NICU Mothers Are Struggling With Mental Health Problems

April 15, 2018
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A few weeks into her last trimester, Stephanie May, 32, called her OB-GYN.

Her back was in pain and she was having cramps, all of which sounded fairly typical to the doctor on call. The Doctor suggested that she take it easy and hydrate, so May settled in for some sleep.

When she awoke, she was in full-on labor and rushed to the emergency room.

By the next morning, her daughter Evie was born — 9 weeks early. May saw her for about a second before the newborn was whisked up to the neonatal intensive care unit while May stayed behind on the delivery table, stunned.

“When they finally took me up to see her, she was hooked up to all these monitors. I couldn’t see her face. I couldn’t feel her skin. I didn’t know what to do,” May recalled. “My first reaction was to try not to feel anything … I was so afraid I was going to fall in love with this baby and then she would be gone.”

Over the next 54 days, she did her best to adapt to the peculiar rhythms of the NICU. The new Mom learned to hold her daughter without tugging at any wires and to stay calm when Evie forgot to breathe — patting her tiny foot or arm as a reminder while monitors blared.

She dutifully hooked herself up to the hospital breast pump every couple of hours, intent on producing exactly the 32 mL of milk her daughter required per feeding.

But as the days wore on, May felt herself being pulled under by anxiety and depression.

May worried every time someone coughed or cleared their throat. She worried they would never leave the hospital.

Only once did a doctor or nurse ask May how she was holding up emotionally — nearly 3 weeks into her daughter’s hospital stay.

He knelt by me and asked, ‘Is there anything I can do for you?’” May recalled, quickly adding that the doctors and nurses were wonderful, lest she come across as ungrateful. “It was the first time someone made me feel like a mom and reminded me I had to take care of myself, too.”

Based on the most conservative of estimates, 11 % of Mother’s in the US suffer from symptoms of postpartum depression (PPD), and postpartum anxiety may be even more common.

But NICU moms suffer from postpartum mood issues at much higher rates. There are no definite numbers, but studies have suggested that up to 70 percent of women whose babies spend time in the NICU experience some degree of postpartum depression, while up to one-quarter may experience symptoms of post-traumatic stress disorder.

And its easy to see why.

These women’s babies are sick or premature — or both. They have to learn the particular protocols of the NICU, all while hormonal, exhausted and in recovery themselves.

NICUs have done a remarkable job of transforming outcomes for the most vulnerable babies, but it has not traditionally been their job to screen and help women.

That’s why so many women just like May feel like they’ve slipped through the cracks.

I don’t know if the majority of NICUs have a psychologist on board or a social worker who can provide an assessment,” said Kathleen Hawes, a psychologist who does happen to work in a NICU at Women & Infants Hospital of Rhode Island.

Hawes reportedly worked on a 2016 study that found that roughly 20 percent of moms who had preterm babies suffered postpartum depression one month after discharge, regardless of how early their infants were born. “I think we’re doing a good job, but we could be doing a better job.”

“My first reaction was to try not to feel anything … I was so afraid I was going to fall in love with this baby and then she would be gone.”

Stephanie May, NICU mom

Unfortunately, screening women isn’t an easy task — even with buy-in from doctors and nurses.

Research has indicated that NICUs struggle to overcome even simple challenges, like tracking down moms while they’re in the hospital, and then finding ways for nurses to incorporate mental health wellness screening into their typical jam-packed days.

At pediatric hospitals, it’s unclear who is trained to see adults, or what degree of liability the hospital then takes on. Whose chart does the screening information go on? Who is billed?

One of the things that has been hard is that medicine is so siloed,” said Dr. Samantha Meltzer-Brody, a perinatal psychiatrist who runs the University of North Carolina’s Center for Women’s Mood Disorders.

That’s why neonatal ICU has not interacted well maternal mental health, she explained.

“That’s what needs to happen, and there’s been a push to make it happen,” Meltzer-Brody added. “You have some places that are doing it well, but to have it systematically rolled out across the U.S. is a big, long, slow process.”

Groups such as the American College of Obstetricians and Gynecologists and the U.S. Preventive Services Task Force now recommend that all women be screened for mood issues at least once in the perinatal period by using one of several questionnaires that can help catch PPD — typically at the six-week postpartum check-up.

Such a screening would however be one of many things crammed into what is often a 15- or 20-minute appointment that needs to cover a lot of ground.

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