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Brooke Harbor Health System

PMHNP Clinical Learning Environment

TRAINING ENVIRONMENTFictional educational health system · No real patient data

Specialty Practice Area

Specialty Practice GuideGuidance for a population, acuity, or practice context.

Perinatal and Reproductive Psychiatry

Psychiatric care during preconception, pregnancy, and postpartum requires weighing maternal illness against medication and fetal or infant exposure risks. Untreated psychiatric illness also carries important risks for both parent and child.

Clinical application

Using this resource

Apply these prompts within the simulated clinical context. They support—but do not replace—clinical judgment, supervision, consultation, current guidance, local policy, law, or emergency procedures.

Use this when

  • A reproductive transition or goal changes the information, consultation, monitoring, or shared decision needed now.

Clarify first

  • Identify the decision required at this stage and whose input is needed.

Act now

  • Compare feasible options and coordinate one monitoring plan across involved clinicians.

Document and communicate

  • Record the clinical context, options discussed, known risks and uncertainties, patient preferences, consultation, and rationale for the agreed plan.
  • Specify monitoring, follow-up, care-team responsibilities, transition planning, and what changes would prompt reassessment.

Escalate or consult when

  • Symptoms are severe or rapidly changing, or include psychosis, mania, catatonia, acute safety concerns, marked functional decline, or significant medical or obstetric complications.
  • The decision involves complex exposure, conflicting recommendations, treatment resistance, limited evidence, or needs beyond the current clinician’s scope.

Practice overview

Care across a changing reproductive timeline

Treatment decisions should reflect the individual's psychiatric history, current symptoms, reproductive stage, preferences, support system, medical context, and the risks of both treatment exposure and untreated illness.

Care model
Longitudinal psychiatric care coordinated closely with obstetrics, pediatrics, and lactation support
Typical pace
Visit frequency increases across pregnancy and the early postpartum period, with rapid escalation pathways for acute presentations
Population
Individuals who are preconception planning, pregnant, or postpartum, and their infants

Common presentations

  • Preconception psychiatric planning and counseling
  • Psychiatric illness onset or exacerbation during pregnancy
  • Perinatal depression, anxiety, and OCD
  • Bipolar disorder in the perinatal period
  • Postpartum psychosis
  • Medication safety questions across pregnancy and lactation

PMHNP priorities

  • Weigh risks of untreated illness against medication and fetal or neonatal exposure risks
  • Use current, specific evidence when addressing medication safety in pregnancy and lactation
  • Recognize postpartum psychosis and initiate immediate emergency action
  • Include sleep protection and parent-infant bonding in the treatment plan
  • Coordinate closely with obstetric and pediatric care

Care team

Reproductive psychiatrists, PMHNPs, obstetricians, maternal-fetal medicine clinicians, pediatricians, lactation consultants, doulas, and postpartum support services.

Clinical Sources

Use exposure-specific evidence rather than general impressions

Decisions about medication in pregnancy and lactation turn on the specific drug, dose, timing, and the risk of untreated illness. Consult a current exposure-specific source for the agent in question rather than relying on category-level generalizations.

LactMed

NIH database of drug levels in breast milk and infant blood, adverse effects in the nursing infant, and suggested therapeutic alternatives, referenced to the literature and peer reviewed.

Open LactMed ↗

MotherToBaby

Fact sheets on exposures during pregnancy and breastfeeding, written for both clinicians and patients, useful when counseling directly.

Open MotherToBaby ↗

DailyMed

Current FDA labeling for the specific product, including the pregnancy and lactation sections.

Open labeling ↗
← Specialty Practice AreasTreatment planning tools →
Last updated July 29, 2026