Skip to main content
SpringerLink
Log in

Maternal Experience of Neonatal Intensive Care Unit Hospitalization: Trauma Exposure and Psychosocial Responses

  • Chapter
  • First Online:
Motherhood in the Face of Trauma

Part of the book series: Integrating Psychiatry and Primary Care ((IPPC))

Abstract

For mothers in the postpartum period, admission of their newborn to a neonatal intensive care unit (NICU) is often an unanticipated experience that can be shocking and traumatic, and can elevate maternal risk for psychiatric symptoms, including posttraumatic stress. In this chapter, the NICU experience, psychosocial implications, mental health consequences, and screening tools that have been used to identify maternal psychiatric symptoms in this setting will be reviewed. Psychosocial interventions and programs addressing the stress and psychological reactions of mothers with an infant in a NICU will be introduced, as will recently developed interdisciplinary recommendations for the support of NICU families and a nurse training program to promote optimal communication between NICU nurses and parents. The chapter concludes with future clinical and research directions to continue improving maternal adjustment and mental health during a child’s NICU hospitalization.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Alcorn KL, O’Donovan A, Patrick JC, Creedy D, Devilly GJ (2010) A prospective longitudinal study of the prevalence of post-traumatic stress disorder resulting from childbirth events. Psychol Med 40(11):1849–1859

    Article  CAS  PubMed  Google Scholar 

  • Alkozei A, McMahon E, Lahav A (2014) Stress levels and depressive symptoms in NICU mothers in the early postpartum period. J Mater Fetal Neonatal Med 27(17):1738–1743. doi:10.3109/14767058.2014.942626

    Article  Google Scholar 

  • Barr P (2011) Posttraumatic growth in parents of infants hospitalized in a neonatal intensive care unit. J Loss Trauma Int Perspect Stress Coping 16(2):117–134. doi:10.1080/15325024.2010.519265

    Google Scholar 

  • Beck CT (2003) Recognizing and screening for postpartum depression in mothers of NICU infants. Adv Neonatal Care 3(1):37–46

    Article  PubMed  Google Scholar 

  • Beck S, Wojdyla D, Say L, Betran AP, Merialdi M, Requejo JH, Rubens C, Menon R, Van Look PF (2010) The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bull World Health Organ 88(1):31–38. doi:10.2471/BLT.08.062554

    Article  PubMed  Google Scholar 

  • Beck CT, Driscoll JW, Watson S (2013) Traumatic childbirth. Routledge, New York

    Google Scholar 

  • Bonacquisti, A, Geller, PA (2016) Psychological responses and treatment among mothers in the neonatal intensive care unit: the impact of attachment, attitudes, social support, and health behaviors. Unpublished doctoral dissertation, Drexel University, Philadelphia

    Google Scholar 

  • Callahan JL, Borja SE, Hynan MT (2006) Modification of the perinatal PTSD questionnaire to enhance clinical utility. J Perinatol 26(9):533–539

    Article  CAS  PubMed  Google Scholar 

  • Carter JD, Mulder RT, Darlow BA (2007) Parental stress in the NICU: the influence of personality, psychological, pregnancy and family factors. Personal Ment Health 1(1):40–50

    Article  Google Scholar 

  • Cherry AS, Blucker RT, Thornberry TS, Hetherington C, McCafferee MA, Gillaspy SR (2016) Postpartum depression screening in the neonatal intensive care unit: program development, implementation, and lessons learned. J Multidiscip Healthc 18(9):59–67. doi:10.2147/JMDH.S91559

    Article  Google Scholar 

  • Chertok IR, McCrone S, Parker D, Leslie N (2014) Review of interventions to reduce stress among mothers of infants in the NICU. Adv Neonatal Care 14(1):30–37

    Article  PubMed  Google Scholar 

  • Chow S, Chow R, Popovic M, Lam M, Popovic M, Merrick J, Margalit RNS, Lam H, Milakovic M, Chow E, Popovic J (2015) A selected review of the mortality rates of neonatal intensive care units. Front Public Health 3:225. doi:10.3389/fpubh.2015.00225

    PubMed  PubMed Central  Google Scholar 

  • Committee on Fetus and Newborn (2012) Levels of neonatal care. Pediatrics 130(3):587–597. doi:10.1542/peds.2012-1999

    Article  Google Scholar 

  • Davidson JR, Book SW, Colket JT, Tupler LA, Roth S, David D, Hertzberg M, Mellman T, Beckham JC, Smith RD, Davison RM, Katz R, Feldman ME (1997) Assessment of a new self-rating scale for post-traumatic stress disorder. Psychol Med 27(1):153–160

    Article  CAS  PubMed  Google Scholar 

  • Davis DL, Stein MT (2004) Parenting your premature baby and child: the emotional journey. Fulcrum Publishing, Golden

    Google Scholar 

  • Davis L, Edwards H, Mohay H, Wollin J (2003) The impact of very premature birth on the psychological health of mothers. Early Hum Dev 73(1):61–70

    Article  PubMed  Google Scholar 

  • Doering LV, Moser DK, Dracup K (2000) Correlates of anxiety, hostility, depression, and psychosocial adjustment in parents of NICU infants. Neonatal Netw 19(5):15–23

    Article  CAS  PubMed  Google Scholar 

  • Fairbrother N, Janssen P, Antony MM, Tucker E, Young AH (2016) Perinatal anxiety disorder prevalence and incidence. J Affect Disord 200:148–155. doi:10.1016/j.jad.2015.12.082

    Article  PubMed  Google Scholar 

  • Feeley N, Zelkowitz P, Cormier C, Charbonneau L, Lacroix A, Papageorgiou A (2011) Posttraumatic stress among mothers of very low birthweight infants at 6 months after discharge from the neonatal intensive care unit. Appl Nurs Res 24(2):114–117. doi:10.1016/j.apnr.2009.04.004

    Article  PubMed  Google Scholar 

  • Fegran L, Helseth S, Fagermoen MS (2008) A comparison of mothers’ and fathers’ experiences of the attachment process in a neonatal intensive care unit. J Clin Nurs 17(6):810–816

    Article  PubMed  Google Scholar 

  • Feldman R (2009) The development of regulatory functions from birth to 5 years: insights from premature infants. Child Dev 80(2):544–561

    Article  PubMed  Google Scholar 

  • Feldman R, Weller A, Leckman JF, Kuint J, Eidelman AI (1999) The nature of the mother’s tie to her infant: maternal bonding under conditions of proximity, separation, and potential loss. J Child Psychol Psychiatry 40(6):929–939

    Article  CAS  PubMed  Google Scholar 

  • Field T (2010) Postpartum depression effects on early interactions, parenting, and safety practices: a review. Infant Behav Dev 33(1):1–6

    Article  PubMed  Google Scholar 

  • Forray A, Mayes LC, Magriples U, Epperson CN (2009) Prevalence of post-traumatic stress disorder in pregnant women with prior pregnancy complications. J Matern Fetal Neonatal Med 22(6):522–527

    Article  PubMed  PubMed Central  Google Scholar 

  • Grekin R, O'Hara MW (2014) Prevalence and risk factors of postpartum posttraumatic stress disorder: a meta-analysis. Clin Psychol Rev 34(5):389–401

    Article  PubMed  Google Scholar 

  • Hall SL, Hynan MT (2015) Interdisciplinary recommendations for the psychosocial support of NICU parents. J Perinatol 35:S1

    Article  PubMed  PubMed Central  Google Scholar 

  • Hall SL, Cross J, Selix NW, Patterson C, Segre L, Chuffo-Siewert R, Geller PA, Martin ML (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support. J Perinatol 335:s29–s36

    Article  Google Scholar 

  • Harrison W, Goodman D (2015) Epidemiologic trends in neonatal intensive care, 2007–2012. JAMA Pediatr 169(9):855–862. doi:10.1001/jamapediatrics.2015.1305

    Article  PubMed  Google Scholar 

  • Helle N, Barkmann C, Ehrhardt S, von der Wense A, Nestoriuc Y, Bindt C (2016) Postpartum anxiety and adjustment disorders in parents of infants with very low birth weight: cross-sectional results from a controlled multicentre cohort study. J Affect Disord 194:128–134. doi:10.1016/j.jad.2016.01.016 h

    Article  PubMed  Google Scholar 

  • Holditch-Davis D, Bartlett TR, Blickman AL, Miles MS (2003) Posttraumatic stress symptoms in mothers of premature infants. J Obstet Gynecol Neonatal Nurs 32(2):161–171. doi:10.1177/0884217503252035

    Article  PubMed  Google Scholar 

  • Holditch-Davis D, Santos H, Levy J, White-Traut R, O’Shea TM, Geraldo V, David R (2015) Patterns of psychological distress in mothers of preterm infants. Infant Behav Dev 41:154–163

    Article  PubMed  PubMed Central  Google Scholar 

  • Hummel P (2003) Parenting the high-risk infant. Newborn Infant Nurs Rev 3(3):88–92

    Article  Google Scholar 

  • Hynan MT, Steinberg Z, Baker L, Cicco R, Geller PA, Lassen S, Milford C, Mounts KO, Patterson C, Saxton S, Segre L, Stuebe A (2015) Recommendations for mental health professionals in the NICU. J Perinatol 35:S14–S18

    Article  PubMed  PubMed Central  Google Scholar 

  • Kazak AE (2006) Pediatric psychosocial preventative health model (PPPHM): research, practice, and collaboration in pediatric family systems medicine. Fam Syst Health 24(4):381–395

    Article  Google Scholar 

  • Kenner C, Press J, Ryan D (2015) Recommendations for palliative and bereavement care in the NICU: a family-centered integrative approach. J Perinatol 35:S19–S23. doi:10.1038/jp2015.145

    Article  PubMed  PubMed Central  Google Scholar 

  • Lee HC, Green C, Hintz SR, Tyson JE, Parikh NA, Langer J, Gould JB (2010) Prediction of death for extremely premature infants in a population-based cohort. Pediatrics 126(3):e644–e650. doi:10.1542/peds.2010-0097

    Article  PubMed  Google Scholar 

  • Lefkowitz DS, Baxt C, Evans JR (2010) Prevalence and correlates of posttraumatic stress and postpartum depression in parents of infants in the neonatal intensive care unit (NICU). J Clin Psychol Med Settings 17(3):230–237

    Article  PubMed  Google Scholar 

  • March of Dimes Perinatal Data Center (2011) Special care nursery admissions. National Perinatal Information System/Quality Analytic Services. White Plains, NY

    Google Scholar 

  • Matricardi S, Agostino R, Fedeli C, Montirosso R (2013) Mothers are not fathers: differences between parents in reduction of stress levels after a parental intervention in a NICU. Acta Pediatr 102(1):8–14

    Article  CAS  Google Scholar 

  • Melnyk BM, Feinstein NF, Moldenhouer Z, Small L (2000) Coping in parents of children who are chronically ill: strategies for assessment and intervention. Pediatr Nurs 27(6):548–558

    Google Scholar 

  • Melnyk BM, Feinstein NF, Alpert-Gillis L et al (2006) Reducing premature infants’ length of stay and improving parents’ mental health outcomes with the creating opportunities for parent empowerment (COPE) neonatal intensive care unit program: a randomized, controlled trial. Pediatrics 118(5):e1414–e1427

    Article  PubMed  Google Scholar 

  • Meyer EC, Zeanah CH, Boukydis CFZ, Lester BM (1993) A clinical interview for parents of high-risk infants: concept and applications. Infant Ment Health J 14(3):192–207. doi:10.1002/1097-0355(199323)14:3<192::AID-IMHJ2280140305>3.0.CO;2-R

    Article  Google Scholar 

  • Meyer EC, Coll CTG, Lester BM, Boukydis CFZ, McDonough SM, Oh W (1994) Family-based intervention improves maternal psychological well-being and feeding interaction of preterm infants. Pediatrics 93(2):241–246

    CAS  PubMed  Google Scholar 

  • Meyer EC, Coll CTG, Seifer R, Ramos A, Kilis E, Oh W (1995) Psychological distress in mothers of preterm infants. J Dev Behav Pediatr 16(6):412–417.

    Google Scholar 

  • Meyer EC, Brodsky D, Hansen AR, Lamiani G, Sellers DE, Browning DM (2011) An interdisciplinary, family-focused approach to relational learning in neonatal intensive care. J Perinatol 31:212–219. doi:10.1038/jp.2010.109

    Article  CAS  PubMed  Google Scholar 

  • Miles MS, Funk SG, Carlson J (1993) Parental stressor scale: neonatal intensive care unit. Nurs Res 42(3):148–152

    Article  CAS  PubMed  Google Scholar 

  • Miles MS, Holditch-Davis D, Schwartz TA, Scher M (2007) Depressive symptoms in mothers of prematurely born infants. J Dev Behav Pediatr 28(1):36–44

    Article  PubMed  Google Scholar 

  • Nearing GB, Salas AA, Granado-Villar D, Chandler BD, Soliz A (2012) Psychosocial parent support programs and short-term clinical outcomes in extremely low birth-weight infants. J Mater Fetal Neonatal Med 25(1):89–93

    Article  Google Scholar 

  • Niela-Vilen H, Melender HL, Axelin A, Loyttyniemi E, Salantera S (2016) Predictors of breastfeeding initiation and frequency of preterm infants in the NICU. J Obstet Gynecol Neonatal Nurs 45(3):346–358

    Article  PubMed  Google Scholar 

  • O’Hara MW, Swain AM (1996) Rates and risk of postpartum depression – a meta-analysis. Int Rev Psychiatry 8(1):37–54

    Article  Google Scholar 

  • Obeidat HM, Bond EA, Callister LC (2009) The parental experience of having an infant in the newborn intensive care unit. J Perinat Educ 18(3):23

    Article  PubMed  PubMed Central  Google Scholar 

  • O'Hara MW (2009) Postpartum depression: what we know. J Clin Psychol 65(12):1258–1269

    Article  PubMed  Google Scholar 

  • Osterman MJK, Martin JA, Mathews TJ, Hamilton BE (2011) Expanded data from the new birth certificate national vital statistics reports. National Center for Health Statistics, Hyattsville

    Google Scholar 

  • Pai AL, Patiño-Fernández AM, McSherry M, Beele D, Alderfer MA, Reilly AT et al (2008) The psychosocial assessment tool (PAT2. 0): psychometric properties of a screener for psychosocial distress in families of children newly diagnosed with cancer. J Pediatr Psychol 33(1):50–62

    Article  PubMed  Google Scholar 

  • Paul IM, Downs DS, Schaefer EW, Beiler JS, Weisman CS (2013) Postpartum anxiety and maternal-infant health outcomes. Pediatrics 131(4):e1218–e1224

    Article  PubMed  Google Scholar 

  • Perelman A (2014) Needs, services, and barriers: staff perceptions of mental health care in the NICU. Unpublished Doctoral Dissertation. Widener University, Chester

    Google Scholar 

  • Poehlmann J, Schwichtenberg A, Bolt D, Dilworth-Bart J (2009) Predictors of depressive symptom trajectories in mothers of preterm or low birth weight infants. J Fam Psychol 23(5):690

    Article  PubMed  PubMed Central  Google Scholar 

  • Profit J, Sharek PJ, Amspoker AB, Kowalkowski MA, Nisbet CC, Thomas EJ, Chadwick WA, Sexton JB (2014) Burnout in the NICU setting and its relation to safety culture. BMJ Qual Saf 23(10):806–813

    Article  PubMed  PubMed Central  Google Scholar 

  • Raposa E, Hammen C, Brennan P, Najman J (2014) The long-term effects of maternal depression: early childhood physical health as a pathway to offspring depression. J Adolesc Health 54(1):88–93

    Article  PubMed  Google Scholar 

  • Reck C, Noe D, Gerstenlauer J, Stehle E (2012) Effects of postpartum anxiety disorders and depression on maternal self-confidence. Infant Behav Dev 35(2):264–272. doi:10.1016/j.infbeh.2011.12.005

    Article  PubMed  Google Scholar 

  • Ross LE, McLean LM (2006) Anxiety disorders during pregnancy and the postpartum period: a systematic review. J Clin Psychiatry 67(8):1285–1298

    Article  PubMed  Google Scholar 

  • Schappin R, Wijnroks L, Tuniken VA, Johnmans MJ (2013) Rethinking stress in parents of preterm infants: a meta-analysis. PLoS One 8(2):e54992

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Schuit E, Hukkelhoven CWPM, Manktelow BN, Papatsonis DNM, de Kleine MJK, Draper ES et al (2012) Prognostic models for stillbirth and neonatal death in very preterm birth: a validation study. Pediatrics 129(1):e120–e127. doi:10.1542/peds.2011-0803

    Article  PubMed  Google Scholar 

  • Shaw RJ, Bernard RS, Storfer-Isser A, Rhine W, Horwitz SM (2013) Parental coping in the neonatal intensive care unit. J Clin Psychol Med Settings 20(2):135–142

    Article  PubMed  PubMed Central  Google Scholar 

  • Shelton SL, Meaney-Delman DM, Hunter M, Lee S (2014) Depressive symptoms and the relationship of stress, sleep, and well-being among NICU mothers. J Nurs Educ Pract 4(8):70

    Google Scholar 

  • Shen H, Magnusson C, Rai D et al (2016) Associations of parental depression with child school performance at age 16 years in Sweden. JAMA Psychiat 73(3):239–246

    Article  Google Scholar 

  • Shin H, White-Traut R (2007) The conceptual structure of transition to motherhood in the neonatal intensive care unit. J Adv Nurs 58(1):90–98

    Article  PubMed  Google Scholar 

  • Sneath N (2009) Discharge teaching in the NICU: are parents prepared? An integrative review of parents’ perceptions. Neonatal Netw 28(4):237–246

    Article  PubMed  Google Scholar 

  • Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC et al (2010) Neonatal outcomes of extremely preterm infants from the NICHD neonatal research network. Pediatrics 126(3):443–456. doi:10.1542/peds.2009-2959

    Article  PubMed  PubMed Central  Google Scholar 

  • Tietz A, Zietlow AL, Reck C (2014) Maternal bonding in mothers with postpartum anxiety disorder: the crucial role of subclinical depressive symptoms and maternal avoidance behavior. Arch Womens Ment Health 17(5):433–442

    Article  CAS  PubMed  Google Scholar 

  • Treyvaud K, Lee KJ, Doyle LW, Anderson PJ (2014) Very preterm birth influences parental mental health and family outcomes seven years after birth. J Pediatr 164(3):515–521. doi:10.1016/j.jpeds.2013.11.001

    Article  PubMed  Google Scholar 

  • United Nations Interagency Group for Child Mortality Estimation (2016) Mortality rate, neonatal, per 1,000 live births. Available from: http://data.worldbank.org/indicator/SH.DYN.NMRT

  • van Bussel JC, Spitz B, Demyttenaere K (2009) Anxiety in pregnant and postpartum women. An exploratory study of the role of maternal orientations. J Affect Disord 114(1):232–242

    Article  PubMed  Google Scholar 

  • Vanderbilt D, Bushley T, Young R, Frank D (2009) Acute posttraumatic stress symptoms among urban mothers with newborns in the neonatal intensive care unit: a preliminary study. J Dev Behav Pediatr 30(1):50–56. doi:10.1097/DBP.0b013e31819b0de

    Article  PubMed  Google Scholar 

  • Wenzel A, Haugen EN, Jackson LC, Brendle JR (2005) Anxiety symptoms and disorders at eight weeks postpartum. J Anxiety Disord 19(3):295–311

    Article  PubMed  Google Scholar 

  • Wenz-Gross M, Weinreb L, Upshurt C (2016) Screening for post-traumatic stress disorder in prenatal care: prevalence and characteristics in a low-income population. Matern Child Health J 20(10):1995–2002

    Article  PubMed  Google Scholar 

  • Wigert H, Johansson R, Berg M, Hellström AL (2006) Mothers’ experiences of having their newborn child in a neonatal intensive care unit. Scand J Caring Sci 20(1):35–41

    Article  PubMed  Google Scholar 

  • Yurdakul Z, Akman I, Kuşçu MK, Karabekiroglu A, Yaylalı G, Demir F, Özek E (2009) Maternal psychological problems associated with neonatal intensive care admission. Int J Pediatr 2009:591359

    Article  PubMed  PubMed Central  Google Scholar 

  • Zelkowitz P, Papageorgiou A (2005) Maternal anxiety: an emerging prognostic factor in neonatology. Acta Paediatr 94(12):1704–1705

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, Drexel University, 3141 Chestnut Street, Stratton Hall 288, Philadelphia, PA, 19104, USA

    Pamela A. Geller PhD & Alexa Bonacquisti PhD

  2. Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, PA, 19104, USA

    Chavis A. Patterson PhD (Director of Psychosocial Services, Assistant Professor of Clinical Psychology in Psychiatry)

  3. Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Blvd. 2nd Floor, Philadelphia, PA, 19104, USA

    Chavis A. Patterson PhD (Director of Psychosocial Services, Assistant Professor of Clinical Psychology in Psychiatry)

Authors
  1. Pamela A. Geller PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexa Bonacquisti PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chavis A. Patterson PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pamela A. Geller PhD .

Editor information

Editors and Affiliations

  1. Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA

    Maria Muzik

  2. Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA

    Katherine Lisa Rosenblum

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Geller, P.A., Bonacquisti, A., Patterson, C.A. (2018). Maternal Experience of Neonatal Intensive Care Unit Hospitalization: Trauma Exposure and Psychosocial Responses. In: Muzik, M., Rosenblum, K. (eds) Motherhood in the Face of Trauma. Integrating Psychiatry and Primary Care. Springer, Cham. https://doi.org/10.1007/978-3-319-65724-0_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-65724-0_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-65722-6

  • Online ISBN: 978-3-319-65724-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation