New mothers with babies in the NICU are at increased risk of PPD – Part 2

Continuing on the topic I started on January 13th titled “New mothers with babies in the NICU are at increased risk of PPD,” I wanted to add a few points I missed earlier, inspired by a post that came across my feed recently from the Emerald Doulas website titled Preemies Parents and PMADs.  The post was authored by Carrie Banks, an Emerald Doula and one of the North Carolina state coordinators for Postpartum Support International.

Finally home from the NICU with the baby, it is natural for parents to feel anxious, now that they are responsible for their baby’s care and there are no nurses, doctors and machines tending to their baby’s care any longer.  The feeling of being fully responsible and the fear that something may go wrong can cause the parents to feel overwhelmed, especially if there are still medications, feeding and weight gain challenges, as well as physical (e.g., vision, hearing, motor skills) and cognitive development concerns.

I can recall feeling overwhelmed with having to deal with colic, cradle cap and eczema all at once.  My baby was not even a preemie, and my postpartum depression (PPD) starting once the one-week colic period ended.  So, yes, factors that cause stress during the first postpartum weeks while a new mom is still healing from childbirth can indeed lead to PPD.

The Emerald Doulas article contains great tips on addressing:

  • impaired/delayed bonding due to inability to hold the baby/feelings of fear/awkwardness of holding the baby in the NICU
  • transitioning to life at home after the NICU
  • feelings of isolation, guilt and shame
  • why getting help is important

Parents of preemies may also feel ungrateful or even guilty for seeking help for themselves, since everyone’s focus has been on the preemie baby for days, weeks or even months.  While these parents may feel like the only thing that matters is their baby to be okay, they need to remember that they need to stay strong and healthy, both mentally and physically, in order to be there for their baby!  Weeks if not months of having to stay strong for their NICU baby and for other children they may have can chip away until suddenly they find themselves unable to keep it together any longer.  Being anxious and sleep-deprived over an extended period can lead to a postpartum mood and anxiety disorder (PMAD) to set in.

Another contributing factor to the development of a PMAD is the feeling of isolation that occurs from staying home with the baby and keeping visitors away to protect the baby against germs, especially during the winter when colds and the flu abound.  The disappointment that comes from not having friends and family around like they would’ve wanted to have can also contribute toward the development of a PMAD.  Finding a community and support in the form of a NICU support group in-person and/or online can be invaluable, as it can help them feel less alone and more hopeful knowing they are not along in their experience both inside and outside of the NICU having to deal with physical/cognitive development concerns/challenges in addition to the seemingly endless visits with doctors, speech therapists, occupational therapists and/or physical therapists.

There should be no doubt as to whether seeking help is an option.  If you need help, do not hesitate to get it.  Reach out to friends and relatives.  See if you can get a friend and/or relative to help coordinate the search for specific kinds of help.  I’ve seen many situations where a friend sets up a Meal Train account and shares it on social media or email to get friends/relatives/neighbors/colleagues to pitch in money or orders from local restaurants/delis to be sent directly to the family.  If you need help with overnight care and you can afford to hire a postpartum doula, then see if you can locate one through referral from a friend/relative or by searching for one on the Doulas of North America (DONA) website.

You, my dear mother (and father), need to remember self care!

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The Importance of Mothering the New Mother

Chinese call it Zou Yue.
Mexicans call it la cuarentena.
Greeks call it sarántisma.
Indians (Hindi) call it Jaappa.

Regardless of what it’s called or how long it is observed–be it 30 or 40 days–the goal is the same.  Taking care of the mother, so she can take care of her baby and get adequate sleep to recover from childbirth.

Many other countries in Asia, the Middle East, South America, and Africa observe a traditional mothering the new mother period.  40 seems to be a magical number, a number that has survived through the centuries and therefore has special significance….no doubt it has something to do with the fact that 40 days is the average length of time for a new mother’s body to recover from childbirth and return to a pre-pregnant state.  That is also why your OB/GYN will say to you once you’ve given birth that he will see you in 6 weeks.

The May 11th NY Times Well section included an article How to Mother a Mother by Tara Parker-Pope.  In it she talks about Claudia Kolker’s new book, The Immigrant Advantage: What We Can Learn From Newcomers to America About Health, Happiness and Hope and how practices such as la cuarantena can help Americans (if they are willing to learn from immigrants) to achieve–just as the title says–health, happiness and hope.

Cuarentena sounds like how the word sounds in English for quarantine, or a period of isolation for illness.  The term refers to the first 40 days after childbirth in which the female family members and friends of the new mother surround her and provide her and her baby with care, so that the new mother’s only focus is on getting rest and bonding with/feeding her baby. They also help around the house and prepare meals.  Certain rituals are observed that are similar to those observed by the Chinese Zou Yue, such as the preparation of certain foods, like chicken soup, to help keep her body/system warm, as chicken is viewed as a warm food.  Foods that are considered cold, like cucumbers, are avoided.  She is to be protected from feeling overwhelmed; hence, visitors are kept away (or kept at a very minimum) during this time (this is probably how the term la cuarantena was derived).  She is told to avoid bathing for fear of catching cold.  All these rituals have the mother’s well-being in mind.  I am rather surprised to see such similarities between the Mexican and Chinese customs….after all, the countries are nowhere near each other!  In terms of breastfeeding, female family members are on hand to teach her how to do it. In these other cultures, there is no expectation that the new mother know how to breastfeed instinctively and easily.  There is a reason behind the phrase It takes a village.

Since I blogged previously about the importance of social support and how through the years we seem to have lost perspective on things when it comes to the community coming together to help a new mother who has just had a baby, I won’t repeat myself here.  What I will say is–because we can’t emphasize it enough nowadays–that getting adequate social support–comprised of both emotional support (e.g., shoulder to cry on, listening non-judgmentally) and practical support (e.g., help with breastfeeding, cleaning, errands, laundry, taking care of the baby for a few hours so mom can take a nap or shower) IS CRITICAL FOR NEW MOMS.  Having enough support during the first 4-6 weeks–until your body recovers from childbirth and your hormone levels return to their pre-pregnancy state–can help keep anxiety levels down, help you get the rest you need from all the changes your body has gone through with childbirth, and minimize risk for postpartum depression.

Don’t be afraid to ask for help or accept help from your significant other, family members and/or friends.  Before baby’s arrival, you should try to line up 4-6 weeks’ worth of live-in help from a family member (mother, mother-in-law, sister) or at minimum help with night-time feedings those first few weeks is critical in allowing you to get adequate rest.  If you don’t have any family members nearby and/or willing or able to help, you may want to consider hiring a postpartum doula, if finances allow.  The presence of a doula that is experienced in infant care can help keep anxiety levels and concerns about infant care to a minimum, and provide comfort in knowing that both you and your baby are in good hands.  Click here to learn more about postpartum doulas and how to find one near you.

I devote a chapter in my book to the importance of social support, what social support entails, how to go about ensuring you get adequate support in your first postpartum weeks, postpartum rituals in various countries, and postpartum support services in this country (including support groups like Santa Barbara Postpartum Education for Parents, as well as doulas)–and unfortunate lack thereof and the trend of having postpartum doulas fill the void in support for new mothers.  I have Sally Placksin’s book Mothering the New Mother to thank for educating and inspiring me to write about social support in my own book and every chance I can get.

I started writing this blog post on Monday (late at night after my daughter went to bed), lost gas quickly and stopped.  I started it up again on Tuesday (late at night, again after my daughter went to bed) and lost gas quickly (the result of a combination of a long, stressful day and aging).  On Wednesday, I had a lovely time catching up with a good friend over dinner so I didn’t get a chance to write at all.  Just today, I happened to stumble across a website/blog named Mother Love Postpartum Doula Services that just recently linked up to me by way of its blogroll.  Thank you, Liz, for linking to my blog!    She happens to touch on the postpartum rituals I touch on in this post.  What fortuitous timing, as I just needed to finalize the post…and voila, I’m hitting the Publish button….now!