Case Study 3
SB, 43, married (husband abroad), unemployed, lives with 22 year old son.
Baby L 2 weeks on admission to Coombe Wood
Has 7 year history of schizophrenia, two previous psychiatric admissions
(experiences chronic auditory hallucinations). Under care of Intensive Mental
Health Care Support Team for 1½ years.
Was made by ICST during pregnancy for support in managing SB’s perinatal
Reason for Admission
Following an unplanned pregnancy, SB’s antipsychotic medication
(Clozapine) was changed to Haloperidol (relatively safe in pregnancy). There
were concerns about risk of relapse of mental illness during pregnancy or
following delivery. Additionally SB had a number of physical health issues –
severe asthma, hypertension, diabetes and osteoarthritis, which along with
her mental health issues, raised concerns about ability to care for baby. SB
had several admissions to general hospital during the pregnancy with severe
asthma attacks and had to be started on insulin as her diabetes was poorly
Coombe Wood Community Team (psychiatrist and CPN) were involved in
pre-birth planning meetings, along with SB’s midwives, mental health team
and children and families social services. An admission to Coombe Wood
post delivery was planned in order to assess and monitor SB’s mental health
and care of baby.
Baby was delivered by LSCS. SB developed bilateral DVT post delivery and
was admitted to a medical ward to initiate anticoagulant treatment, while baby
L remained in neonatal unit. Mother and baby were subsequently transferred
to Coombe Wood.
Treatment and Progress
On admission SB was medically unstable with shortness of breath and poor
mobility and needed interventions for her physical health. She needed regular
blood tests to manage her anticoagulant therapy, the treatment of her
diabetes was gradually changed from insulin injections to oral hypoglycaemic
and prednisolone (prescribed for acute asthma) was gradually reduced and
She was treated with antipsychotic medications. Her mental health remained
stable, despite considerable stress. She was supported fully with the care of
her baby initially. As her physical health improved, she became more involved
in caring for her baby. Her mobility difficulties and daily living skills were
assessed by the occupational therapist at Coombe Wood and at SB’s home
and the community physical disability team were involved to support her at
home. Coombe Wood recommended that children’s social services assess
and monitor SB’s parenting of L at home following discharge. A discharge
CPA meeting was held at SB’s home and a number of community
professionals were involved in aftercare.