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Perinatal mental health during the coronavirus: it is okay to mourn



In our series How it is we talk to people of different origins about how their lives have changed as a result of the COVID-19 pandemic. For this part, we spoke to Pooja Lakshmin, M.D., a perinatal psychiatrist certified by the board who specializes in the mental health of women. ( Perinatal means the weeks before and after childbirth.)

Lakshmin currently maintains a private practice in Washington, DC, where she uses telemedicine to treat patients for perinatal mental health problems. As a clinical assistant professor at the George Washington University School of Medicine, she oversees general practitioners in the Five Trimesters Perinatal Psychiatric Clinic. Lakshmin is also a member of the Board of Directors of the Maternal & Mental Health Leadership Alliance, a national nonprofit organization dedicated to promoting maternal mental health policy.

Here are the perinatal mental health trends that Lakshmin noticed in her patients, what she recommends for perinatal people During this crisis and why she says that it is okay to mourn a "normal" pregnancy, labor and postpartum experience that has interrupted the corona virus. (Your answers have been edited and compressed for clarity.)

SELF: What does your work normally involve?

Pooja Lakshmin: The majority of my patients are women who are pregnant and after giving birth. I prescribe medication and offer psychotherapy for clinical conditions such as depression, anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder. Part of my job is to help women understand the profound change of identity during the transition to motherhood and to teach them to take care of themselves in a world where they are constantly focused on caring for others. I'm also excited to share evidence-based mental health information for all stages of women's lives, and I'm launching a digital women's mental health education service in May with a virtual pilot course for small groups.

How has your work now changed with telemedicine sessions instead of personal ones?

Just like in my office, I can have personal conversations with my patients in real time. I still offer psychotherapy, adjust drug doses and even see new patients through telepsychiatry. Because of the pandemic, government agencies have relaxed some regulations to encourage as many medical professionals as possible to use telemedicine services.

Do you see mental health trends in your patients?

I. I see a worsening of mood and anxiety symptoms in my patients, including obsessions and compulsions, feelings of hopelessness, and loneliness and insomnia.

The lack of certainty as to when social distance measures end and when children return to school is particularly destabilizing. Without the reliable external structure of going to work or school, time melts and it is more difficult to feel mentally and emotionally organized. We also have no access to common coping mechanisms such as attending a real yoga class or spending time with friends in person. Now that many of my patients are reconciling full-time work, childcare, and home tuition, they have even less time for themselves.

Do you think this linchpin for telemedicine provides better access to mental health? Care for perinatal women?

The COVID-1

9 pandemic has required the entire area to change dramatically fairly quickly. In many ways, this has improved patients' ability to seek services. Before COVID-19, childcare or work duties were limiting factors for my patients. It is much easier for some mothers to meet on video.

However, these telepsychiatry sessions have disadvantages. Data protection is more difficult. In addition, there is still a large part of our population who do not have access to psychiatric services due to costs and lack of insurance coverage. Many of these patients also have no access to computers or telemedicine, and their needs are still not being met.


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