How to Help Perinatal Clients Navigate Psychiatric Medication Decisions
- Mindy Wara
- 26 minutes ago
- 4 min read
For many pregnant and postpartum clients, deciding whether to start or continue psychiatric medication is not just a medical decision—it’s an emotionally and ethically charged process, layered with uncertainty, vulnerability, and care.
The stakes can feel impossibly high as clients weigh their options.
On one hand, there’s the urgency of untreated symptoms: the need for emotional stability, presence, and safety in the early stages of parenting.
On the other, concerns about side effects, stigma, long-term unknowns, and the weight of deeply rooted personal or cultural beliefs about what it means to need medication.
As perinatal mental health professionals, we may not prescribe medication, but we are often the ones clients trust to help them navigate these choices. Our role is not to provide answers—it’s to hold space for the questions.
So how do we support our clients in a way that’s grounded, attuned, and within scope?
Medication Decisions Are Never Just Clinical
Psychiatric medication decisions during the perinatal period live at the intersection of medical advice, personal history, relational dynamics, and a client’s evolving identity. They are rarely about a single prescription. They are about parenting values, safety, and the kind of presence a client hopes to bring to their child and themselves.
Touchstone instructor Ayelet Amittay, PMHNP-BC, a psychiatric nurse practitioner specializing in perinatal mental health, has spent nearly a decade working alongside clients and their care teams through these decisions. Her approach emphasizes transparency, consent, and a deep respect for the emotional complexity that surrounds these conversations.
“There is no risk-free choice: every option has its risks and benefits, including the ‘not taking action’ option.” – Ayelet Amittay, PMHNP-BC
As therapists, our job is not to tell clients what to do. It’s to help them discern what matters most to them—and to ensure they don’t have to navigate this process alone.
What’s “In the Air” Right Now About Antidepressants?
Medication-related fear isn’t only personal—it’s cultural.
In early 2025, public discourse around antidepressants, especially SSRIs, reignited after RFK Jr. falsely claimed a connection between their use, the opioid crisis, and violence in the United States. While these claims lack scientific support, they continue to circulate widely, complicating how clients understand and relate to psychiatric care (Mann & Riddle, 2025).
For clients already grappling with shame or fear, this kind of rhetoric can deepen hesitation and self-doubt. “There’s a gap between how providers feel about medication in pregnancy or breastfeeding and what they wish they could speak with their clients about,” Ayelet explains.
Many clinicians have witnessed medication be life-changing. Others have seen it used in ways that felt dismissive, misaligned, or pathologizing. We carry those stories—and our clients do too.
Support in this space requires more than data. It requires attunement, humility, and the ability to sit with complexity without rushing toward certainty. A recent qualitative study affirms this, highlighting how women with severe mental illness described medication decisions during pregnancy and breastfeeding as deeply emotional, relational, and shaped by prior healthcare experiences and perceived stigma (Megnin-Viggars et al., 2023).
Reframing the Decision as a Parenting Act
One of the most impactful reframes we can offer clients is this: medication decisions during pregnancy and postpartum aren’t separate from parenting. They are parenting decisions. “Clients are making parenting decisions before the baby is born, by making these choices around treatment for symptoms they might be experiencing,” says Ayelet.
These choices are often layered with clients’ hopes about the kind of parent they want to be—and fears about what treatment might mean for their child or their identity. Research supports this tension, highlighting how women with significant mental health concerns often navigate medication decisions alongside internalized stigma, parenting ideals, and a deep desire to protect their children (Dolman et al., 2016).
Supporting Within Scope: What We Can Do
Even without prescribing authority, perinatal professionals have a meaningful role to play in this process. We can:
Validate the emotional weight of the decision
Explore the client’s past experiences, beliefs, and hopes
Provide psychoeducation grounded in evidence
Refer clients to collaborative, perinatal-informed prescribers
Advocate when clients feel dismissed or disempowered
Stay attuned as their needs and values evolve
This is meaningful, relational work—and it’s well within our scope.
Want Tools, Language, and Confidence?
If you’ve felt the tension of wanting to support these decisions without overstepping your role, this training was created for you.
Perinatal Mental Health Medications: A Clinical Guide
🗓 May 22, 2025
Support perinatal clients in navigating medication decisions with psychoeducation, advocacy, and therapeutic strategies.
Led by Ayelet Amittay, PMHNP-BC, this training will equip you to ethically and effectively support psychiatric medication conversations in the perinatal period. You’ll gain:
A working knowledge of common medications used in the perinatal period
Ethical strategies for psychoeducation and scope-based support
Tools to explore client values, beliefs, and fears surrounding medications
Practical approaches for interprofessional collaboration and client advocacy
A Final Reflection
Medication decisions during the perinatal period are rarely about finding the “right” answer. More often, they are about helping clients sort through competing truths, hopes, fears, and possibilities—without rushing, and without judgment.
Ayelet reminds us that we don’t need to be prescribers to make a difference. Our role is not to fix or decide. It’s to walk alongside our clients as they find their way forward.
“Even if you're not talking about the meds themselves… you really are supporting the client on their journey through thinking through these very complex questions and concerns.”
This is what it means to hold therapeutic space: not to give answers, but to witness, guide, and trust our clients’ capacity to choose for themselves. Let’s keep holding space for the whole story.
References
Dolman, C., Jones, I., & Howard, L. M. (2016). Pre-conception to parenting: A systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness. BMJ Open, 6(1), e010130. https://doi.org/10.1136/bmjopen-2015-010130
Mann, B., & Riddle, K. (2025, January 30). Antidepressants harder to quit than heroin? Fact-checking RFK Jr. NPR.https://www.npr.org/sections/shots-health-news/2025/01/30/nx-s1-5281164/antidepressants-ssris-rfk-jr-heroin
Megnin-Viggars, O., Martin, L., Leverton, M., & Howard, L. M. (2023). Experiences of decision-making about psychotropic medication during pregnancy and breastfeeding in women living with severe mental illness: A qualitative study. BMC Psychiatry, 23, Article 215. https://doi.org/10.1186/s12888-023-04672-9