Breastfeeding by patients with serious mental illness: An ethical approach

e16 D ifficult ethical situations can arise when treating perinatal women who have serious mental illness (SMI).Clinicians must consider ethical issues related to administering antipsychotic medications, the safety of breastfeeding, and concerns for child welfare.They need to carefully weigh the risks and benefits of each decision when treating perinatal women who have SMI.Ethical guidelines can help clinicians best support families in these situations.In this article, we describe 2 cases of women with psychotic disorders who requested to breastfeed after delivering their child during an inpatient psychiatric hospitalization.The course of their hospitalizations illustrated common ethical questions and facilitated the creation of a framework to assist with complex decision-making regarding breastfeeding on inpatient psychiatric units. CASE 1Ms. C, age 41, is multigravida with a psychiatric history of chronic, severe schizoaffective disorder and lives in supportive housing.When Ms. C presents to the hospital in search of a rape kit, clinicians discover she is 22 weeks pregnant but has not received any prenatal care.Psychiatry is consulted because she is found to be intermittently agitated and endorses grandiose delusions.Ms. C requires involuntary hospitalization for decompensated psychosis because she refuses prenatal and psychiatric care.Because it has reassuring reproductive safety data, 1 olanzapine 5 mg/d is started.However, Ms. C experi-Our framework can guide decisions about breastfeeding on a psychiatric unit Breastfeeding by patients with serious mental illness: An ethical approach