Stacy *  aged 34

Stacy * aged 34 and living with her partner of 10 years and 2 year old son was referred into the service originally at 14 weeks pregnant with her second child.

The initial referral came from her GP for possible PTSD experienced following the birth of her first child, therefore this referral went straight to the High Intensity CBT link worker for an initial assessment. She was seen and assessed by the CBT therapist and it was felt that the presentation of PTSD was no longer Stacys main problem and that her main difficulties was around anxiety and worry, especially with regards to her current pregnancy and birth.

She was not reporting any active symptoms of PTSD and felt at the time any difficulties she was having in relation to her traumatic birth had been managed previously.

Therefore, the High Intensity link worker directly liaised with myself and we agreed a handover to me for PWP low intensity intervention with the primary aim of anxiety management.

It was noted in the handover that the patient found attending appointments difficult due to travelling, child care and her anxiety of certain medical places, so I initially spoke with the patient over the telephone and introduced myself and what treatment I could offer and then we agreed I would visit her at home around the time her partner was home to look after their 2 year old son.

Both myself and Laura attended for her initial assessment home visit in line with our lone working policy, at this assessment it was identified that her main problem was anxiety and she was struggling with both the physical symptoms of anxiety as well as the cognitive effects of worrying and being overwhelmed with anxious thoughts. This difficulty was impacting on her ability to go out places and especially in relation to planning the birth and attending hospital appointments.

Treatment: begin with anxiety management in the form of psycho-education, relaxation and understanding the physical symptoms.

Exposure therapy to help with the hospital appointments and birth.

Devised an ‘emotional birth plan’ together and copies sent to midwives and GP.

Referral to Doula service for support if home birth was not possible.

Delay placed on treatment once patient had had baby in order to allow her to adapt and adjust to new arrival, telephone calls and support was offered during this time.

Then reviewed care with her after 6 weeks postpartum again at her home and offered 4 follow up appointments to ensure no further anxiety difficulties and to be able to monitor and detect postnatal depression.



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