsychosocial approach, the medical social worker needs to be present. 

What we in the unit look at are the clinical, social and cultural factors that have an impact during the gestation period and that may increase the chance of a high-risk pregnancy. We aim to work with women before the baby is born and see which circumstances may end up creating problems.

There's no catch-all profile. We have a very wide range of cases, including underage pregnancies, victims of violence against women, drug use, other situations of social risk or cases in which women haven't received enough medical care during pregnancy, with fewer than three appointments with a specialist.

There are minors who realize they are pregnant in the sixth month. Or, women coming from other countries seeking a new life and who are pregnant or find out they are here, with no social support network and having to deal with a major change in their plans. There are also other kinds of cases, such as women who, while pregnant, find that their future baby has a heart problem, who live outside of Barcelona and, on top of all the stress of the birth and of a possible operation, have to face up to the logistics of the time they'll have to stay here. These are just some examples. Each of the 270 cases we dealt with in 2022 was different and had its own individual features. 

There are perinatal psychiatric units in other hospitals. The difference with us is the way we work together in obstetrics, psychiatry, psychology, neonatology and medical social work. Obstetrics has always featured medical social work, and it's something that's taken into account in all hospitals, but that tends to be carried out at the medical team's request. In other words, its interventions are reactive. Our unit aims to ensure intervention is proactive and that alerts can also be raised by nursing staff, the midwife and the rest of the team. We want to integrate social intervention prior to childbirth, via outpatient appointments, and we want medical social workers to have their own schedule.

The year 2023 marks the 10th anniversary of its start-up, thanks to Dolors Colom Masfret, and, to date, it's the only official master's degree in the discipline, which has seen it establish the theoretical foundations for medical social work. Another important aspect is that this programme provides access to the doctoral programme in Health Sciences, something that wasn't the case until now.

I belong to the first set of graduates who became passionate about medical social work thanks to this programme, and I've spent five years teaching on it, first as course instructor and now as adjunct instructor. It's been an ongoing learning process. Being at the UOC allows for, and demands, constant professional growth.