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For many families, having a baby is a happy yet stressful time. Parents who have experienced the birth of a premature baby may experience more than average stress levels, including anxiety disorders, as well as higher incidences of postpartum depression (PPD) or postpartum post-traumatic stress disorder (PTSD).  

"I'll be honest, entering my second pregnancy, after experiencing severe preeclampsia at 26 weeks with my first pregnancy, was nerve-wrecking.  I reminded myself to focus on what I could control versus what was out of my hands.  I worked with a team that I trusted, followed through on all my home and office-based prenatal monitoring, and tried, as best I could, to be open and confident that we could handle whatever outcome resulted.  I also reminded myself to savor each day of the pregnancy!  By the third trimester I was over the moon with increasing joy and relief.  We met our second son a few days after term!" Erin C.


Anxiety, Signs and Symptoms

Let’s face it, day-to-day life is stressful. We all have days when we feel irritable, have difficulty sleeping, or just a lack of focus. But if you are suffering from chronic problems that are interfering with your life or you just can’t seem to function, it may be time to seek some professional help. These are some generalized anxiety disorder symptoms:
  • Constant worrying or obsession about small or large concerns
  • Restlessness and feeling keyed up or on edge
  • Fatigue
  • Difficulty concentrating or your mind "going blank"
  • Irritability
  • Muscle tension or muscle aches
  • Trembling, feeling twitchy or being easily startled
  • Trouble sleeping
  • Sweating, nausea or diarrhea
  • Shortness of breath or rapid heartbeat
 

Postpartum Depression (PPD)

Postpartum depression (also called PPD) is a type of depression that some women develop after having a baby. PPD is characterized by strong feelings of sadness that last for a long time. These feelings can make it hard for you to take care of your baby. About one out of every eight women has postpartum depression after giving birth. PPD is the most common complication for women who have just had a baby and should be taken seriously. PPD can happen any time after childbirth but it often starts within 1 to 3 weeks of having a baby. It’s a medical condition that needs treatment in order to get better.
If you think you may have PPD, call your health care provider right away. Your provider can be the person who delivered your baby, like an obstetrician or certified nurse-midwife. Or she could be your primary care provider or your baby’s provider. Also don’t hesitate to seek out a mental health professional, like a social worker, psychologist, psychiatrist or psychiatric nurse practitioner. There are several treatments options your provider can offer to help you feel better.
How is PPD treated?
  • Counseling. This also is called therapy. It’s when you talk about your feelings and concerns with a mental health professional. They help you understand your feelings, solve problems and cope with things in your everyday life.
  • Support groups. These are groups of people who meet together or go online to share their feelings and experiences about certain topics. Being part of a support group connects you with people who understand what you are going through and may help you feel better. Your provider can help you find a PPD support group near you or tell you about online groups.
  • Medication. PPD often is treated with medicine.
Source: K. L. Wisner, B. L. Parry, C. M. Piontek, Postpartum Depression N Engl J Med vol. 347, No 3, July 18, 2002, 194-199

Postpartum Post-Traumatic Stress Disorder (PTSD)

Mothers and fathers of premature infants are at significantly higher risks for developing Postpartum Post-Traumatic Stress Disorder(PTSD). Women who have a premature delivery are especially vulnerable but it can affect both men and women. The disorder develops in response to complications before delivery, during delivery or in the postpartum period. Unlike PPD,  few parents of preemies are screened for Postpartum PTSD even though it is very common for parents of preemies to develop it.
Not everyone who suffers trauma in childbirth or immediately after will suffer from Postpartum PTSD. There are many normal responses to the emotional trauma of a premature birth such as:
  • Shock and disbelief that this is happening
  • Guilt
  • Sadness
  • Grieving the loss of the pregnancy
  • Difficulty seeing another pregnant woman
  • Relief that the worst of it is over and looking forward to life getting back to normal



Ways to cope may include:
  • Eating regular nutritious meals
  • Walking, practicing yoga, dancing, or other exercise program you enjoy
  • Seeking out a parent support group
  • Keeping a journal or an online blog
  • Saying positive daily affirmations
  • Meditation
  • Talking to other NICU parents
  • Talking to a social worker or counselor

Some risk factors that increase a person’s vulnerability to the trauma may be:
  • Lack of support system
  • Past traumatic event
  • Past sexual abuse particularly in childhood
  • Lack of coping skills

My toughest challenge was my work situation. My manager and co-workers were uncaring and unkind. I was not allowed a lesser workload, or time off or compassion. Therefore, I felt vulnerable....needing my job but needing to grieve the loss of one son and visit my surviving son in the NICU. My PTSD is triggered whenever I am in similar work situations.  Greg H.
When to seek help:Some people are able to process trauma better than others, however everyone affected by a premature birth can benefit from professional support.
I didn’t know PTSD was affecting me until I came across other preemie parents talking about it online. I recognized my symptoms right away. It was a huge relief to finally realize what I was dealing with and to know there was help! Mary S.
If your symptoms seem intense and interfere with your day-to-day living, seek professional treatment as soon as possible.  The sooner you seek treatment the better your long-term outcome.  Some people do not feel the effects of the trauma until months later or after their baby has been discharged from the hospital.
Postpartum PTSD Signs and Symptoms:
  • Reoccurring thoughts and dreams about the trauma
  • Avoidance of where the trauma occurred such as not wanting to go to the hospital where your baby was born
  • Not  being able to drive down the same road the hospital is on
  • Not being able to look at baby pictures from the NICU
  • Feeling emotionally numb, closed off from loved ones, or having a lack of feelings
  • Feeling in a constant state of alert that something bad is going to happen.  
  • Feeling like you are “waiting for the other shoe to drop” or you are waiting for something else bad to happen
  • Have difficulty sleeping or staying asleep
  • Increased irritability or anger
  • Concentration problems
  • Exaggerated startle response.  You may be more jumpy or startle easily
  • In a constant state of flight or fight, for example are you quick to anger or find yourself avoiding difficult situations
  • Feelings of guilt or shame or anger
  • Feeling hopeless that situation is not going to get better

Triggers

Certain experiences can trigger feelings of stress and anxiety in parents. You can’t always control the situations you find yourself in, but the more you understand your triggers the better you will be able to avoid them, or mediate the situations. Examples of triggers for Postpartum PTSD among parents of preemies:
  • Your child’s birthday.
  • Visiting a doctor’s office or having medical procedures.
  • Baby showers, being around pregnant women in their third trimester.
  • Facing new diagnoses, especially while still dealing with previous ones.
  • When you see friends have full-term healthy pregnancies, healthy babies, with minimal interruption to their lives, careers, and hobbies it can bring up painful thoughts and frustrations.
  • When your child gets hurt or experiences the bumps and bruises that come with childhood and growing up.
  • Fielding questions about your child’s size, weight, or developmental progress.
  • Realizing delays by watching/comparing skills and abilities of other kids your child’s age.
  • Listening to parents complain about minor problems when you’re dealing with serious life-altering issues.
 My child was on a piece of playground equipment and fell through a gap between the seat and the back, hitting her head on the way down. I couldn’t reach her and had to coax her to stand up so I could pull her out. She was a bit stunned but stopped crying after a few minutes. I sobbed for half an hour. I could not stop. Looking back, I think her falling out of my reach reminded me of the helplessness I felt watching her struggle in the incubator without being able to really help. Juliana S.
Handling PTSD triggers:The hardest part for me was going back to the OBGYN. It took a long time before I could be there without crying. I started telling them as soon as I walked in that I had PTSD and not to be alarmed if I started crying. Riya V.
Every time my child got a new diagnosis I spiraled into depression for several days. I wanted so badly for everything to be “normal.” Having a trusted counselor to talk to helped me with these recurring stressors.  Tina M.
A close friend had a healthy full-term baby and complained often about the demands of motherhood. It hurt to see how much of her life remained intact. I found that putting a little distance between me and her early motherhood helped to save our friendship. Alice K.   

Treatment Options for Postpartum PTSD

When people think of treatment for mental health issues, talk therapy and medications come to mind. These are two effective approaches, but there are also newer approaches available now. Learn about your options and see what seems best for you. If one thing doesn’t work, try something else. Hang in there, it gets better.
  • Cognitive Therapy also known as Talk therapy
  • Medication
  • EMDR (Eye Movement Desensitization and Reprocessing)
  • EFT (Emotional Freedom Technique)
  • Energy healing modalities such as Reiki, Cranial Sacral, etc. 
Recognizing if you or your spouse has any of these symptoms is the first step on the road to a happier life with your newly expanded family. You are not alone and there is always help around the corner—whether it’s from a parent, friend, spouse, or a professional therapist or other type of healer. We hope that this information has helped you and your family.