Dr. Phil Kronk: Psychiatric issues and pregnancy risks over time
The risks for a pregnant female may be greater than we realized. A recent New York Times’ editorial noted that maternal mortality in the United States has risen by more than half since 1990.
For example, in New York City, African American women “are 12 times more likely to die from childbirth related causes as white women.” The national figure is three times more likely.
It is shocking to grasp that in New York City, African American women have childbirth complication rates comparable to the country of Sierra Leone. That African country has the fifth highest maternal mortality rate in the world.
What are the pregnancy risks in our community?
Monte Biggs, M.D. has been involved in many aspects of caring for families throughout his long career as an internal medicine specialist and Professor of Medicine at the University of Tennessee Medical Center in Knoxville.
Now retired, but still unbelievably active, Dr. Biggs can look back on the many ways he served the medical needs of families from pregnancy on, delivering babies, caring for multiple generations of family members (sometimes, three or four successive generations), and starting a volunteer “cuddling service” with his wife, Shannon, for infants born prematurely and often, hooked on opioids, long before we were conscious of an opioid crisis in our country.
I recently sat down with Dr. Biggs at his home for this third column on pregnancy risks, particularly concerning the use of or discontinuation of psychiatric drugs. Please see the last two columns for specific facts.
Dr. Biggs brought my attention to a very important fact. Thirty to 50 years ago, most babies were born to women in their teens and early 20s.
Dr. Biggs explained that this was important because by the time a woman reaches her 30s and beyond, she has a “different physiology.” Her body is different, but not just on the outside. She has had a longer history of “hormonal intrusions” that younger women have not yet progressed through. A woman in her thirties and beyond has had her body exposed to a greater variety of environmental factors than a younger woman.
The New York Times article noted that the three leading causes of childbirth-related deaths today were: hemorrhage, hypertension and blood clots.
Dr. Biggs noted that social pressures and traditions decades ago also contributed to a different type of pregnancy.
Some women could not take artificial birth control due to religious factors. Dr. Biggs noted that he felt concern for a woman, who already had several children, but needed to take care of herself during pregnancy. How much more difficult was it to be treated for a psychiatric issue when you had a household to run and multiple children to take care of?
This was where family and friends helped the pregnant and postpartum woman decades ago. Such care was needed if the woman experienced psychiatric problems after giving birth. Dr. Biggs noted that such issues ranged from the mild “baby blues” to postpartum depression to postpartum psychosis.
Dr. Biggs noted that today more pregnancy and delivery issues are tied to opioid addiction today. He and Mrs. Biggs remembered the first cuddling programs and classes they started to help premature and newborn infants, who were withdrawing from narcotics. These memories are bittersweet for the Biggs. Helping and cuddling an infant always seems rewarding to many, but it is difficult to imagine the ongoing, intense suffering of these children.
Dr. Biggs noted that the present state of pregnancy care also has many positive aspects, including many new technologies. He believes that “banked embryos” facilities could now be fraught with issues. We shared our thoughts about the recent facility that had a technical electrical incident that destroyed those frozen embryos as well as the hopes and dreams of so many parents.
Finally, pregnancy issues can go beyond those nine months and the delivery room. Pregnancy events have been potentially associated with issues, such as ADHD and learning disabilities, seen later in a child’s life.
Phil Kronk, M.S., Ph.D. is a semi-retired child and adult clinical psychologist and clinical neuropsychologist. Dr. Kronk has a doctorate in clinical psychology and a postdoctoral degree in clinical psychopharmacology (the use of drugs to treat psychiatric disorders.) He writes a weekly Friday online column on mental health for the Knoxville News Sentinel’s website, knoxnews.com. He can be reached at (865) 330-3633.