Pamela A Geller

AbstractFetal care centers, neonatal intensive care units, and neonatal follow-up settings provide a vast and unique frontier for important and novel research. Investigative efforts focusing on psychosocial issues and mental health across fetal and neonatal care settings have surged in recent decades, but additional research is necessary to further identify psychosocial needs of parents, refine and develop evidence-based care for families, better assist with staff education and support, create an evidence base to provide information critical to advocate for staffing and policy changes, and extend knowledge to propel the field forward. This chapter discusses two investigative disciplines—research and quality improvement—and presents their distinctions as well as their synergies and application within fetal and neonatal care settings. This is followed by presentation of key areas that warrant research exploration related to behavioral health issues and an overview of practical considerations for research application in these settings.

Abstract Advances in technology have allowed for more complex medical interventions at a much younger gestational age. With such advances in neonatal care, the age of viability has improved. Medical teams are now able to intervene in utero to identify, address, and correct certain congenital anomalies, malformations, and disruptions in the normal process of fetal development. Medicine is also embracing a more inclusive, patient- and family-centered approach to care. Multidisciplinary teams across fetal care, obstetrics, neonatal intensive care unit (NICU), and NICU follow-up clinic settings that offer emotional support to families have grown to include psychology, social work, child life specialists, and chaplains. In some hospitals, perinatal psychiatry is also available to caregivers who have an infant in the NICU. These disciplines take an active role in helping parents manage the perinatal mood and anxiety disorders that often accompany the stress that they experience, both while the fetus is in utero and postpartum.

Recent shifts towards the integration of mental health care in primary care settings have made clinical psychologists practicing in women’s health care settings an indispensable asset to both patients and medical providers. Women of all ages have higher rates of primary and specialty care visits than men, and many women of reproductive age receive primary and preventive health care within obstetrics and gynecology (ob/gyn) settings where medical providers are often the first professionals to triage and address complex mental health problems. Women face unique psychosocial and mental health challenges, including stress from multiple roles and caregiving responsibilities, relational context, and possible exposure to violence. In addition to discussion of these contextual factors, this chapter will examine current research regarding those conditions more commonly seen and treated by clinical psychologists in ob/gyn settings, including mental health issues surrounding pregnancy and childbirth, sexual health and functioning, pelvic pain, urinary incontinence, perimenopause and menopause, and infertility. For each area, when evidencein the research literature exists for the benefit of psychological intervention, this information also will be presented.

This chapter contains sections titled: Stressors in the Workplace Examining the Model of Rugged Individualism The Stress of Work and its Influence on Women Job‐Related Stressors Unique to Women Workplace Support Emphasis on Individualistic Orientation in the Workplace Stress at Home Work–Family Role Conflict Home‐Based Support Communal Orientation: Developing a Collectivist Perspective The Multiaxial Model of Coping How the Multiaxial Model of Coping Changes Common Coping Assumptions Implications for Intervention Conclusions References