{Professional Insight} Postpartum Stress & Mental Health after a Preemie

August 29, 2014

Having a baby is one of the most life-changing events a person will go through; having a baby born prematurely or with a NICU experience is not only life-altering, it’s also complicated with extra layers of fear, trauma, and loss of control. This article highlights mental health functioning and ways to support the mental well being of parents of a preemie baby.

It is estimated that 10 – 15% of all new moms will experience mood disturbances after birth. The occurrence of postpartum mood disorders in mothers of babies born prematurely and in the NICU is much higher, and is currently estimated at 28% to 70%.1 A sense of loss and disappointment impacts the progression of postpartum depression (PPD) in mothers of NICU babies. A mother of an infant in the NICU may not have had a normal pregnancy or a normal delivery, and she is not able to experience the normal bonding period that occurs immediately after birth. Instead of being held and breastfed, the infant is in an incubator or warmer, connected to monitors, IVs, and other equipment. With this departure from a normal birth experience, there is a sense of grief and loss. Loss of the expectation of how we thought our child would enter this world and loss of our sense of control over the female body and safety of the baby.

It’s important to be aware of the factors that put a woman at a higher risk for experiencing mood disturbances after birth. Due to the high stress levels involved with a NICU stay, preventive measures for extra support, such as baby sitters and maids, should be put into place for women and their partners who have more than two of the risk factors listed below. The following list describes the known risk factors for developing a postpartum mood disorder2:

  • depression or anxiety during pregnancy
  • history of PMS or premenstrual dysphoric disorder
  • thyroid dysfunction
  • unexpected events at delivery (birth trauma)
  • perfectionist
  • poor social support
  • recent life stressors (job loss, move, divorce)
  • unwanted or unplanned pregnancy
  • poor relationship with a partner
  • financial difficulties

Acute stress disorder and posttraumatic stress disorder (PTSD) are also very commonly a consequence of being a NICU parent. Mothers feel guilt that they have done something wrong or have somehow failed. This sense of guilt is compounded when mothers feel they cannot protect their babies, and a sense of loss of control in the predictability of life. Other times traumatic birth experiences can leave the mother longing for different memory of her labor and delivery. A traumatic experience is defined as an event that goes beyond the range of usual human experience, it is overwhelming physically or emotionally, and there is a threat to your life or the life of the baby during the experience.

As a way of coping with the traumatic events and extreme stress, the body can undergo a series of physiological changes in an attempt to regain homeostasis. The human body has an “on” switch, the fight vs. flight response and an “off” switch, the relaxation response. Our nervous systems have a mechanism that pendulates between activation and rest and recovery modes, in order to regain balance after stressors in the environment. When a person doesn’t have the time and space to discharge and process an overwhelming experience, it is as if their nervous system gets stuck in activation mode and their brain and body carry the tension and hyper vigilance to prepare for the next stressor.

Here are some common symptoms associated with PTSD after childbirth3:

  • re-experience the events in flashbacks
  • nightmares
  • intrusive and obsessive thoughts
  • hypersensitivity to certain people places and events
  • irritability
  • feelings of being out of control
  • numbness, withdrawal from social support
  • depression and anxiety


Therapy can help women to understand and learn to accept their feelings and experiences and openly share and process the traumatic experience. Talk therapy has been shown to help reduce symptoms of anxiety and depression following a highly stressful birth experience.4

Yoga is also another great way to activate the body’s relaxation response and help one to recover from the deleterious effects of extreme stress and trauma. Learning relaxation and breathing techniques helps PTSD patients learn how to calm themselves down and self-regulate when they sense that a flashback or panic attack is coming.

Here are some simple exercises to practice in times of extreme stress or after a trauma:

  • Get Grounded – in times of high stress, the nervous system becomes overactive and thoughts tend to race, with an inner experience of constriction or restlessness. Being grounded means being anchored in the present moment. With your eyes open, begin feeling your feet on the floor; sensing the toes and heals making contact with your shoes. Next, begin to notice and touch objects around you and describe them. For example “I’m sitting in a red chair”, etc.
  • Calm the Breath – Close your eyes and for five breaths, imagine breathing in through your toes and bringing the breath all the way up through the top of your head. Visualize the oxygen illuminating every inch of you: organs, muscles, bones, even your cells. Then, as you exhale, visualize the air going down through your body and out through your toes. See the breath flowing outward from your feet, like a shimmering, billowing fog.
  • Lengthen the Exhale – Making your exhale longer in relation to the inhale shifts the body from sympathetic (fight vs. flight) to parasympathetic (relaxation response) and is useful in calming down the agitation that typically comes with anxiety. Try this: sit comfortably with your eyes open or closed and inhale for a count of two… hold the breath in for a count of one… exhale gently, counting out for four… and finish by holding the breath out for a count of one. This deep breathing with longer exhalations helps slow heart rate and respiration, and calms anxiety by sending a signal to the body that it is ok to relax.

The good news is that there are a variety of options to treat and manage mood symptoms after life’s big stressors. Based on the statistics, it is also plain to see how common mood disturbances are after having a preemie baby or NICU stay. There is help, hope, and support available; you are not alone!


kelli foulkrodKelli Foulkrod, MS, LPA, RYT is a psychotherapist and yoga teacher in Austin, Tx. Kelli specializes in pregnancy and postpartum mood disorders and offers individual and group sessions.  She hosts a weekly support group for postpartum moms at the Austin Midwife Collective and is supervised by Sarah Griesemer. Kelli has been practicing yoga for 11 years and teaching therapeutic yoga classes for the past 5 years.  Kelli integrates the body and her knowledge of yoga into the therapy process, by teaching women practical ways to calm and regulate their nervous systems. She is an advisory board member of the Pregnancy and Postpartum Health Alliance (www.pphatx.org), an active member of the Postpartum Support International, and continues to further her education in women’s health issues during the childbearing years.  For more information about her practice, visit www.counselingfornewmoms.com


1)    Vasa R, Eldeirawi K, Kuriakose V. et al. (2014). Postpartum depression in mothers of infants in neonatal intensive care unit: risk factors and management strategies. Am J Perinatol. 31:425-34.
2)    McCoy, S. J. et al. (2006). Risk Factors for Postpartum Depression: A Retrospective Investigation at 4-Weeks Postnatal and a Review of the Literature. The Journal of the American Osteopathic Association, 106, 193-98.
3)    Ballard, C. G. et al (1995) Post-Traumatic Stress Disorder (PTSD) after Childbirth. British Journal of Psychiatry. 166: 525 – 528.
4)    Czarnocka, J and Slade, P (2000) Prevalence and predictors of post-traumatic stress symptoms following childbirth. British Journal of Clinical Psychology. 39: 35-51.
5)    Emerson, D., Sharma, R., Chaudry, S. , & Turner, J. (2009). Trauma sensitive yoga: principles, practice, and research. International Journal of Yoga Therapy. 19: 123-128.