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.

 

 

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November 17, 2010 – Blogging to Promote Awareness of Premature Births

I wrote this last night and should’ve posted it last night…thought I’d have a chance to do so during the day today, but I was wrong.  Boy, it has been a rough few weeks at work.   Today was another day where I only had time to visit the ladies’ room once.  But at least I had a chance to grab lunch, which is better than yesterday (no lunch and 1 visit to the restroom).  TMI, I know….

Because I am exhausted and otherwise tied up right now, I can’t come up with a fresh blog post for Prematurity Awareness Day, so I’m just going to direct you to my blog post from last year, still just as relevant, plus the one from last week

These posts contain a lot of links to help you learn more on how you can help and why it’s so, so important to promote awareness of premature births.

As always, thank you for dropping by!

November is Prematurity Awareness Month – Join in blogging efforts to raise awareness on November 17, 2010

Premature birth is the #1 killer of newborns during the first month of life.  Each year 20 million babies–half of a million of them in the US– are born premature.  A baby that is born too early is not fully developed and thus cannot even suck and/or breathe on his/her own.   It’s simply heartbreaking.  

For those that survive the first year, all too many end up facing serious health challenges and lifelong disabilities.  What is alarming is the fact that the rate of premature birth is increasing (i.e., it has increased > 30% since 1981).  In half the cases, the cause of premature birth is not known, which is why we need to unite in our effort to raise awareness, raise funding and promote research efforts to prevent premature births! 

Here are a couple of things you can do to help promote awareness of this crisis:

1.      November is Prematurity Awareness Month®.  If you are a blogger, please grab a badge and post it on your blog for the month, as well as join other bloggers on November 17th to raise awareness of this crisis.   You can join in this event at Bloggers Unite and at the March of Dimes site.

2.  Ask your U.S. Senators to support the PREEMIE Act (S. 3906), a bill designed to increase research and education on preterm birth, by sending a letter to your Senators and tell them to act quickly on this March of Dimes priority.  To see details of the bill, click here.

3.  Sign up for advocacy alerts, which is a great way to stay informed on legislative developments.

Some of you who have been following my blog for some time and read my blog post last year on the same topic, the following is a reiteration, which I’m including again because I think it’s highly relevant……

What’s premature birth got to do with perinatal mood disorders, you ask?  Well, for starters, approximately 1 out of 10 women experience antepartum (antenatal, prenatal) depression (or depression during pregnancy), though unfortunately many cases go undiagnosed.  Research has shown that preterm births are twice as likely to occur for women suffering from prenatal depression (or depression during pregnancy). To complicate matters, antidepressants to treat prenatal depression have also been shown to contribute to premature births.  And let’s not forget that there is a high risk for postpartum depression (PPD) in women who give birth to premature babies, not only for those with prenatal depression—since depression during pregnancy in most cases will follow into postpartum—but also because the amount of anxiety, stress and exhaustion caused by having a baby in the NICU for an extended period of time can lead to PPD. 

In Deborah Sichel’s and Jeanne Watson Driscoll’s “Women’s Moods: What Every Woman Must Know About Hormones, the Brain, and Emotional Health” (pg 178),  “Anxiety, whether mild or severe, can…..harm the fetus.”  Per Sichel and Driscoll, high levels of anxiety can cause premature births, stillbirths, low birth weight babies, and other complications due to the reduced blood flow, and therefore flow of oxygen and nutrition, to the fetus that results from the constriction of arteries in the uterus when the mother experiences high levels of anxiety.  You need to be aware, if you don’t already know, that the fetus is connected to you via the placenta.  The fetus is basically a part of you.  Just as all the nutrition you get from your food passes between you and the fetus through the placenta, medicine that you take will pass through to the fetus.  Similarly, stress hormones in a woman’s bloodstream from chronic anxiety will flow through the placenta.  In severe cases, stress hormones can cause blood vessels in the placenta to contract so much that it can pull away from the uterine wall, causing hemorrhaging and premature labor.

BOTTOM LINE:  Depression during pregnancy can lead to premature labor and delivery, not to mention low birth weight babies.  Since antepartum depression and antidepressants can cause premature births, more research is URGENTLY needed for the early detection and treatment of prenatal depression, as well as to find ways to treat prenatal depression without harming the developing baby.

November 17, 2009 – Blogging to Promote Awareness of Premature Births

They say that the reason for nearly half of all the preterm births–which amounts to 10 million babies– that occur each year is unknown.   While thanks to the miracles of modern technology and medicine, many preterm babies are nursed to health, the rate of preterm births is increasing, and all too many that are nursed to health face lifelong challenges.  Per the Bloggers Unite site, the rate has increased 31% since 1981.  Per the March of Dimes website, one in eight babies born in the U.S. is premature (coincidentally, postpartum depression rate is one in eight new mothers), and  the rate of premature birth in America is higher than that of most other developed nations).   I wouldn’t be a bit surprised if there’s a correlation between the increase in preterm births and the increase in fertility issues (refer to past post on infertility and anxiety/depression).

Just as PPD is more common that you realize, depression during pregnancy—or antepartum (or antenatal) depression—is more common than you realize.  Again, due to the lack of public education about this kind of perinatal depression, many women do not seek treatment because they think that feeling tired, having trouble sleeping, and experiencing mood swings, irritability, anxiety and weepiness are normal pregnancy experiences.  The key indicators of PPD—namely, persistent and debilitating sadness and other symptoms that interfere with your ability to function for longer than two weeks—would also apply to antepartum depression and should prompt you to seek help immediately.  

In Perinatal Depression: Hiding in Plain Sight – The Canadian Journal of Psychiatry. August 2007; 52(8), page 483 by Shari I. Lusskin, MD, Tara M. Pundiak, MD, Sally M. Habib, MD:

  • “[The] patient with antenatal depression often worsens postpartum in the setting of sleep deprivation and the stress of caring for the newborn.”  As I’d mentioned in my 11/9 post, since approximately 50% of women with antepartum depression will go on to develop PPD, you will need to decide—in consultation with your doctor—whether to take medication.  Whether to take antidepressant medication or undergo some form of alternative medicine (including therapy) while pregnant is a hard one to make and also depends on the severity of your depression–not to mention, taking into consideration the impact on the developing fetus.  Avoiding treatment altogether will only expose your developing baby to the effects of untreated depression and increase your risk for pregnancy complications and premature birth.  There is risk that untreated depression and anxiety during pregnancy can lead to poor nutrition from loss of appetite, self medication through substance abuse (drinking, smoking or drugs), and/or suicidal thoughts/behaviors.  Preterm births, low birth weight, smaller head circumference, developmental problems, and even infant deaths have been associated with anxiety and depression during pregnancy. 
  • Signs of fetal distress (i.e., alterations in heart rate variability, fetal movement patterns, fetal sleep-wake cycles) have been detected in pregnant women during their 2nd and 3rd trimester obstetrical visits, and studies seem to indicate that 2nd trimester anxiety may have a negative impact on fetal brain development.
  • “The fetuses of highly anxious mothers who had also scored high on depression and anger measures also had growth delays, compared with the fetuses of mothers with less anxiety.  Findings at birth for the same cohort included lower dopamine and serotonin levels, lower vagal tone [which is linked with poor emotion regulation and vulnerability to stress in infancy and childhood].  At age 8 months, infants exposed to antenatal anxiety were found to be highly reactive, to have poorer interactions with their mothers, and to have poorer scores on Bayley Scales of Infant Development [which is a standard series of measurements used to assess motor, language, and cognitive development of infants and toddlers ages 0-3].  At age 24 months, they were also reported by their mothers to have more sleeping, activity, and feeding problems.”

As I mentioned in my November 9th post, 1 out of 10 women experience antepartum (antenatal, prenatal) depression (or depression during pregnancy), though unfortunately many cases go undiagnosed, and as mentioned over at Postpartum Progress, research has shown that preterm births are twice as likely to occur for women suffering from prenatal depression (or depression during pregnancy).  Given the correlation between antepartum depression and preterm births, there should be an increase in public awareness of antepartum depression and not just of postpartum depression, which you hear so much more about—relatively speaking—than depression during pregnancy.  The following are needed if we hope to reduce the number of preterm births due to antepartum depression:

  • increase in public awareness and destigmatization associated with perinatal mood disorders, so women will recognize when there is a problem and seek treatment without hesitation
  • increase in research for earlier detection of antepartum depression
  • increase in research into safer/improved treatment options for antepartum depression. 
  • increase in public awareness of the effects of stress (and provide the spectrum of the range of stressors) on pregnancy

For more information about antepartum depression, check out this March of Dimes page and the Beyond Postpartum blog.

For more information about efforts to promote awareness of premature births, visit the Bloggers Unite and March of Dimes websites.  Many bloggers share their stories on the Bloggers Unite site.  There’s also the touching story about Charlotte.

Calling All Bloggers! November is Prematurity Awareness Month – Join in blogging efforts to raise awareness on November 17, 2009

Premature birth is the #1 killer of newborns during the first month of life.  Each year 20 million babies–half of a million of them in the US– are born premature.  A baby that is born too early is not fully developed and thus cannot even suck and/or breathe on his/her own.   It’s simply heartbreaking.  

For those that survive the first year, all too many end up facing serious health challenges and lifelong disabilities.  What is alarming is the fact that the rate of premature birth is increasing (i.e., it has increased 31% since 1981).  In half the cases, the cause of premature birth is not known, which is why we need to unite in our effort to raise awareness, raise funding and promote research efforts to prevent premature births!

If you are a blogger, here are a couple of things you can do to help promote awareness of this crisis:

1.      November is Prematurity Awareness Month®.  Please grab a badge and post it on your blog for the month.

2.      On Tuesday, November 17th, please join others to blog about and raise awareness of this crisis.   You can join in this event at Bloggers Unite and at the March of Dimes site.

What’s premature birth got to do with perinatal mood disorders, you ask?  Well, for starters, approximately 1 out of 10 women experience antepartum (antenatal, prenatal) depression (or depression during pregnancy), though unfortunately many cases go undiagnosed.  Research has shown that preterm births are twice as likely to occur for women suffering from prenatal depression (or depression during pregnancy). To complicate matters, antidepressants to treat prenatal depression have also been shown to contribute to premature births.  And let’s not forget that there is a high risk for postpartum depression (PPD) in women who give birth to premature babies, not only for those with prenatal depression—since depression during pregnancy in most cases will follow into postpartum—but also because the amount of anxiety, stress and exhaustion caused by having a baby in the NICU for an extended period of time can lead to PPD. 

In Deborah Sichel’s and Jeanne Watson Driscoll’s “Women’s Moods: What Every Woman Must Know About Hormones, the Brain, and Emotional Health” (pg 178),  “Anxiety, whether mild or severe, can…..harm the fetus.”  Per Sichel and Driscoll, high levels of anxiety can cause premature births, stillbirths, low birth weight babies, and other complications due to the reduced blood flow, and therefore flow of oxygen and nutrition, to the fetus that results from the constriction of arteries in the uterus when the mother experiences high levels of anxiety.  You need to be aware, if you don’t already know, that the fetus is connected to you via the placenta.  The fetus is basically a part of you.  Just as all the nutrition you get from your food passes between you and the fetus through the placenta, medicine that you take will pass through to the fetus.  Similarly, stress hormones in a woman’s bloodstream from chronic anxiety will flow through the placenta.  In severe cases, stress hormones can cause blood vessels in the placenta to contract so much that it can pull away from the uterine wall, causing hemorrhaging and premature labor.

BOTTOM LINE:  Depression during pregnancy can lead to premature labor and delivery, not to mention low birth weight babies.  Since antepartum depression and antidepressants can cause premature births, more research is URGENTLY needed for the early detection and treatment of prenatal depression, as well as to find ways to treat prenatal depression without harming the developing baby.