Ever wondered what it's like to be a psychiatrist? This series explores a day in the life of psychiatrists who work in different areas of psychiatry.

In this article, we hear from consultant psychiatrist Dr Lyndall White AM who specialises in perinatal mental health.

A Day in the Life of a Perinatal Psychiatrist

In my office I have a beautiful set of Matryoshka or nested dolls. We are all familiar with the skilled craftsmanship that goes into making each set of these amazing symbols of a woman carrying a child within her. This mother in turn is surrounded and supported by “mothers” at symmetrical and concentric levels. 

The Matryoshka dolls are a perfect symbol to me of the work done by so many perinatal mental health professionals at so many different levels and over time to support and empower each mother and infant we care for. What a privilege.  

Why I chose to specialise in perinatal psychiatry

I was a late and rather reluctant recruit to psychiatry. My second-year internship saw me as a paediatric and then neonatal intensive care unit (NICU) registrar. Thereafter I spent ten years in remote and rural general practice. Following eighteen months overseas while my husband pursued postgraduate study, I “happened “upon a six-month non-training psychiatric registrar position. I then realised that all my previous workplace experience had been excellent training for psychiatry. 

I planned to become a child psychiatrist. After completing my general Fellowship, a year into child work saw me disillusioned with what I called “parental attention deficit disorder”.  Perinatal psychiatry was fledging at the time but I was determined to work with parents and their infants and attempt to ‘get the attachment right from the beginning’. Now many years later, the RANZCP’s Section of Perinatal and Infant Psychiatry is working towards becoming a College Faculty in the near future. 

What does perinatal psychiatry entail?

Perinatal psychiatry is such a complex and challenging field. Not only do we treat every type of serious mental illness, substance use disorder and personality vulnerability, but it is frequently in an acute and urgent setting driven by the complexities of hormonal shift, sleep deprivation and fragile attachment. Then there is the challenge of pharmacotherapy and neurostimulation treatment with potential effects on a foetus or newborn to always consider.

Working as a perinatal psychiatrist

I have the privilege of working in a large private hospital with a ten bed Mother Baby Unit. This context provides an enriching and safe environment for mothers and their infants. The unit has a strong multidisciplinary team approach. The programs are diverse and comprehensive, not only covering parenting and attachment but also therapies including cognitive behavioural therapy (CBT), Positive Parenting Program, Circle of Security and dialectical behavioural therapy (DBT). The unit is co-located with a High Dependency Unit where mothers with severe mental illness can be securely treated.

Working in this context has allowed me the opportunity to provide inpatient care and support a busy outpatient practice. I also provide private consultation liaison to two busy Obstetric Units. Mentoring advanced trainees is a privilege as is the teaching of medical students in daily rounds and weekly supervision. My day’s work is richly diverse. 

A varied outpatient clinic caseload

A recent outpatient clinic began with the review of a young mother whom I had previously seen in acute Consultation–Liaison. Three nights of acute sleep deprivation post-delivery had initially made it a challenge to discern clinically whether she was suffering delirium or early postpartum psychosis.

Next was a first meeting with a young woman with a complex mood disorder who attended for preconception planning with respect to her psychotropic medication. This appointment was followed by a regular review of one of my most severe postpartum psychosis patients who had previously required emergency electroconvulsive therapy (ECT).

My next two cases were both health professionals. One had suffered severe postnatal depression (PND) with suicidal ideation and had required inpatient care. The other had previously suffered a brief psychotic illness following major surgery and had recently given birth to her first child.

The following patient was a woman with an unplanned pregnancy where paternity was uncertain. Her mental state was complicated by more than twenty years of unsupervised psychotropic medications and substance use. This case was challenging both clinically and psychosocially. 

Inpatient perinatal psychiatry

I chaired a weekly multidisciplinary team meeting attended by psychiatrists, allied health professionals, clinical nurses, the team registrar and medical students. This was followed by a supervision session for a junior colleague and a new urgent PND case assessment.

The inpatient round that day included two new postnatal admissions who were both new mothers, one with an alcohol abuse disorder and the other with severe anxiety and obsessive-compulsive disorder.

Review of other inpatients included two mothers with resolving acute PND with anxious distress and a patient with relapsing major depressive disorder and generalised anxiety disorder, whom I had cared for during each of her four pregnancies. I also briefly reviewed a patient of twenty years with acute Bipolar I depression whom I had cared for in both of her pregnancies as well.

A young woman with complex personality issues and major depressive episode (MDE) was having Transcranial magnetic stimulation (TMS). She had recently lost her first pregnancy and was grieving this loss.

Another long-term patient with complex post-traumatic stress disorder, recurrent MDE and infertility was receiving ECT for an acute relapse as was my one male patient on that round.  He had a complex presentation of MDE, multiple medical comorbidities and a challenging psychosocial situation. 

The final inpatient was in the High Dependency Unit. She had previously suffered severe PND and was now diagnosed with multiple medical comorbidities. Her recent major psychosocial loss together with an active substance use disorder had complicated her MDE with significant suicidal ideation and plan.

That week I was also regularly reviewing two acute consultation liaison cases in a Maternity Unit. One patient suffered from an acute adjustment disorder with anxiety while the other mother was experiencing the great sadness of her infant being nursed in NICU with a previously undiagnosed serious congenital disorder.

One of the major aims in perinatal psychiatry is to promote maternal wellbeing across as many domains as possible, thereby maximising best foetal and infant development. This work truly is an investment in the future.

Disclaimer: Any patients mentioned in this article have been deidentified and created for the purposes of this article. This article may represent the views of the author and not necessarily the views of The Royal Australian and New Zealand College of Psychiatrists ('RANZCP'). By accessing the article you also agree to the RANZCP Website Terms of Use Agreement.