Abstract:
Auckland's Mother and Baby Unit (MBU) was established in October 2014 to provide inpatient treatment for women with perinatal mental illness. Co-admission of their infant supported the mother-infant relationship and enabled the needs of the infant to be examined. This mixed methods, observational design examines maternal, infant and relational outcomes, and maternal subjective experience, during admission and in the post-discharge period. The demographic profile of women admitted to this service was atypical for mental health services, with 60% being ethnic-majority and high educational and income status. Women had high rates of mental illness antenatally (62%) and had high comorbidity, including secondary diagnoses (69%), personality psychopathology (40%) and use of illicit substances (24%). Irrespective of diagnosis, women improved symptomatically and functionally during admission, however within three months post-discharge, 31% were experiencing a significant deterioration and 17% were readmitted to inpatient care. Early infant adversity was observed; being born small (20%), experiencing physical health (33%), mental health (51%) and developmental concerns (51%). Multiple approaches to the measurement of mother-infant interactions were utilised, and results were concerning, both at discharge, and three months post-discharge. At this time, only 17% of relationships were adequate and 10% of infants had been placed in out-of-home care. Inconsistent correlations were observed between maternal and relational outcomes (discharge, r²=0.29, p=0.07; post-discharge, r²=0.03, p=0.89). Qualitative analysis illustrated the fear and negative self-perceptions women experienced when they were unwell. Women valued co-admission of the infant, staff warmth and availability, inclusion of their families and holistic care practices. The inpatient experience was influential in their reflections and recovery in the postdischarge period. Collectively these findings suggest that this new, small MBU is associated with improvement in maternal mental illness and was an acceptable approach to care for these women. However, the wellbeing of their infants warrants further clinical consideration. Valid measures are essential to progressing research on caregiving interactions. Future studies should have increased emphasis on cultural acceptability, comparative models of care and addressing the needs of infants. Keywords: mother and baby unit, postpartum disorders, mother-infant interaction, mother-infant relationship, infant outcomes.
