Postpartum depression may affect as many as 70 percent of mothers whose newborns have to be kept in intensive care units in the days following their births.
Babies that end up in the unit are born early or sick (if not both), adding even more stress to new mothers whose hormonal changes already leave them vulnerable to depression.
This week, the American College of Obstetricians and Gynecologists released new guidance, urging doctors to see women within three weeks after they give birth.
The group’s new standards are aimed at women at high risk for postpartum issues, including depression, but do not speak directly to the needs of women whose babies’ first days are spent in the NICU.
Women whose babies have to spend their first days in the NICU are more vulnerable to postpartum depression, but the setting may stress them more rather than provide more care
Every year, about seven percent of babies born in the US wind up in the neonatal intensive care unit.
Usually, these infants are there because they were born to early, with heart or breathing problems, birth defects, infections or some combination thereof.
Survival rates for babies who have to stay in the NICU after birth are now quite high – somewhere around 70 percent or higher – but these numbers are unlikely to do much for their parents’ peace of mind.
Postpartum depression can affect men or women, but is known to affect between 10 and 15 percent of women, regardless of how healthy or not their babies were.
That number nearly quadruples once babies have to spend time in the NICU, according to one 2014 study.
‘People who are under stress and had premature babies clearly have higher risks for postpartum depression,’ American College of Obstetricians and Gynecologists (ACOG) president Dr Haywood Brown told Daily Mail Online.
‘That’s why we as OBGYNs have to avert it, screen them and not take it for granted,’ he adds.
‘We recommend that anybody that’s had a baby early needs to be seen by their OBGYN within two weeks not six weeks.’
Beyond the obvious stress of watching one’s baby being hooked up to machines and tubes and fighting for its life, the NICU ‘is a particularly challenging environment for new mothers as several natural processes are disrupted,’ wrote researchers from Mercer University earlier this year.
The study asked mothers what factors made the NICU such a stressful environment for them.
They responded that they tended to feel poorly supported by both the medical staff and mothers and families of other NICU babies and that the NICU environment was cold and alienating.
For one, the very nature of spending the first days, weeks or even months of a baby’s life meant that women were more likely to miss out on or feel less a part of milestones like a first bath or more mundane, but intimate experiences like feeding.
Breastfeeding, for example, has been shown in many studies to help prevent postpartum depression.
Women are allowed to breastfeed in the NICU – assuming their children are not on feeding tubes – but the time and space constraints of a hospital setting mean that moms can easily miss out on meal time.
So suddenly, a nurse doing her job and simply caring for a hungry baby becomes an act that alienates a mother from her child.
Bedside manner and communication from the nurses and medical staff at the NICU also had a huge impact on how the mother felt. Often, the women felt excluded, ‘in the way,’ and out of the loop of information shared by the medical personnel.
The women who got more support from doctors – and other NICU – families fared better, but for most, the physical and regulatory restrictions on the facilities were inevitably stressful.
Many women reported that they were not allowed to stay the night at the hospital with their babies, and even when they were at the hospital, logistical issues like the locations and availability of bathrooms and food required them to go farther and be away from their babies longer than they would have liked.
Worryingly, parents’ depression risks don’t end when their baby’s hospital stays do, according to a study published last year.
In a study of 300 infants and their parents, doctors at Children’s national Health System found that nearly half – 45 percent – were depressed, anxious and stressed after they took their newborns home from the NICU.
Dr Brown says that the ‘majority’ of hospitals with NICUs have social workers or some other personnel who can provide mental health support to women spending much of their days in the NICU.
But, he acknowledges that their OBGYNs need to share this role, ‘developing a relationship with their patients’ – especially the high risk ones – ‘where they want to talk about it.’