5 reasons why NICU parents might be more susceptible to depression and anxiety

Unless you’ve been a parent of a baby in the NICU, you may not understand the toll it takes on your mental health. It’s no wonder that there’s mounting research specifically showing that parents of preterm babies have an increased risk of depression, anxiety,¹Malouf R, Harrison S, Burton HA, Gale C, Stein A, Franck LS, Alderdice F. Prevalence of anxiety and post-traumatic stress (PTS) among the parents of babies admitted to neonatal units: A systematic review and meta-analysis. EClinicalMedicine. 2022 Jan 1;43:101233. doi:10.1016/j.eclinm.2021.101233 post-traumatic stress disorder,²Gateau K, Song A, Vanderbilt DL, Gong C, Friedlich P, Kipke M, Lakshmanan A. Maternal post-traumatic stress and depression symptoms and outcomes after NICU discharge in a low-income sample: a cross-sectional study. BMC Pregnancy and Childbirth. 2021 Dec;21(1):1-0. doi:10.1186/s12884-020-03536-0 and other mental health conditions. It makes sense: The neonatal intensive care unit (NICU) is an intense place. But we’re leaving parents to cope on their own, which isn’t right.  

According to the authors of one study, “Mental health support should be embedded and tailored to the NICU trajectory, with special attention to the discharge transition, parents living in rural areas, and non-English-speaking parents.”³Garfield CF, Lee YS, Warner-Shifflett L, Christie R, Jackson KL, Miller E. Maternal and paternal depression symptoms during NICU stay and transition home. Pediatrics. 2021 Aug 1;148(2). doi:10.1542/peds.2020-042747 Despite this conclusion, many NICUs throughout the country do not address parental mental health and well-being as a standard protocol. NICUs take care of babies—rightfully so—but what about the parents who are left to care for their children once they come home?

While I am, and always will be eternally grateful for the NICU doctors and nurses that assisted us during our time in the NICU, when it came to dealing with our mental health issues, it felt like my husband and I were left to our own devices, which is just a result of the way the system is currently built. Looking back on that time, I often say that we were left high and dry in the deep end of the ocean without a lifeboat.  

Related: You’re allowed to feel the grief and joy of being a NICU mom

Fortunately, I had a huge support system in my husband (who quite frankly does not get enough credit in being my rock throughout our journey), and I am privileged to have had a supportive family, OB-GYN, and therapist on my side, but I still felt alone in my lowest moments.  

Those days my daughter was in the NICU were some of the most challenging, but ultimately rewarding days of my life. I learned a lot about myself and my daughter—mainly how incredibly strong and resilient we both are. I am in awe of her ability to overcome obstacles. In watching her flourish and grow, I knew I had to use our story to support other NICU parents. 

Related: Dear NICU mama: Your strength is profound–and unexpected

We live in one of the most medically advanced countries in the world, but we are so behind as a society in recognizing mental suffering as true suffering. Why are NICU and preemie parents often left to struggle in silence as a result of their traumatic birth stories? 

Now, as the founder of FLRRiSH, I believe it’s my calling to offer NICU parent education, empowerment and resources to help families navigate this beautiful and challenging journey. 

As a NICU parent myself, here’s what I gathered during my 77-day NICU journey—and in the days since.

Related: Dear mama sitting in the NICU: Sometimes you’ll fall apart and that’s okay

5 reasons why anxiety and depression are common among parents of preterm babies

Here are the top five reasons, in my estimation, why parents of preterm babies are susceptible to depression and anxiety, as well as my tips on navigating the NICU.

1. The NICU is a highly stressful environment

Aside from the sounds of bells, whistles, machines and monitors, there is a bustle of doctors, nurses, specialists, lactation consultants and many other “noises” that leave parents overstimulated. Over long periods of time, this takes a physical and mental toll. 

Navigating the NICU: While you can’t do much to control the stimulating sounds around you in the NICU environment, you can employ techniques and tools while you’re there to help calm your central nervous system, like breathwork, or listening to calming sounds. I created the FLRRiSH audio course for parents to listen to 3- to 5-minute personal stories while holding their child during skin-to-skin contact. These stories are designed to provide support, empowerment and create overall positivity.  Perhaps most importantly, they’re voiced by a NICU mom to remind all NICU parents that they’re not alone.

And though you can’t turn the volume down at the hospital, you can control your space at home. Invest in a white noise machine, blackout curtains and other sleep tools to help you get the best rest you can during these long days. 

Related: Dear NICU mama—I’m the nurse who sees you, everyday

2. Having a baby in the NICU is never what parents plan or expect 

Even if you are considered to have a high-risk pregnancy, have had a premature baby before, or are pregnant with multiples and aware you might have an early birth, nothing can fully prepare you for missing all of the “firsts” in the early minutes of your baby’s life. It is even more difficult to comprehend you and your child could be separated for days, weeks and months to come. 

Navigating the NICU: One of the first pieces of advice I was given was to write a journal entry for every day of my daughter’s journey. Each day I would write down her vital stats, my emotions and feelings (and my spouse’s too), any questions or concerns I had, and also any celebrations or challenges encountered in the past day. Doing this helped me so much. I plan to give my journal to my daughter one day so she can see how far she has come, but I also created a special FLRRiSH “NICU Notes” spiral notebook in hopes other parents out there will do the same and get just as much out of it as I did. 

3. Isolation, both physical and social, are real

Sitting alone by your child’s bedside leaves you with time to think and get into your own head. Wandering thoughts, heightened emotions, and plummeting postpartum hormones creates the perfect cocktail for stress. Not to mention, these feelings don’t end once you come home from the hospital. Once home, protecting your vulnerable baby from the outside world often means you probably won’t see or socialize with anyone for several months, which in turn takes a toll on you mentally.

Navigating the NICU: Your journey with your NICU baby doesn’t instantly end once your child comes home. While it’s normal to be anxious, it’s also imperative to both validate all your feelings and learn how to channel that energy into caring for your child. Processing and accepting these emotions can help you begin to embrace this special time with your child. Consider reaching out to a therapist for extra support. FLRRiSH can help you connect with another NICU parent for 1:1 counseling or group support.

Related: Can I still be sad if my baby is the healthiest in the NICU?

4. Self-care falls to the bottom of the priority list

As a NICU parent, it’s not unusual to let your own needs fall by the wayside. Understandably, you want to be by your child every moment you can, and taking time away from that sometimes feels selfish. Unfortunately, this is the time you’ll need to practice self-care most, and by not showing up for yourself, you can become more vulnerable to depression and other mental health disorders such as PTSD, anxiety and PPD.

Navigating the NICU: Self care looks different for everyone. For some it may be as simple as going for a long walk, practicing meditation or sharing a meal with friends. I encourage all parents to give themselves some grace and to be good to themselves. With my clients, I make sure to emphasize that everything they are doing at that moment is good enough.

5. Lack of support is common, though the onus shouldn’t be placed on NICU doctors and nurses to handle parents’ mental health

These angels of human beings are often overworked, understaffed and may not have the time, nor is it within their job description to support NICU parents’ mental health. NICU staff do not have a standard course of action in assisting parents to seek help if they’re struggling. 

“NICU physicians recognize that having a baby in the NICU with a life-threatening condition is a major shock for most parents. We see on the parents’ faces that they are feeling grief, guilt, and fear. Moreover, some become clinically depressed. Parents cope better during their baby’s NICU stay if they receive peer and professional help during this most trying time,” says Susan Landers, MD, a neonatologist and author of “So Many Babies”.

Navigating the NICU: As you’re faced with new decisions at every turn, finding a coach or therapist to help you navigate this confusing time can be incredibly reassuring. If I had magical powers, I would like to sit on the tired shoulders of each NICU parent and whisper in their ear the following: “You and your child are much stronger than you know.”

Related: I’m a survivor. I’m a NICU mama

A note on mental health for NICU parents

It’s vital that integrated mental health care is available for parents, and it’s beyond time to do something about it. Yes, the barriers to entry are high: money, time, privacy concerns and staffing to name a few, but NICU families deserve it. As a society, we cannot afford to continue to let NICU parents’ mental health needs go unsupported. 

Source(s)

• 1
  Malouf R, Harrison S, Burton HA, Gale C, Stein A, Franck LS, Alderdice F. Prevalence of anxiety and post-traumatic stress (PTS) among the parents of babies admitted to neonatal units: A systematic review and meta-analysis. EClinicalMedicine. 2022 Jan 1;43:101233. doi:10.1016/j.eclinm.2021.101233
• 2
  Gateau K, Song A, Vanderbilt DL, Gong C, Friedlich P, Kipke M, Lakshmanan A. Maternal post-traumatic stress and depression symptoms and outcomes after NICU discharge in a low-income sample: a cross-sectional study. BMC Pregnancy and Childbirth. 2021 Dec;21(1):1-0. doi:10.1186/s12884-020-03536-0
• 3
  Garfield CF, Lee YS, Warner-Shifflett L, Christie R, Jackson KL, Miller E. Maternal and paternal depression symptoms during NICU stay and transition home. Pediatrics. 2021 Aug 1;148(2). doi:10.1542/peds.2020-042747