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

The motivation for this blog post is a Huffpost article that popped up in my Facebook feed yesterday titled “NICU Moms Are Struggling With Mental Health Problems–And They Aren’t Getting Help” by Catherine Pearson.  It happens to be from 4/13/2018, but I’m only seeing it now for the first time.

I have blogged about the many risk factors for PPD before.  One of the risk factors happens to be premature births.  Last time I blogged about premature births being one of the risk factors for PPD was 9 years ago.  So, I’m way overdue blogging about this topic again!

A new mother who was pregnant one minute–and expecting several more weeks of pregnancy–and suddenly giving birth and seeing your baby hooked up to machines is an overwhelmingly anxiety-provoking experience.  All new mothers are not only hormonal, exhausted and trying to recover from childbirth, but NICU mothers are also anxious about their babies, unwilling to leave their babies’ sides, and find it hard to eat, sleep or even talk to friends and family members who don’t fully understand what it’s like to have a baby in the NICU. Unable to touch, hold and feed her baby and instead seeing her tiny, precious baby hooked up to so many wires, it is natural for a NICU mother to be consumed with feelings of helplessness, distress and fear.  Each day, the NICU mother spends many hours each day at their baby’s side, pumping every few hours, and on high alert with respect to her baby’s breathing and the noises of the machines keeping her baby alive.

In the daily hustle and bustle of the nurses and doctors in the NICU, having them stop and ask the mother (and/or father) how they are holding up and making sure they are taking care of themselves and getting enough rest are not going to be at the forefront of their priorities, though you’d think it should be second nature for them to do so.  In fact, they are seldom trained to know what to ask.  Even if they did ask, there is an inadequate referral system in place to get help for a mother with a postpartum mood disorder.

“…[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.”  Simply put, a new mother’s risk of experiencing a postpartum mood disorder is very high.  And that is not surprising in the least.”

What should the screening entail?

I’ve previously blogged about and will repeat here that mothers should be assessed for postpartum depression (PPD) between 4-12 weeks postpartum.   She should be encouraged to have her six-week follow-up visit with her OB/GYN, provided she doesn’t complain about symptoms up to that point.  If she is symptomatic before the six-week visit, she should be screened right then.  If the 6-week screen doesn’t indicate PPD, she should be assessed once more at the 12-week point and also when she weans and when her period returns, since these events can trigger PPD in some women.

The following—in addition to screening tools like the Edinburgh Postnatal Depression Scale or Cheryl Beck’s Postpartum Depression Screening Scale—should be asked at the six-week follow-up visit with the OB/GYN, which can help diagnose PPD:

1. Have you been feeling any of the following for the past 2 weeks:

  • Persistent and mostly inexplicable sadness/tearfulness and feeling empty inside
  • Loss of interest/pleasure in hobbies/activities you once enjoyed; inability to laugh
  • Overall impaired functioning
  • Sleep difficulties (either insomnia or sleeping too much)
  • Weight loss (usually fairly quick) associated with a decrease in appetite
  • Weight gain associated with an increase in appetite
  • Excessive worrying/anxiety/concern about the baby
  • Restlessness/irritability
  • Difficulty thinking, concentrating or making decisions
  • Onset of panic attacks
  • Sense of despair and/or hopelessness leading to thoughts of death/suicide

2. How have you been feeling physically and emotionally?

3.  How is your appetite?

4.  How are you sleeping?  Have you been able to get at least 4, if not 5, hours of sleep a night?

5.  Have you had any recurring thoughts/images that are disturbing?

 

If local resources for PPD are not readily available (though all hospitals around the country should have a list of local psychologists, psychiatrists, social workers, registered nurses, PPD support groups on hand), the least they can do is provide a pamphlet for Postpartum Support International. Its website lists resources in every state.  And many states have already formed, or are in the process of forming, chapters to focus on state-specific efforts at advocacy, training, and other improvements.

If you are a new mom with a baby in the NICU, please, please, please remember that, though your attention is preoccupied with your baby, if you let your own strength and health go by the wayside, it is possible to succumb to a postpartum mood disorder.  Not everyone will succumb, but just remember the increased risk and higher occurrence among NICU moms.  Don’t forget to take care of yourself.  When your baby comes out of the NICU, you need to be strong and healthy to care for your baby.