ECT in pregnancy and the postpartum

It is becoming increasingly well-established that maternal mental illness has a significant impact on the development of the fetus as well as the ability of the mother to parent her baby. For some women with severe mental illness in pregnancy pharmacological therapy can be problematic with a delay to response and therefore risk of maternal morbidity and mortality as well as the risks to the fetus. ECT has long been used as a treatment for severe mental illness and in some cases it may offer a viable option for treating these more severe disorders in pregnancy. When making a decision regarding treatment of mental illness in pregnancy it is important to have the available information regarding risks and benefits in order to guide treatment in the individual patient. In this chapter the relevant literature regarding ECT and pregnancy will be reviewed, and management guidelines offered for the implementation of ECT across pregnancy and early postpartum, including management of anaesthesia and fetal wellbeing during the period of treatment.