Podcast Episode 12
Introduction
In our 12th podcast, we focus on identifying ways to support maternal mental health for NICU Mamas. As May is Maternal Mental Health Month, I sat down with Anese Barnett, a perinatal mental health therapist and clinical psychology doctoral student who is passionate about improving the mental health of all mothers during a high risk pregnancy and/or for those who have a baby in the NICU.
We discuss NICU trauma associated with the unnatural maternal-child separation and many of the common feelings of shame and guilt correlated with it. The repetitive rituals many NICU mothers obsessively focus on as they attempt to regain control during their baby’s NICU journey and we discuss why it can be dangerous for their mental well-being.
We also share some of the best ways we feel after our NICU experience that nurses, NNPs, and Neonatologists can help to empower parents as well as alleviate some of the feelings of powerlessness that many mothers feel. We discuss the all-important role that a NICU Psychologist can play in the NICU to help identify mothers at risk as well as ways to wrap support around them to help during their baby’s NICU journey and beyond.
If you are a member of the NICU care team, you will hear specific ways to help bring empowerment and support to NICU parents. If you are a friend or family member to a NICU parent and want to offer support, you will gain a much better understanding of some of their feelings and associated behaviors. And if you are a NICU mama, you will completely relate to many of the feelings, behaviors, and struggles, but also learn ways to help you cope. We had so much to chat about, we split up the discussion into 2 episodes, so sit back and enjoy Part I.
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Meet Anese Barnett
Anese Barnett is a veteran NICU mama to a now rambunctious toddler who inspires her work and education daily. She is a perinatal mental health therapist and clinical psychology doctoral student who is passionate about improving mommy’s mental health, especially for those experiencing high-risk pregnancy and the NICU.
She lives in northern Virginia with her husband and little boy. She specializes in supporting a mother’s mental health during pregnancy and beyond, specifically for high-risk pregnancies and those enduring NICU trauma. She is passionate about the community she was once a part of and strives to learn more beneficial ways to support the mothers who are now going through the experience.
Previously, she worked with small children and their mothers. But, after unexpectantly delivering her son prematurely at 33 weeks, she felt driven after her personal high-risk pregnancy complicated by IUGR and NICU trauma, to focus on maternal trauma. She is very knowledgeable on maternal mental well-being from a personal and professional point of view. I know you will gain a significant amount of new knowledge after listening to our conversation.
Anxiety and High-Risk Pregnancy
Research has shown that with anxiety, there is a connection between the nervous system and our actual physical health. Therefore, with high-risk pregnancies, the mother may not be able to control what is happening, but she must try to control further anxiety. Otherwise, all of the anxiety has the potential to negatively affect the pregnancy outcome and the mother’s overall health.
NICU Trauma
Trauma occurs when something happens to you that is too much for you too handle. With NICU trauma, it is sudden and typically unexpected. The events often move very quickly and there is an unnatural separation between the mother and baby. It is in that moment that a large amount of trauma occurs. Mothers have an preconceived idea of what it will be like to give birth and to hold and bond with their baby. But that dream is suddenly disrupted once a baby is admitted to the NICU whether they are term or preterm. Mothers grieve over those lost experiences.
NICU trauma is also considered complex trauma. Complex trauma comes from experiences that occur when we are very young or due to trauma that occurs repeatedly and constantly. So if day after day a mother hears the NICU alarms, observes her baby wince in pain, and helplessly watches her baby undergo endless painful treatments, it constitutes complex trauma.
Another key component of NICU trauma is the feeling of powerlessness. Powerlessness is the core to what trauma is since when we endure it, we have no control over it. The lack of power results in extreme injury. For NICU mothers, this is our child who was suddenly thrust into a situation where we, as mothers, are not the primary care provider as we had anticipated. Now, without any preparation, parents have to place their trust into other people to care for their baby which causes significant emotional turmoil.
How can the healthcare team support NICU families?
Health care providers in the NICU know parents often feel powerless and they are full of guilt. If we, as part of the NICU care team do not empower and educate parents, they have the potential to retreat even further into their grief. Family-centered care supports the parents as being an active and integral member of their baby’s care team. They should be part of the decision-making process everyday. The parents should actively participate in their baby’s daily cares, whether it is oral care, kangaroo care, a diaper change or even just containment. The NICU care team should praise them and encourage them to enhance their confidence.
If parents feel incompetent, it will further enhance mental health issues. NICU mothers already struggle to identify themselves as their baby’s mom. They work so hard to pump, to arrive on time for their baby’s cares, all to just try and feel like a mom. Without empowerment and building confidence it the mothers, it can result in them ultimately neglecting their own self care.
Psychosocial support for mothers after delivery
Many hospitals focus on the mother when they are pregnant and the baby once they are born. Sadly, the necessary psychosocial support for mothers after delivery and while their baby is in the NICU is often neglected entirely.
NICU psychologists need to be a part of the care team to actively check in on parents and their emotional state of mind. They know exactly what to ask the NICU parents so they are able to wrap the necessary support around them. If parents psychological needs are not met, it becomes very difficult for them to pull out of their deep feelings of overwhelm. If they remain in the state of overwhelm, it inhibits their ability to ask questions and participate in their baby’s care. With a trauma response, we are filled with overwhelm and stress and it affects our cognitive function that tells us what are appropriate questions to ask on behalf of our own baby.
Additional small gestures that show parents you care about their baby and the family as a whole are incredibly meaningful. We as parents remember the very good moments and unfortunately, the very bad. Something as small as a provider who takes the time to pull up a chair next to a parent and ensure all of their questions were answered means a lot.
A provider, social worker, nurse, NICU psychologist, or chaplain checking in with the mother repeatedly is also helpful. Especially for mother’s who experienced a high-risk pregnancy, they are already in the habit of pushing their needs and feelings aside to ensure that the baby is doing well. With time and repetitive check-ins, the mother will slowly begin to trust someone and hopefully open up enough to share their real feelings and concerns.
How to identify mothers at risk
There are ways to identify a NICU mother who is experiencing mental health issues. NICU mothers often perform rituals from arriving at the NICU the same time everyday, parking in the same spot, walking around the isolette a certain way, or even leaving a cloth with their scent on it each night. It is not always the rituals that signify maternal emotional distress, but the mother’s reaction if their ritual is interrupted.
The additional danger of ritualistic behavior for NICU mothers is that they believe their baby will be okay as long as they continue the routine. Or, if their ritual is interrupted, they believe something will go wrong with their baby. The behavior is unhealthy, because it sends a false message to the mother that she has control over her baby’s ultimate outcome. It may also lead her to believe it was her fault if something does go wrong with the baby.
Closing
Time as a parent in the NICU is extremely difficult and traumatic. But if you do not deal with some of the responses to the trauma endured during your baby’s time in the NICU, you will not be at your best to care for them once they come home. Please consider talking to someone if you feel that you are unable to get beyond the overwhelm.
The NICU care team should do their best to always include parents as part the baby’s care team to empower them and help build confidence. In the NICU, there should be a dedicated person who repeatedly checks in with the mother and asks appropriate questions to assess their mental well-being. And we must never forget that the small gestures make big memories.
For additional information or to contact Anese Barnett, head to hear website HERE.
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