Post-partum psychosis is a consistent source of new episodes of severe mental illness and its worldwide prevalence has remained unchanged at 1 in 1000 live births over the past 150 years. For some women, admission to hospital is necessary. In the UK special mother and baby units (MBUs) are available in some areas to allow mothers to remain with their babies during treatment. This can help avoid the potential detrimental effects of separation from the mother on the baby and the effect this separation would have on the mother's confidence and capability as a future carer.
While surveys have reported that many women strongly prefer admission to MBUs, there are concerns that admitting a baby to a psychiatric unit for long periods of time may be harmful in terms of institutionalisation of the baby, and the rarer potential risk of physical harm from severely ill mothers. Although MBUs are recommended as the optimal site for treating a perinatal psychosis in the UK, outside of some parts of Australia, Europe, Canada, and New Zealand, they are either virtually non existent or very limited. There is no real clarity in the literature to explain the reasons why there is such a difference in the treatment of women with mental illness around the world.
To assess the efficacy of MBUs we systematically searched for any randomised trials of MBUs compared to standard care. We found no trials involving either mothers suffering from post partum psychosis or severe post natal depression. Anecdotal results from a 1961 trial did suggest a beneficial effect, but non-randomised data from over 40 years ago is difficult to apply to today's care. Such lack of data is of concern as MBUs are expensive to set up and run. If they are to be the 'gold standard' of care for mothers and their babies, their effectiveness needs to validated. Good quality, relevant research is urgently needed.
Mother and bay units are reportedly common in the UK but less common in other countries and rare or non-existent in the developing world. However, there does not appear to be any trial-based evidence for the effectiveness of these units. This lack of data is of concern as descriptive studies have found poor outcomes such as anxious attachment and poor development for children of mothers with schizophrenia and a greater risk of the children being placed under supervised or foster care. Effective care of both mothers and babies during this critical time may be crucial to prevent poor clinical and parenting outcomes. Good, relevant research is urgently needed.
Mother and baby units (MBUs) are recommended, in the UK, as an optimal site for treating post partum psychoses. Naturalistic studies suggest poor outcomes for mothers and their children if admission is needed during the first year after birth, but the evidence for the effectiveness of MBUs in addressing the problems faced by both mothers with mental illness and their babies is unclear.
To review the effects of mother and baby units for mothers with schizophrenia or psychoses needing admission during the first year after giving birth, and their children, in comparison to standard care on a ward without a mother and baby unit.
We undertook electronic searches of the Cochrane Schizophrenia Group's Register (June 2006).
We included all randomised clinical trials comparing placement on a mother and baby unit compared to any other standard care without attachment to such a unit.
If data were available we would have independently extracted data and analysed on an intention-to treat basis; calculated the relative risk (RR) and 95% confidence intervals (CI) of homogeneous dichotomous data using a random effects model, and where possible calculated the number needed to treat (NNT); calculated weighted mean differences (WMD) for continuous data.
Unfortunately, we did not find any relevant studies to include. One non-randomised trial, published in 1961, suggested beneficial effects for those admitted to mother and baby units. For the experimental group, more women were able to care for their baby on their own and experienced fewer early relapses on their return home compared with standard care. Care practices for people with schizophrenia have changed dramatically over the past 40 years and a sensitively designed pragmatic trial is possible and justified.