Clinical and Legal Considerations Regarding Breastfeeding on Psychiatric Units

Marissa P Caan; Nina E Sreshta; Jennifer A Okwerekwu; Jacqueline S Landess; Susan Hatters Friedman

doi:10.29158/JAAPL.210086-21

Clinical and Legal Considerations Regarding Breastfeeding on Psychiatric Units

J Am Acad Psychiatry Law. 2022 Jun;50(2):200-207. doi: 10.29158/JAAPL.210086-21. Epub 2022 Mar 16.

Authors

Marissa P Caan¹, Nina E Sreshta², Jennifer A Okwerekwu², Jacqueline S Landess², Susan Hatters Friedman²

Affiliations

¹ Dr. Caan is a Resident in the Adult Psychiatry Training Program Cambridge Health Alliance, Cambridge, MA and Clinical Fellow at Harvard Medical School, Boston, MA. Dr. Sreshta is affiliated with a private psychiatric practice, Cambridge, MA. Dr. Okwerekwu is a Fellow, Division of Women's Mental Health, Department of Psychiatry Brigham and Women's Hospital, Boston, MA. Dr. Landess is Clinical Assistant Professor of Psychiatry, and Associate Training Director, Forensic Psychiatry Fellowship, Medical College of Wisconsin, Milwaukee, WI. Dr. Hatters Friedman is The Phillip J. Resnick Professor of Forensic Psychiatry and Professor of Reproductive Biology, Pediatrics, and Adjunct Professor of Law, Case Western Reserve University, Cleveland, OH. mcaan@challiance.org.
² Dr. Caan is a Resident in the Adult Psychiatry Training Program Cambridge Health Alliance, Cambridge, MA and Clinical Fellow at Harvard Medical School, Boston, MA. Dr. Sreshta is affiliated with a private psychiatric practice, Cambridge, MA. Dr. Okwerekwu is a Fellow, Division of Women's Mental Health, Department of Psychiatry Brigham and Women's Hospital, Boston, MA. Dr. Landess is Clinical Assistant Professor of Psychiatry, and Associate Training Director, Forensic Psychiatry Fellowship, Medical College of Wisconsin, Milwaukee, WI. Dr. Hatters Friedman is The Phillip J. Resnick Professor of Forensic Psychiatry and Professor of Reproductive Biology, Pediatrics, and Adjunct Professor of Law, Case Western Reserve University, Cleveland, OH.

PMID: 35296524
DOI: 10.29158/JAAPL.210086-21

Abstract

Women in the postpartum period are at especially high risk of developing psychiatric disorders, and in severe cases, they may require inpatient psychiatric hospitalization. Because of the lack of specialized units for peripartum mothers in the United States, this treatment is usually relegated to general inpatient psychiatric units. Despite the clear benefit of breastfeeding for both mother and child, lactation can be a barrier to placement on a general inpatient psychiatric unit and often is not supported during the hospital stay. Limiting access to inpatient psychiatric care for postpartum mothers with mental illness could be considered sex discrimination under the Affordable Care Act (ACA) because of failure to accommodate lactation. With improvements in education and accommodations around breastfeeding, general inpatient psychiatric units could provide appropriate care for this population.

Keywords: Affordable Care Act (ACA); breastfeeding; discrimination; inpatient; lactation; postpartum.

MeSH terms

Breast Feeding*
Female
Humans
Mental Disorders* / psychology
Mental Disorders* / therapy
Mental Health Services*
Mothers / psychology
Patient Protection and Affordable Care Act
United States