Editor's Note: Today's blog was authored by guest-blogger (and Emerald Doula) Carrie Banks. In addition to her work as a postpartum doula, Carrie serves on the board of directors for Postpartum Education and Support, a local non-profit and is the North Carolina Coordinator for Postpartum Support International. Today, as we close out Prematurity Awareness Month, Carrie offers her insight on the correlations between premature birth and postpartum mood struggles, as well as how to find help when you need it.
Perinatal mood and anxiety disorders (PMADs), like postpartum depression, are the number one complication of pregnancy and childbirth. Let that sink in... the number one complication!
Each year, 10-15% of newly delivered mothers will develop PMAD. If your baby goes to the NICU, then your chances of developing a mood disorder increase, and additionally, the severity of your symptoms also increases.
After a premature (and often unexpected) birth, your focus will be 150% on your tiny baby. That's normal. It's also draining, and takes attention away from the birthing parent who is also recovering from birth, and in need of physical and emotional support. This hyper-focus and attention on your baby can also last very long time; weeks or even sometimes, months.
While their baby is in the NICU, parents operate on adrenaline and sheer willpower, making the trip each day into the hospital to visit with and care for their newborn. It's when their baby comes home that postpartum depression or anxiety tends to creep in.
It's totally understandable- you've just brought home a teeny-tiny baby who, until now, has been attached to a host of tubes, sensors, and monitors; and under the expert watch of the NICU medical staff. Your baby may seem naked without these, and you both may feel very vulnerable.
It's a common parent experience, preemie parents or not, to question your abilities to care for this baby! You might ask yourselves, "They are really letting us take this baby home? Surely someone will stop us from walking out of the doors!" This feeling is further complicated if your baby is smaller, still on medications, or has prolonged feeding challenges.
In my time supporting preemie parents with a PMAD, I’ve seen the following common challenges and wanted to walk through those struggles today, with you, as well as offer tips to overcome them:
Impaired or Delayed Bonding
NICU parents relish the time spent holding their preemies, but it can also be a stressful experience. Your baby is likely connected to various machines soon after birth, which makes holding him or her awkward or feel scary. Many NICU parents report feeling disconnected from their baby and not having a firm bond for a prolonged period of time. Parents also feel like they must stay strong for their baby or spouse or older children, and if they allow their emotions to take hold they will never be able to pull themselves back together.
If you are feeling this way, ask your NICU care team, and specifically check in with your NICU nurse, for tips on how to hold your baby in a way that is safe for them and comfortable for you. Be present in their care times, diaper changes, and feedings. Small steps like learning how to lift or reposition your baby can feel empowering and build your confidence! You can also leave "snuggle squares" or small pieces of flannel with your baby that smell like you (and will smell like them when you trade them out), or leave photos of your family up and around your baby's bedside.
Transitioning to life after NICU
Even after your baby is home, sometimes the health and logistical/daily concerns may continue. Many preemies face issues with feeding and weight gain, vision, hearing, cognitive development, muscle tone and motor skills. Your life might be full of appointments: pediatricians, specialists, speech therapists, occupational therapists, physical therapists. Bills may start rolling in, adding to your financial strain. You have used up all your leave and must go back to work and you are still not sleeping well.
This is a recipe for anxiety and depression.
Reach out for help to your friends and family. Be specific in what they can help you with. Do you need assistance feeding yourselves each day? Ask for a Meal Train to be set-up. Do you need help balancing life between your older children and your preemie? Ask friends to set-up playdates (at their homes) or to take your older children on outings around town, or to come by and hold your preemie (with clean hands!) so you can reconnect with your older children. Is rest a struggle? Hire a postpartum doula to provide infant care at night (or during the day!), so you can recharge your own batteries.
It may feel like you've used all of your friends and family's good will, but I assure you... they will be ready and willing to help you with your transition home.
Feelings of Isolation
Preemie parents often stay home, and away from public places to protect their immune-sensitive babies from germs, especially during cold and flu season when often preemies are placed in "Quarantine" at home. They may also discourage or refuse visitors for the same reason. Preemie parents often feel disconnected from other parents of full-term babies because of these vastly different "homecoming" experiences.
Or, when they do go out, Preemie Parents can feel like they're walking a landmine of questions and awkward interactions with strangers. For example, in the grocery store someone behind you will invariably ask, “How old is your baby?”. You'll respond and see the look of confusion on the woman’s face so you launch into “Well, the adjusted age is x-weeks because he was born prematurely.” And, then you find yourself telling your whole story to a stranger in sweat-pants, buying tampons and orange juice. You might even start lying about your baby’s age to avoid this situation all together.
These anxieties often lead to isolation, which can exacerbate anxiety and depression. Some preemie parents find community and support from one another during this time. Whether that's in an online community forum (like this one hosted by Rex Hospital's NICU staff), or in-person, it's important that you create the opportunity to connect with someone other than your adorable, but wordless, newborn. You and your partner might consider alternating attendance at support groups, if you don't feel comfortable leaving your preemie without one of you.
Here are some other great tips from Jessi Bennion, a micro-preemie's mother, on surviving RSV season with a preemie.
Guilt and Shame
Preemie Parents who are struggling with anxiety or depression feel like they can’t reach out for help for a variety of reasons. They might feel their support people are tapped out after their long NICU stay. They may also feel ungrateful or even guilty for seeking help for themselves, “I prayed for 3 months solid for my baby to be well enough to come home. Now he’s here, and I’m miserable. What’s wrong with me?”
I’ve also heard several moms say something like, “I can’t complain. My baby is healthy and out of the NICU.” It goes along with a common theme we hear from lots of parents that "the only thing that matters is a healthy baby". This is so untrue for so many reasons, but mostly because it's devaluing the critical importance of healthy (both mentally and physically) parents. If the premature birth was unexpected, it can also cause the birthing person to feel physically responsible for their premature birth. This is also untrue. Even if you do everything "right", you can still have a premature birth. In fact, one in four premature babies are born with no obvious explanation as to why!
Seeking treatment for yourself is not complaining or being selfish. It is the best thing you can do for your family.
Please reach out to us at Emerald Doulas. We can help get you connected to our area’s many resources for parents who are struggling with anxiety and depression. The sooner you seek treatment, the sooner you will enjoy your baby and all the joys and struggles of being a parent.