Meeting the Emotional and Psychological Needs of Mothers of Preterm Infants

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Meeting the Emotional and Psychological Needs of
Mothers of Preterm Infants

• Kathleen Kendall-Tackett, Ph.D.
• Family Research Lab
• University of New Hampshire

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Overview

• Factors related to distress in mothers
• Timing of difficulties
• Range of emotional reactions
• Nursing interventions

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Level of illness or prematurity

• The sicker the baby, the higher the risk of
  depression in the mother
• Related to depression
• May be involved in delayed reactions that you
  see in transfers
• Can persist throughout childhood particularly for
  very ill or very small babies

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Circumstances of the birth

• Unexpected
• Precipitant of the birth
• Assault or accident
• Medical emergency
• Where was the baby delivered?
• Was there a chance that the baby would die?
• Was the mom able to have the kind of birth she
  wanted/have her support people present?
• Does she perceive that her care was competent?
• Separation after birth

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Unfamiliarity with Illness

• The mother may have always been healthy and so is
  completely unfamiliar with medical routines
• Tests and proposed procedures will sound more
  frightening to her than they will to you because
  you know that tests are often negative

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The Medical Situation in the NICU/SCN

• The mother may feel unnecessary rather than part
  of the team caring for her baby
• She may be overwhelmed by the technology
• She may feel that unless she obeys the medical
  personnel, that they wont care for her baby

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The Family Situation

• Low income
• Young mother
• Little or no prenatal care
• Substance abuse
• Domestic violence
• Family chaos/low level of family coping

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Beliefs about why the preterm birth occurred

• Was it brought about because of something she did
  wrong?
• God is punishing them
• God shouldnt do this because she is a good
  person
• Are family members being unsupportive or
  accusative?
• Was it faulty genes or incompetent body parts?

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Anticipatory Grieving

• Was the mother convinced that the baby might die?
• Has the mother experienced previous or current
  losses?
• Prior infant death
• Loss of a multiple
• Previous abortion or miscarriage

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Difficulties with the Transition to Home

• Degree of continuing illness/strenuousness of
  care
• Attachment to the baby
• Amount of physical and emotional support
  available
• Sleep deprivation
• Cumulative stresses on the family
• Abruptness of the transition

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Guilt

• Real or imagined
• Dont automatically assume that mother did
  nothing to cause the prematurity
• Lack of prenatal care
• Substance abuse
• Not complying with treatment

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Powerlessness

• Mother and father may be overwhelmed by the
• Birth
• NICU/SCN
• Getting services for baby once they leave the
  hospital

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Feeling Silenced

• Moms may feel they cannot share their worries or
  concerns, or issues about their births, with
  anyone
• Others may expect her to positive or upbeat
  while baby is in the hospital
• They may be expected to move on once the baby
  is home
• Anything else is ingratitude

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Anger/Resentment

• Care providers
• Labor/delivery
• NICU/SCN
• Current pediatrician
• Family members
• Other mothers
• For unhelpful comments
• Because they have it so easy in comparison
• God
• For allowing it to happen to them

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Post-traumatic stress disorder (PTSD)

• An event will be troubling to the extent that it
  is
• Sudden
• Dangerous
• Overwhelming
• Can come from the birth or the hospital
  experience
• Care providers can either ameliorate it or make
  it worse

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PTSD

• Common symptoms
• Avoidance
• May have a difficult time coming to see baby in
  hospital
• Numbing
• Can explain delayed reaction
• Often labeled as coping well
• Dissociation
• Intrusive thoughts
• Sleep deprivation
• Can also increase vulnerability to depression

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PTSD

• Risk Factors
• Trauma history
• Prior childbearing loss
• Childhood abuse
• Natural/man-made disaster
• Car accident
• Prior depression
• Life-threatening birth for mother or baby

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Depression

• Can occur at any time
• Related to perceived illness/fragility of the
  baby
• Symptoms include
• sleep problems
• irritability
• crying
• feelings of hopelessness and helplessness
• despondency

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Depression

• Vulnerable times
• Immediately after birth
• After initial crisis
• After subsequent crises
• The transition home
• Subsequent diagnoses of chronic conditions or
  impairments

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Depression

• Risk Factors
• Prior episode
• Unhelpful beliefs
• No support
• Prior traumatic events including infant loss
• Immediate separation from baby
• Prolonged separation from other family members

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Isolation

• May be physically isolated from family and
  friends
• Hospital may be in a different town or state
• Mother may feel torn because she is separated
  from her other children
• Even separation from multiples (e.g., one at
  home, one in the hospital)
• Can feel different from other mothers now and
  later

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Sadness and Loss

• Loss of ideal baby
• Loss of ideal birth
• Previous losses
• Infant losses
• Loss of partner
• Loss of a parent

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Uncertainty/Anxiety

• Worry about the future
• About getting services
• About being able to cope
• About attaching to their babies

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Barriers to Attachment

• Misreading of babys cues
• Premature babys tendency to become easily
  overwhelmed
• Responds by turning away, startling, or arching
• Mother may interpret this as baby doesnt like
  them

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Barriers to Attachment

• Different physical appearance
• Babies may appear wizened
• Do not have typical baby features that trigger
  nurturing response
• May also look different because of disability
• Gestational age
• Baby is likely to be behind age mates on
  milestones

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Risk Factors for Maltreatment

• Misreading a babys cues
• Lack of attachment
• Blaming baby for his/her health problems and
  stress on the family
• Untreated PTSD/Depression
• Unsupportive/Violent Home
• Isolation
• Ongoing health issues/disability

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Abuse of Children with Disabilities (Sullivan
Knutson, 2000)

• Study of 50,278 children in Omaha, NE
• Overall, CWD 3.4 times more likely to be
  maltreated than children with no disability
• Deaf children, twice the risk of ea and neglect,
  4 times the risk of physical abuse
• Developmental disability, 4 time the risk of all
  types
• Behavioral disorders, 7 times the risk of ea, pa,
  and neglect

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Encourage Attachment

• Teach them about their babies
• Encourage them to process any issues they have
  about the babys birth/current health situation
• Help them find support from family members,
  friends, or other mothers of premature babies

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Anticipatory Guidance

• Help them anticipate
• Some of the challenges that they may face in
  caring for their baby/child
• Some of the emotional reactions that they might
  experience
• Let them know where they can go for help when
  this happens

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Your role in PTSD

• Recognize the signs of PTSD
• Screen for PTSD in normal conversation and/or
  while taking a history
• Be familiar with local treatment options

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Signs to look for in PTSD

• Re-living the event
• Avoiding reminders of the event
• Being on-guard or hyperaroused all the time

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Psychotherapy for PTSD

• Examine the role of the traumatic event in their
  lives
• Create meaning from the experience
• Learn skills to manage symptoms
• Build or rebuild the ability to trust

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Medications for PTSD

• Reduce symptoms
• Counter the flood of stress hormones
• Enhance the effectiveness of psychotherapy
• Treat co-occurring depression

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Resolving Traumatic Beginnings

• Encourage mothers to
• Get medical charts to understand what happened
• Talk with medical practitioner about what
  happened
• Encourage seeking support or journaling or
  writing about the experience
• Seek out self-help resources
• Check in with mental health practitioner if
  necessary

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Screen for Depression

• Suspect depression if the mother
• Seems depressed
• Blames herself
• Seems hopeless even when the baby is doing better
• Is having a hard time connecting with her baby

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Treatment for Depression

• Moms may need to have depression treated in order
  to cope with current stressors
• Support
• Outlet for traumatic events
• Cognitive therapy for maladaptive beliefs
• Medication if necessary

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Medications for Depression

• Reduces symptoms
• Helps mothers cope with current situation
• Can help with therapy and/or support
• May be necessary if at high-risk
• Previous depression or PTSD
• Prior trauma
• Make interactions with baby more positive

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Finding resources

• Learn about supports available in your community
• Some categories to include
• Social services
• WIC
• Domestic violence
• Grief and trauma counselors
• Parenting groups
• Early intervention services
• Warmlines for stressed moms

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Resources for Help

• Help mothers learn where they can go for future
  help
• Self-help books or organizations
• Online resources
• Give them permission to seek out this kind of
  help and support

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Empower Mothers

• Counter powerlessness
• Involve them in caring for their babies as soon
  as possible
• Encourage breastfeeding and baby wearing/handling
  as soon as is medically feasible
• Let them be involved in treatment decisions

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Ease the Transition to Home

• Help them in discharge planning to locate
  services in the community
• Help them gain closure
• Provide certificates or other mementos that marks
  their time with you
• Leave door open for future contacts in case they
  need referrals