When the Stress of the NICU Goes Away, Trauma May Last

Newborn babies who need intensive or specialized medical attention are often admitted to the Neonatal Intensive Care Unit until they’re healthy enough to go home, but research has found that even after a baby comes home from the NICU, many parents find themselves dealing with their own long-lasting effects.

According to statistics kept by the March of Dimes, in 2015 there were 3,418 preterm births in Dallas County—or 8.5 percent of all live births. In Tarrant County, there were 2,731 preterm births, or 9.6 percent of all live births. About one in 10 babies is born prematurely each year in the United States, the March of Dimes says.

A preterm birth is a birth that occurs prior to 37 weeks of gestation. While preterm and premature are often used interchangeably, the World Health Organization says there are three levels of premature births—late preterm, or born after 32 weeks but before 37 weeks; very preterm, or born between 28 weeks and 32 weeks; and extremely preterm, or born before 28 weeks.

Even if their baby spends little time in the NICU, a parent can find themselves reacting to similar situations, smells or even sounds months after. Studies have found that post-traumatic stress disorder (PTSD) and/or acute stress disorder are not uncommon among parents of children who spent time in the NICU.

In a study published in Europe’s Journal of Psychology, researchers surveyed 21 Italian parent couples of preterm infants and 29 couples of full-term babies. All parents filled out the same questionnaires designed to measure how they were reacting to the stressors they were experiencing.

The study found that mothers and fathers of preterm infants reported more tension, depression, anger and fatigue than parents with full-term babies.

“Our findings suggest that parents of premature babies, in particular mothers, since the birth of their babies, are at risk of developing higher levels of anxiety, depression, anger and stress,” the article says. “Furthermore, the preterm infants’ external characteristics and signals associated with immaturity and severity of medical status could be a further stressor especially for mothers.”

A similar study in Poland also found that parents of premature babies were at higher risk for PTSD.

Everything that can happen in a NICU—the health of the tiny infants, the noises, the uncertainty—can certainly provide the circumstances for developing PTSD, says Donald Hafer Jr., Ph.D., director of the Texas Health Behavioral Health Service Line, especially when you also consider the potential traumatic surroundings of the birth that brought the baby to the NICU to begin with.

PTSD, Hafer explains, is diagnosed after someone has been having symptoms for more than 30 days. “Acute Stress Disorder can be diagnosed from day one to day 30, and the criteria are pretty much the same,” he says.

“It always has to be tied to some event; it could be something that actually occurred to you, that you saw happen, or even that you heard about,” Hafer says. “You can develop this vicariously.

“And PTSD can show up later—it doesn’t always, but it could come even years later.”

There are four main ways PTSD symptoms may manifest:

  1. Reliving the event (nightmares, flashbacks or something that triggers a memory of a traumatic time);
  2. Avoiding situations that trigger memories of the traumatic event, or even avoiding discussing the event;
  3. Negative beliefs and feelings (anxiety about the future, difficulty in having positive or loving feelings toward people);
  4. Hyperarousal (feeling like you must be on the lookout for danger, trouble sleeping, trouble concentrating)

But not everyone who spends time watching over their infant in the NICU will experience PTSD, Hafer says.

“You can be there, seeing this traumatic experience, and for some people there’s trauma, and for some people there’s not,” he explains. “If you’re there and there’s a big code on a baby, whether it’s yours or not, that can be a traumatic experience.

“It really all depends,” he continues. “Not everyone with a NICU stay has the same experience. For some, it is a relatively short stay with minimal medical complications and for others, it turns into months of one crisis followed by another.”

Whether that trauma continues to affect someone can often depend on what a parent has dealt with in the past.

“Trauma for one person is not the same as for another, based on their past life experiences,” Hafer explains. “Seeing your child in NICU, or vicariously seeing another child go through a code may become a trauma trigger.”

Hafer says that treatment for PTSD can take many forms. For some, knowing their triggers and avoiding the ones they can is helpful. “You may or may not be able to avoid them,” he says.

Sometimes medication is helpful, especially if there is underlying depression or anxiety tied to the PTSD, Hafer says. Others find a more psychoanalytical route helpful.

“There are also effective strategies that are symptom-based—things like breathing training, cognitive therapy, and relaxation training—that help you cope with the symptoms,” he says. “Sometimes it’s a matter of self-talk, asking if you’re saying things to yourself that could be exacerbating your anxiety.”

And sometimes seeking out people that have been in the same boat is helpful, too. One study published in the Canadian Medical Association Journal found that 16 weeks after preterm birth, mothers who were matched with parents who had lived through the NICU experience already had less anxiety and depression and felt they had more social support.

But if a parent does feel that they are experiencing PTSD, help is available.

“You need to visit with a mental health professional who is familiar with treating PTSD,” Hafer says. “You can start by talking to your MD about a referral, or you can call Texas Health Behavioral Health and schedule a free hour-long screening at any of our 20 locations within 24 hours.”

Texas Health Behavioral Health welcomes referral calls to its help line 24/7 at 682-236-6023 from physicians, counselors, therapists, family members and others who may be concerned about a parent’s mental, emotional and physical well-being. 

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