Rachel Shmuts, DO

Editor’s note: This essay won an “Honorable Mention” in our writer’s contest, in which readers were invited to write about that one single patient who made them a better psychiatrist. Dr Shmuts is Assistant Clinical Professor and Director of the Women’s Mental Health Program at Rowan University School of Osteopathic Medicine in Cherry Hill, NJ. She serves as the university’s Course Director for the pre-clerkship medical student program.



Up until my last year of my psychiatry training, I was convinced I only wanted to consult in the hospital-that is, until I met Ms. B, a 31-year-old expectant mother. She presented to the women’s mental health clinic where I was biding some elective time during my psychosomatic medicine fellowship. She came in initially about 25 weeks’ pregnant, about 13 weeks further along than I was (which I did not disclose to her at that time).

Unlike me, however, she was not overjoyed about expecting a child. In fact, she was completely appalled by the notion of becoming a mother. She had been pregnant twice before in her 3-year relationship with her boyfriend, but she had made it clear to him that she did not-under any circumstances-want children. Before this relationship, she had identified as homosexual and was exclusively dating women (and never once considered adoption) until she fell in love with her cuddly and kind boyfriend.
 

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She had a strained relationship with her mother, to say the least, and part of her apprehension with becoming a mother stemmed from never once encountering a good, or even “good enough,” parenting model. Yet, somehow, she ended up in my office, gravid, and extremely anxious.

Ms. B’s case was challenging in many ways. Pharmacologically, she had a complicated history with multiple medication trials for depression and anxiety, as well as ADHD, few of which were effective, with the exception of the stimulants. With the limited data we have on psychotropic medication use during gestation, the pregnancy presented another challenge as to how to proceed.

In therapy, Ms. B would ultimately view me as a protective and safe mother figure. My own pregnancy called our situations into stark contrast-both of us pregnant, yet I the trained physician with seeming financial stability, and she the unemployed, unmarried college dropout with an unwanted child on the way. And there was my countertransference to consider when I thought, “You don’t want a baby? How can you not want a baby?!” Despite all this, I liked this patient a lot, and I yearned to help her become more comfortable with the idea of parenting. She really had no other choice, and I wanted to help her be happy with herself and her situation.

Thank goodness, I had a supportive and experienced supervisor. We treated her severe ADHD symptoms (with a stimulant), and she got better. She became less anxious and depressed within several weeks. Yet, she could never come to terms with being pregnant. She admitted she kept the pregnancy out of love for her boyfriend, but she had fears of resenting him, and of more concern, of resenting the baby for “ruining her life.”

I had discussions with her that dispelled the popular notion that giving birth automatically leads to instant and total love of the baby. I reminded her that breastfeeding can be hard but her life won’t be ruined. I challenged her rigid notions that she would lose all sense of identity and be “only” a mother from here on out.
 

After I left the rotation, I woke up one day and said, “I want to do this. Every. Single. Day."

She gave birth, and she came in to see me 10 days’ postpartum. Things were not easy for her, but she was managing. She did not “imprint” on her child like we said she wouldn’t; she noted she was exhausted, anxious, couldn’t sleep, all complaints we had anticipated. We employed some as needed anxiolytic to help her relax. She was then able to sleep and to come into sessions.

Over the next 4 weeks, Mrs. B slowly fell in love with her son. She chose his name. He was hers. She made plans for her life that involved him. She couldn’t imagine life without him. She became grateful for him. She became his mother, but she also returned to herself in the process.

After I left the rotation, I woke up one day and said, “I want to do this. Every. Single. Day.” I changed my job search in between researching double-strollers. I developed a program for women’s mental health at my institution while rocking my newborn to sleep. Now I see patients like Ms. B every day. And I couldn’t be happier-both as a mom and as a psychiatrist.

Articles

Up until her last year of training, this psychiatrist was convinced she only wanted to consult in the hospital-that is, until she met a 31-year-old expectant mother.

Author | Rachel Shmuts, DO

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